Do Low Preoperative Vitamin D Levels Reduce the Accuracy of Quick Parathyroid Hormone in Predicting Postthyroidectomy Hypocalcemia?

BACKGROUND: Although some studies have suggested that low preoperative 25-hydroxyvitamin D (25-OHD) levels may increase the risk of hypocalcemia and decrease the accuracy of single quick parathyroid hormone in predicting hypocalcemia after total thyroidectomy, the literature remains scarce and inconsistent. Our study aimed to address these issues. METHODS: Of the 281 consecutive patients who underwent a total/completion total thyroidectomy, 244 (86.8 %) did not require any oral calcium and/or calcitriol supplements (group 1), while 37 (13.2 %) did (group 2) at hospital discharge. 25-OHD level was checked 1 day before surgery, and postoperative quick parathyroid hormone (PTH) was checked at skin closure (PTH-SC). Postoperative serum calcium was checked regularly. Hypocalcemia was defined by the presence of symptoms or adjusted calcium of <1.90 mmol/L. Significant factors for hypocalcemia were determined by univariate and multivariate analyses. The accuracy of PTH-SC in predicting hypocalcemia was measured by area under a receiver operating characteristic curve (AUC), and the AUC of PTH-SC was compared between patients with preoperative 25-OHD <15 and ≥15 ng/mL via bootstrapping. RESULTS: Preoperative 25-OHD level was not significantly different between groups 1 and 2 (13.1 vs. 12.5 ng/mL, p = 0.175). After adjusting for other significant factors, PTH-SC (odds ratio 2.49, 95 % confidence interval 1.52–4.07, p < 0.001) and parathyroid autotransplantation (odds ratio 3.23, 95 % confidence interval 1.22–8.60, p = 0.019) were the two independent factors for hypocalcemia. The AUC of PTH-SC was similar between those with 25-OHD <15 and ≥15 ng/mL (0.880 vs. 0.850, p = 0.61) CONCLUSIONS: Low 25-OHD was not a significant factor for hypocalcemia and did not lower the accuracy of quick PTH in predicting postthyroidectomy hypocalcemia

Towards a global partnership model in interprofessional education for cross-sector problem-solving

Objectives A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. Methods This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students’ data. Results We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest–posttest differences in students’ readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students’ social interaction anxiety after the IPE simulation. Conclusions The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Preparing for counselling : developing and testing an affective awareness training program for the mentally disabled

This thesis starts with the observation that if mentally disabled individuals are to establish a place for themselves in the community and successfully cope with the accompanying stress, they must, within their own range of capabilities, (1) learn to recognize their emotions, and (2) learn to express these emotions in socially acceptable ways. The thesis then attempts to explore whether this is a realizable goal. A review of the literature reveals that, in spite of its importance to the mainstreaming process, the emotional development of mentally handicapped individuals has received scant attention toy psychologists, special educators, or counsellors. Some of the reasons for this are explored including an examination of the prevalent "cognitive deterministic" viewpoint which assumes that emotional awareness presupposes higher levels of cognitive development than the mentally handicapped are commonly capable of demonstrating. The thesis notes the recent view of researchers in special education and psychotherapy that appropriate behavioral expression of feelings by the mentally handicapped must develop out of awareness of feelings; it cannot come about through efforts to manipulate manifest behavior alone. Perhaps more importantly, it is argued that affective development takes place in tandem with cognitive abilities, not necessarily as a consequence of them. Based on evidence that affective awareness training for mentally handicapped individuals can and should be pursued along with cognitive and life skills training, the thesis focuses on taking up the challenge of developing and field testing "An Affective Awareness Training Program for the Mentally Disabled." A Gestalt approach to developing awareness of oneself and one's environment was utilized as the theoretical basis for preparing the 46 lessons which make up the content of the "Affective Awareness Training Program." The researcher adapted freely from the work of others to create a unique instructional program designed especially to meet the needs and abilities of Trainable Mentally Retarded (TMR) students. The effectiveness of this program in teaching recognition of, and improving ability to empathize with, expressions of the five primary emotions of joy, sadness, fear, anger, and surprise, was then tested by the researcher using 12 TMR subjects living in an institution (six in the control group, six in the treatment or experimental group). The test instrument for measuring changes in pre-treatment, post-treatment, and retention level performance, was a series of 15 specially prepared video vignettes. Each vignette focused on one emotion and there were three different vignettes portraying each emotion. The thesis concludes that the experimental group, who participated in the affective awareness training program, changed significantly in their ability to recognize and empathize with expressions of the five primary emotions.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofGraduat

Defective TGF beta signaling in bisphosphonates associated atypical femoral fracture

