Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies

Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed-incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies

Mexican-American perspectives on participation in clinical trials: A qualitative study

AbstractClinical trials are essential to advancing knowledge to reduce disease morbidity and mortality; however, ethnic and racial minorities remain under-represented in those studies. We explored knowledge and perceptions of clinical trials among Mexican-Americans in Texas. We conducted focus groups (N = 128) stratified by gender, language preference, and geographical location. This paper presents four emergent, primary themes: 1) knowledge and understanding of clinical trials, 2) fears and concerns about participating, 3) perceived benefits of participating, and 4) incentives to participate. Results suggest that lack of knowledge and understanding of clinical trials leads to misunderstanding about research, including fears and lack of trust. Participants indicated that fears related to perceived experimentation, harm, immigration status, and lack of clinical trial opportunities within their communities were barriers to participation. On the other hand, free healthcare access, helping family members in the future, and monetary incentives could facilitate participation. We also found differences across themes by language, gender, and place of residence. Findings from our study could inform the development of interventions to enhance recruitment of Mexican-American participants into clinical trials

Selection of internal control genes for real-time quantitative PCR in ovary and uterus of sows across pregnancy

Reproductive traits play a key role in pig production in order to reduce costs and increase economic returns. Among others, gene expression analyses represent a useful approach to study genetic mechanisms underlying reproductive traits in pigs. The application of reverse-transcription quantitative PCR requires the selection of appropriate reference genes, whose expression levels should not be affected by the experimental conditions, especially when comparing gene expression across different physiological stages.This study was funded by the Spanish Ministerio de Ciencia e Innovación (grant AGL2004-08368-C03/GAN). RN Pena received a contractual grant from INIA. M Martínez-Giner received a predoctoral fellowship from MICINN. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Practice Change in Community Health Centers: a Qualitative Study of Leadership attributes

INTRODUCTION: This paper explores leadership attributes important for practice change in community health centers (CHCs) and assesses attributes\u27 fit with the Full-Range Leadership Theory (FRLT). METHODS: We conducted four focus groups and 15 in-depth interviews with 48 CHC leaders from several U.S. states using a modified appreciative inquiry approach. Thematic analysis was used to review transcripts for leadership concepts and code with RESULTS: CHC leaders most often noted attributes associated with transformational leadership as essential for practice change. Important attributes included emphasizing a collective sense of mission and a compelling, achievable vision; expressing enthusiasm about what needs to be done; and appealing to employees\u27 analytical reasoning and challenging others to think creatively to problem solve. Few expressions of leadership fit with the transactional typology, though some did mention active vigilance to ensure standards are met, clarifying role and task requirements, and rewarding followers. Passive-avoidant attributes were rarely mentioned. CONCLUSIONS: Our results enhance understanding of leadership attributes supportive of successful practice change in CHCs

Health coaching to encourage obese adults to enroll in commercially-available weight management programs: The path to health study

Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥4 calls as compared to those who completedstudy, we found that phone health coaching was successful in increasing obese adults\u27 enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes

Formació del professorat per a la innovació basada en la pràctica reflexiva

Durant dos cursos els autors hem format part, com a formadors o com a participants, d'un seminari de formació del professorat de ciències per la innovació, basat en la pràctica reflexiva. La finalitat era potenciar innovacions en la pràctica docent, en línia amb les concepcions actualment vigents en la didàctica de les ciències. És el moment de fer-ne balanç

(C^Npz^C)AuIII complexes of acyclic carbene ligands: synthesis and anticancer properties

A series of cyclometallated gold(III) complexes supported by pyrazine-based (C^Npz^C)-type pincer ligands were synthesized via two different pathways. Nucleophilic attack on the isocyanide complex [(C^Npz^C)Au(C≡NC6H3Me2-2,6)]SbF6 (2) gave [(C^Npz^C)Au(ACC)]SbF6 complexes with aniline (4·SbF6), adamantylamine (5), glycine ethyl ester (6), alanine methyl ester (7), valine methyl ester (8), phenylglycine methyl ester (9) and methionine methyl ester (10) substituents (ACC = acyclic carbene). The pathway via isocyanide insertion into gold-amide bonds was also investigated; e.g. the reaction of xylyl isocyanide with (C^Npz^C)AuNHPh followed by protonation with HBF4·OEt2 gave the acyclic carbene complex 4·BF4. To the best of our knowledge compounds 6 - 10 represent the first examples of gold(III) acyclic carbene complexes bearing amino acid functions. The compounds provide a versatile platform for the study of anti-proliferative properties of gold(III) complexes. Tests against human adenoma-type lung cancer cells identified 5, 6, 7 and 10 as particularly promising and demonstrate the synthetic flexibility of acyclic carbene complexes and the potential of that class of compounds for anticancer applications. Compared to cisplatin, amino ester-containing ACC complexes showed significantly improved selectivity for MCF-7 breast cancer cells over healthy fibroblasts

Exploration of Latina/Hispanic Women\u27s Experiences Living With Non-Alcoholic Fatty Liver Disease: a Qualitative Study With Patients in Houston

