Az Interkulturális Érzékenység Skála magyar változatának pszichometriai vizsgálata orvostanhallgatók és pszichológia szakos hallgatók mintáján

Háttér és célkitűzések: Az egyre növekvő kulturális diverzitás következtében az utóbbi évek nemzetközi és hazai tudományos irodalma egyre több figyelmet fordít az interkulturális kompetencia mérési és fejlesztési feladataira a gyógyításban. Jelen vizsgálatban célunk az Interkulturális Érzékenység Skála magyar változatának pszichometriai vizsgálata orvostan- és pszichológushallgatók körében, feltárva emellett az empátiával való konvergens validitását és a skálán különböző demográfiai változók mentén megjelenő különbségeket és együtt járásokat. Módszer: A kvantitatív, keresztmetszeti vizsgálatban 396 magyar, gyógyító szakmára készülő hallgató demográfiai és Interkulturális Érzékenység Skála, valamint Interperszonális Reaktivitás Index adatait elemeztük. Az eredeti 5 faktoros kérdőívstruktúra érvényességi és megbízhatósági vizsgálatai mellett korreláció, független mintás t-próba, egyutas ANOVA teszteket és lineáris regressziót alkalmaztunk. Eredmények: Az eredeti skála nem mutatott megfelelő és érvényes illeszkedést magyar mintán, helyette egy alternatív, rövidített, 3 faktoros struktúra bizonyult a legjobban illeszkedőnek, elfogadható vagy jó belső megbízhatósági mutatókkal. Eredményeink szerint a nyelvismeret és az empátia két dimenziója jelentős bejóslója az interkulturális érzékenységnek: a perspektíva- felvétel pozitívan, a személyes distressz pedig fordított irányban jelezte azt előre. Következtetések: Egy olyan magyar nyelvre adaptált mérőeszközt alakítottunk ki, mely megbízhatóan méri a magyar gyógyító szakmára készülők interkulturális érzékenységét. E készség fejlesztése napjainkban az egészségügyi képzések fontos feladata. A hallgatók nyelvtanulásának, kultúrközi tapasztalatszerzésének és empátiafejlesztésének támogatása mellett az interdiszciplináris és interkulturális felépítésű gyógyítói tanuló- vagy kutatócsoportok igen hasznos együtt- működésének irányába mutatnak a jelen kutatás eredményei

Quantitative Histomorphometry of the Healthy Peritoneum

The peritoneum plays an essential role in preventing abdominal frictions and adhesions and can be utilized as a dialysis membrane. Its physiological ultrastructure, however, has not yet been studied systematically. 106 standardized peritoneal and 69 omental specimens were obtained from 107 patients (0.1–60 years) undergoing surgery for disease not affecting the peritoneum for automated quantitative histomorphometry and immunohistochemistry. The mesothelial cell layer morphology and protein expression pattern is similar across all age groups. Infants below one year have a thinner submesothelium; inflammation, profibrotic activity and mesothelial cell translocation is largely absent in all age groups. Peritoneal blood capillaries, lymphatics and nerve fibers locate in three distinct submesothelial layers. Blood vessel density and endothelial surface area follow a U-shaped curve with highest values in infants below one year and lowest values in children aged 7–12 years. Lymphatic vessel density is much lower, and again highest in infants. Omental blood capillary density correlates with parietal peritoneal findings, whereas only few lymphatic vessels are present. The healthy peritoneum exhibits major thus far unknown particularities, pertaining to functionally relevant structures, and subject to substantial changes with age. The reference ranges established here provide a framework for future histomorphometric analyses and peritoneal transport modeling approaches

Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study

<p>Abstract</p> <p>Background</p> <p>A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool.</p> <p>Methods</p> <p>Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability.</p> <p>Results</p> <p>An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.</p> <p>Conclusion</p> <p>Although the MTM-classification covers a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current classification problems.</p

Reduced microvascular density in omental biopsies of children with chronic kidney disease

Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD.Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2.Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01).Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease

Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy.

PURPOSE: The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations. METHODS: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings. RESULTS: After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends. CONCLUSION: The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation. LEVEL OF EVIDENCE: Systematic review of anatomical dissections and imaging studies, Level IV

Neutral pH and low-glucose degradation product dialysis fluids induce major early alterations of the peritoneal membrane in children on peritoneal dialysis

WOS: 000439138700024PubMed ID: 29776755The effect of peritoneal dialysates with low-glucose degradation products on peritoneal membrane morphology is largely unknown, with functional relevancy predominantly derived from experimental studies. To investigate this, we performed automated quantitative histomorphometry and molecular analyses on 256 standardized peritoneal and 172 omental specimens from 56 children with normal renal function, 90 children with end-stage kidney disease at time of catheter insertion, and 82 children undergoing peritoneal dialysis using dialysates with low-glucose degradation products. Follow-up biopsies were obtained from 24 children after a median peritoneal dialysis of 13 months. Prior to dialysis, mild parietal peritoneal inflammation, epithelial-mesenchymal transition and vasculopathy were present. After up to six and 12 months of peritoneal dialysis, blood microvessel density was 110 and 93% higher, endothelial surface area per peritoneal volume 137 and 95% greater, and submesothelial thickness 23 and 58% greater, respectively. Subsequent peritoneal changes were less pronounced. Mesothelial cell coverage was lower and vasculopathy advanced, whereas lymphatic vessel density was unchanged. Morphological changes were accompanied by early fibroblast activation, leukocyte and macrophage infiltration, diffuse podoplanin presence, epithelial mesenchymal transdifferentiation, and by increased proangiogenic and profibrotic cytokine abundance. These transformative changes were confirmed by intraindividual comparisons. Peritoneal microvascular density correlated with peritoneal small-molecular transport function by uni- and multivariate analysis. Thus, in children on peritoneal dialysis neutral pH dialysates containing low-glucose degradation products induce early peritoneal inflammation, fibroblast activation, epithelial-mesenchymal transition and marked angiogenesis, which determines the PD membrane transport function.European Training and Research in Peritoneal Dialysis (EuTRiPD) Programme - European Union within the Marie Curie Scheme [287813]; Medical Faculty of the University of Heidelberg; Fresenius Medical Care (Bad Homburg, Germany); ERA-EDTA; KfH Foundation for Preventive Medicine; Baxter; Fresenius Medical CareMB was supported by the European Training and Research in Peritoneal Dialysis (EuTRiPD) Programme, a project funded by the European Union within the Marie Curie Scheme (287813). BS was supported by the Medical Faculty of the University of Heidelberg. Further support was received from Fresenius Medical Care (Bad Homburg, Germany), ERA-EDTA, and the KfH Foundation for Preventive Medicine. FS, BAW, and CPS obtained further research funding from Baxter and Fresenius Medical Care. We are grateful to Dr. E. Herpel and Mr. J. Moyers from Tissue Bank of the National Center for Tumor Diseases (NCT, Heidelberg, Germany) and Institute of Pathology (Heidelberg University Hospital) for technical assistance