INTRODUCTION: Bisphosphonates (BPs) are potent anti-resorptive agents and their therapeutic use in osteoporosis treatment and fracture prevention has been well established. However, studies investigating the association of atypical femoral fractures (AFF) and use of BPs are still inconclusive due to lack of scientific evidence. Transforming growth factor-beta (TGF-beta) is abundant in bone matrix which plays critical roles in bone remodeling, migration of bone mesenchymal stem cells to resorptive sites, osteoblastic-osteoclastic coupling in bone formation and resorption. Increase of TGF-beta1 has also been shown as the etiology of disease which exhibits diaphyseal dysplasia. PURPOSE OF STUDY: Purpose of this study was to compare expression of TGF-beta in AFF with normal control and to determine TGF-beta as possible cause of AFF. METHODS: Bone marrow supernatant was collected for active TGF-beta levels. Bone marrow stromal cells from AFF patient and control were obtained. Pluripotency of stromal cells had been demonstrated by adipogenic, chondrogenic and osteogenic differentiations. These cells were differentiated to osteoblasts and osteoclasts for in-vitro co-culture with bovine femoral cortical bone discs. Osteogenic differentiation rate was reported by ALP assay. The difference in rate of cells metabolic activities was evaluated by MTT assay. Gene and protein expressions of TGF-beta were reported by q-RT-PCR and cytokine ELISA. After initial comparison of findings between AFF and control samples, further culturing of control sample with alendronate and in-vito treatment of AFF sample by TGF-beta 1 were performed. RESULTS: In initial comparison, active TGF-beta 1 was detected as significantly decreased in bone marrow supernatant of AFF group by cytokine ELISA; higher osteogenic differentiation rate was found in AFF samples in contrary to low clinical serum ALP level in BP-treated patients. The rate of osteoblast metabolic activity was found significantly different in co-cultures with variety of spatial arrangement. Gene expressions of TGF-beta 1 and TGF-beta R1 were found down-regulated; TGF-beta 2 found up-regulated and TGF-beta R2 found down-regulated in AFF sample. ELISA results showed free release of TGF-beta 1 in medium is lower in AFF. In the follow-up culture of control sample with alendronate exhibited change of all ALP, MTT, q-RT-PCR and ELISA findings towards trends of AFF results. Whereas, in-vitro treatment of AFF sample by TGF-beta 1 demonstrated restorative effect towards control level. CONCLUSION: TGF-beta signaling pathway was found different in AFF patients from normal control. Further culture studies recommended causal relationship of defective TGF-beta signaling and BPs associated AFF. BPs affected bone marrow stromal cells which led to this defective TGF-beta signaling.published_or_final_versionOrthopaedics and TraumatologyDoctoralDoctor of Philosoph

Effect of corporate focus on firm performance.

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Pattern and impact of hepatic adverse events encountered during immune checkpoint inhibitors – A territory‐wide cohort study

Abstract Background Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of cancers. We aimed to evaluate the incidence and prognostic impact of hepatic adverse events (AEs) in a territory‐wide cohort of patients who received ICIs. Methods Patients were identified from a territory‐wide database who received ICIs in 2014‐2018. Hepatic AEs were defined as any elevation of liver biochemistries including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels. Hepatic AEs were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Total of 1480 patients were identified (mean age 60 years, male 65.5%) and the commonest malignancies being lung cancer (39.6%), liver cancer (16.5%), and gastrointestinal cancer (10.0%). Grade 1‐2 and grade 3‐4 hepatic AEs occurred in 41.3% and 14.9% of patients during ICI treatment, respectively. Patients with liver cancer had the highest rate of hepatic AEs (grade 1‐2:54.1%; grade 3‐4:32.8%). Among 711 patients with hepatic AEs, 383 (53.9%) had raised ALT/AST only, and 328 (46.1%) had concomitant raised ALT/AST and bilirubin levels. In the whole cohort, median overall survival of patients without any hepatic AEs, grade 1‐2 and grade 3‐4 hepatic AEs during ICI treatment was 9.0 months, 7.2 months, and 3.3 months (P < .001), respectively. Similar results on overall survival were obtained among different types of cancers. Conclusions Hepatic AEs occur in more than half of patients receiving ICIs for cancer treatment, with approximately 15% being grade 3‐4 AEs. Occurrence of hepatic AEs is associated with worse prognosis

EPIC

10.1016/j.jpainsymman.2020.06.016Journal of Pain and Symptom Managemen

Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis

Background &amp; Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis. Methods: All patients with chronic HBV infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration of <1 year were excluded. Participants were classified into three mutually exclusive groups: (1) no decompensated events (i.e. compensated group); (2) decompensated events occurred (i.e. decompensated group); or (3) decompensated events occurred followed by recompensation according to Baveno VII criteria (i.e. recompensated group). A time-dependent Cox proportional hazard model was adopted for evaluation. The follow-up period was 5 years. Results: A total of 4,701 patients with cirrhosis and HBV who were treated with entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) were identified. During a median follow-up of 5 years (interquartile range 3.7, 5 years), 3,327 (70.8%), 1,347 (29.2%), and 265 (5.6%) patients had compensated, decompensated, and recompensated cirrhosis, respectively, at least once before the end of the study. In the time-dependent multivariable model, the recompensated group had similar transplant-free survival compared with the compensated group (adjusted hazard ratio 1.16; 95% CI 0.72–1.86; p = 0.536). The 5-year transplant-free survival rate was 89.3% for the compensated group, whereas it was 76.0% for the recompensated group, reflecting a minimal difference between the two groups. Conclusions: The clinical significance of recompensation of cirrhosis in improving patient outcomes for individuals with CHB infection was highlighted in this study. Early identification and treatment with nucleos(t)ide analogues might promote hepatic recompensation and thus reduce mortality in patients with CHB. Impact and implications: The latest Baveno VII consensus introduces the new concept of hepatic recompensation, which refers to the reversal of the structural and functional changes of cirrhosis after removal, cure, or suppression of the aetiology of cirrhosis. It is essential to investigate the transplant-free survival rates of patients who are able to achieve hepatic recompensation, as this has significant implications for the medical resources required to manage liver failure and transplantation. This study features the clinical significance of hepatic recompensation by comparing patient outcomes of those who achieve it to those who do not. The early identification and use of antiviral treatment with nucleos(t)ide analogues is a pivotal strategy to promote hepatic recompensation, which has the potential to significantly reduce mortality rates in patients with chronic HBV infection and ultimately aid in the elimination of hepatitis