OBJECTIVES: A deeper understanding of the lived experiences of Hispanic patients with non-alcoholic fatty liver disease (NAFLD) can help guide the development of behavioral programs that facilitate NAFLD management. This paper explores Hispanic women\u27s experiences living with NAFLD. DESIGN, SETTING, PARTICIPANTS: We collected brief sociodemographic questionnaires and conducted in-depth interviews with 12 low-income (all had household income ≤USD$55 000 per year) Hispanic women with NAFLD from the Houston area. Transcripts were audio-recorded and transcribed. We developed a coding scheme and used thematic analysis to identify emergent themes, supported by Atlas.ti. RESULTS: Participants identified physicians as their main information source on NAFLD but also consulted the internet, family, friends and peers. Many were still left wanting more information. Participants identified family history, sedentary lifestyles, poor diet and comorbid conditions as causes for their NAFLD. Participants also reported emotional distress after diagnosis. Participants experienced both successes and challenges in making lifestyle changes in nutrition and physical activity. Some participants received desired social support in managing NAFLD, although there were conflicting feelings about spousal support. CONCLUSION: Multifaceted programming that improves patient-provider communication, conveys accurate information and enhances social support is needed to support Hispanic women in managing NAFLD

Activation of innate and specific immune responses in hemolytic uremic syndrome (HUS)- patients

La función primaria del sistema inmunológico es preservar al individuo sano frente a infinidad de agentes microbianos patógenos o injuriantes. Sin embargo, en determinadas circunstancias los mecanismos agresores normalmente montados contra un agente invasor, pueden tornarse altamente injuriantes para el propio individuo. Hay importantes evidencias tanto clínicas como experimentales, de que la reacción inflamatoria inducida por los distintos componentes de las bacterias Escherichia coli productoras de toxina Shiga (Stx) (STEC), fundamentalmente la Stx y los lipopolisacáridos (LPS), contribuye decisivamente en la evolución a la forma completa de SUH Así los pacientes al ser diagnosticados de SUH, presentan evidencias de haber sufrido un proceso de activación del sistema inmune innato, o reacción inflamatoria muy aguda y temprana en la evolución de la enfermedad. Algunas de estas evidencias pueden resumirse como: una neutrofilia marcada, leucocitos neutrófilos (PMN) circulantes que se encuentran “agotados o exhaustos”, los monocitos diferenciados hacia un fenotipo inflamatorio (menor expresión de CD14 y aumento de CD16), y se encuentra un significativo descenso en los leucocitos que presentan el receptor para la quimioquina Fractalquina (FKN, CX3CL1)) (CX3CR1): los. monocitos clásicos y células Natural Killer (NK). Estas células tienen un alto potencial citotóxico. La FKN se expresa en endotelio y epitelio renal y ha sido involucrada en los mecanismos patogénicos en distintas nefropatías. Llamativamente, encontramos una correlación significativa entre la severidad del cuadro renal y las alteraciones mencionadas. Por último se discute el papel protector que la respuesta inmune específica podría ejercer, fundamentalmente a través de la producción de anticuerpos neutralizantes de la Stx.The central role of the immune system is the preservation of the health against several pathogenic microbes and injury agents. However, on special conditions defensive mechanisms triggered towards the foreign agent can damage the host. Clinical and experimental evidence indicate that inflammatory reaction triggered by the main components of Shiga toxin (Stx)- producing Escherichia coli (STEC), participate in the evolution to the complete form of HUS. When children are diagnosed of HUS, they present evidence that have suffered a very strong and early inflammatory response. These features include: the presence of a marked neutrophilia, the polymorfonuclear leucocytes (PMN) are “deactivated or exhausted” and the monocytes are differentiated towards an inflammatory phenotype (CD14-reduced and CD16-enhanced membrane expression). In addition, HUS-patients show a marked reduction in the absolute and relative number of leucocytes carrying the receptor (CX3CR1) for the chemokine “Fractalkine” (FKN, CX3 CL1), which are the classic monocytes and Natural Killer cells (NK). All these cells express a high cytotoxic potencial. The chemokine FKN is expressed in endothelial and epithelial renal cells, and is involved in the pathogenic mechanism of different nephropathies. Noteworthy, we found a significant correlation between the severity of the renal damage (as days of anuria) and the alterations described above. Finally, the protective role of specific immune response, mainly through the antibody production with Stx-neutralizing capacity, is discussed.Fil: Palermo, Marina Sandra. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Fernandez, Gabriela C.. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Ramos, Maria Victoria. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Bentancor, Leticia. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Fernández Brando, Romina Jimena. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; ArgentinaFil: Dran, Graciela I.. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Isturiz, Martín Amadeo. Academia Nacional de Medicina de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentin

Blackwater fever in a non-immune patient with Plasmodium falciparum malaria after intravenous artesunate

Blackwater fever was typically reported after quinine administration, although it is poor recognized in patients receiving artesunate. This case describes a blackwater fever in a non-immune patient after artesunate for severe malaria. It highlights the importance of monitoring haemolytic parameters in severe malaria to avoid renal impairment or severe anaemia