Competencies and skills to enable effective care of severely obese patients undergoing bariatric surgery across a multi-disciplinary healthcare perspective: a systematic review.

Increasing numbers of illicit and unlicensed medicines are in general circulation and regularly seized by the police and other regulatory authorities. Forensic identification of seized tablets tends to focus on visual appearance and chromatographic identification of the contained drug. This process is relatively time consuming and places a strain on forensic laboratories. It was therefore of interest to investigate the possible application of differential scanning calorimetry (DSC) as a fast and efficient tool to facilitate the identification of contained drug/s and associated tablet excipients. Sixteen different cases (Cases A to P) of diazepam tablets obtained from Police Scotland were characterised based on visual appearance (colour and manufacturers' logos), physical attributes (size, weight and hardness), drug type, drug quantity (HPLC) and thermal properties (DSC). Raw DSC data was further processed using principal component analysis (PCA) as an objective assessment of the thermograms obtained with a view to statistical grouping of different cases. Cases J/K, M/O and L/P could be paired on visual appearance and Cases B/C/E/G and J/K/L/P on tablet hardness (17-23 and 80-89 N respectively). HPLC indicated that 75% of the cases examined contained diazepam but less than half of these contained the recognised amount (10 mg); Cases B/E/L/P contained phenazepam and J/K contained etizolam. The thermal signatures of individual tablets provided by DSC produced qualitative information about both drugs and excipients, indicating lactose in Cases D/F/H/I/J/K/M/N/O and Emcompress' in B/E/L/P. In particular, DSC coupled with PCA provided confident groupings of A/C/G, B/E/L/P and H/I/J/K, and specific pairings of B/E, L/P and F/N

Augmenting Hand and Arm Function for Persons with Hemiparesis

Background. Hand and arm dysfunction due to neural disorders significantly influences quality of life. Activity-based training has been found to improve function. These improvements could be augmented with transcutaneous spinal cord stimulation (tSCS) due to the modulatory effect it has on spinal and supraspinal networks. Objective. The primary aim is to determine if a 4-week training program will improve hand and arm function. The secondary aim is to determine if the addition of tSCS to a second 4-week training session will further improve function. Design. This is a pre-posttest, controlled trial for persons 10-75 years of age, \u3e6 months post stroke or with unilateral cerebral palsy.Methods. Participants will engage in two 4-week training periods, 3x/week for 2 hours/day. The 1st period will include unimanual and bimanual training alone. The 2nd period will be augmented with low frequency tSCS to the C5-T1 spinal region. Stimulation intensity will be based on individual muscle activation during 3 tasks: 1) grip dynamometry; 2) grip-lift; and 3) target pointing. Outcome measures taken before, midway, and after training are: Canadian Occupational Performance Measure (COPM), dexterity, daylong arm use, grip/pinch strength, sensibility, questionnaires, bilateral hand/arm surface electromyography, and Upper Extremity Fugl-Meyer (UEFM). Results: Nine participants have completed the 1st 4-week training period without tSCS. Individual data reveals improvements in the COPM, Grip strength, dexterity, and the UEFM. Findings for other measures after the 1st period are mixed or in process. Conclusion: Preliminary findings from this ongoing study reveal that participants made improvements in most measures. The next phase of the study will determine if the addition of tSCS to training further augments hand and arm function

Development of a novel definitive scoring system for an enteral feed-only model of necrotizing enterocolitis in piglets

IntroductionNecrotizing enterocolitis (NEC) is a complex inflammatory disorder of the human intestine that most often occurs in premature newborns. Animal models of NEC typically use mice or rats; however, pigs have emerged as a viable alternative given their similar size, intestinal development, and physiology compared to humans. While most piglet NEC models initially administer total parenteral nutrition prior to enteral feeds, here we describe an enteral-feed only piglet model of NEC that recapitulates the microbiome abnormalities present in neonates that develop NEC and introduce a novel multifactorial definitive NEC (D-NEC) scoring system to assess disease severity.MethodsPremature piglets were delivered via Caesarean section. Piglets in the colostrum-fed group received bovine colostrum feeds only throughout the experiment. Piglets in the formula-fed group received colostrum for the first 24 h of life, followed by Neocate Junior to induce intestinal injury. The presence of at least 3 of the following 4 criteria were required to diagnose D-NEC: (1) gross injury score ≥4 of 6; (2) histologic injury score ≥3 of 5; (3) a newly developed clinical sickness score ≥5 of 8 within the last 12 h of life; and (4) bacterial translocation to ≥2 internal organs. Quantitative reverse transcription polymerase chain reaction was performed to confirm intestinal inflammation in the small intestine and colon. 16S rRNA sequencing was performed to evaluate the intestinal microbiome.ResultsCompared to the colostrum-fed group, the formula-fed group had lower survival, higher clinical sickness scores, and more severe gross and histologic intestinal injury. There was significantly increased bacterial translocation, D-NEC, and expression of IL-1α and IL-10 in the colon of formula-fed compared to colostrum-fed piglets. Intestinal microbiome analysis of piglets with D-NEC demonstrated lower microbial diversity and increased Gammaproteobacteria and Enterobacteriaceae.ConclusionsWe have developed a clinical sickness score and a new multifactorial D-NEC scoring system to accurately evaluate an enteral feed-only piglet model of NEC. Piglets with D-NEC had microbiome changes consistent with those seen in preterm infants with NEC. This model can be used to test future novel therapies to treat and prevent this devastating disease

Working in the Public Interest Law Conference

The two-day conference included a variety of panel discussions and roundtables on such topics as: civil liberties; race and the criminal justice system; decriminalizing mental illness; funding public defender systems; the media\u27s role in the law; immigration; lesbian, gay, bisexual and transgendered youth in state sponsored institutions; environmental justice; and women\u27s reproductive rights

Education, implementation, and teams : 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application

Education, implementation, and teams : 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival