Development and Initial Validation of a Questionnaire to Measure Health-Related Quality of Life of Adults with Common Variable Immune Deficiency: The CVID_QoL Questionnaire.

BACKGROUND: Generic health status quality of life (QoL) instruments have been used in patients with common variable immune deficiency (CVID). However, by their nature, these tools may over- or underestimate the impact of diseases on an individual's QoL. OBJECTIVE: The objective of this study was to develop and validate a questionnaire to measure specific-health-related QoL for adults with CVID (CVID_QoL). METHODS: The 32-item content of the CVID_QoL questionnaire was developed using focus groups and individual patient interviews. Validation studies included 118 adults with CVID who completed Short Form-36, Saint George Respiratory Questionnaire, General Health Questionnaire-12, and EuroQol-5D questionnaire in a single session. Principal component and factor analysis solutions identified 3 scores to be similar in number and content for each solution. Validation of 3 factor scores was performed by construct validity. Reproducibility, reliability, convergent validity, and discriminant validity were evaluated. Matrices consisting of correlations between the 32 items in the CVID_QOL were calculated. RESULTS: Factor analysis identified 3 dimensions: emotional functioning (EF), relational functioning (RF), and gastrointestinal and skin symptoms (GSS). The instrument had good internal consistency (Cronbach's alpha, min. 0.74 for GSS, max. 0.84 for RF, n = 118) and high reproducibility (intraclass correlation coefficient, min. 0.79 for RF, max 0.90 for EF, n = 27). EF and RF scores showed good convergent validity correlating with conceptually similar dimensions of other study scales. Acute and relapsing infections had a significant impact on EF and RF. CONCLUSIONS: This study provides evidence of the reliability and construct validity of the CVID_QoL to identify QoL issues in patients with CVID that may not be addressed by generic instruments

Une approche pour la comparaison, du point de vue fonctionnement hydraulique, de propositions d'extension d'un réseau d'assainissement

Les outils informatiques développés dans le cadre de la conception des réseaux d'assainissement permettent de concevoir plusieurs solutions de réseaux pour un même problème. Il revient ensuite au décideur de choisir quelle solution retenir. Le problème qui se pose alors est la comparaison des propositions selon des critères économiques, écologiques, de fonctionnement, de maintenance, .... La difficulté vient du fait que certains de ces critères sont difficiles à évaluer. Nous présentons dans cet article une méthode permettant d'évaluer l'un de ces critères : le fonctionnement global d'un réseau d'assainissement suite à l'extension de ce dernier. Cette méthode est basée sur des simulations hydrauliques. Or ces simulations donnent des informations en chaque noeud du réseau (histogrammes de vitesses, débits ou hauteurs de charge) et non une indication sur la qualité de fonctionnement du réseau dans son ensemble. Il nous a donc fallu élaborer une technique d'agrégation permettant de passer de l'élément isolé (le tronçon) à l'ensemble organisé (le réseau). Cette technique d'agrégation utilise les notions de "période d'insuffisance" d'un tronçon qui est la période de retour d'une pluie pour laquelle ce tronçon dépasse un certain seuil de dysfonctionnement (dans notre cas, le débordement) et de sensibilité du tissu urbain à un dysfonctionnement hydraulique du réseau. Cette dernière notion est nécessaire car certains tronçons peuvent très bien déborder sans induire de désordres apparents s'ils ont, par exemple, une capacité d'écoulement faible et/ou s'ils se trouvent dans une zone non bâtie. Les informations nécessaires à l'utilisation de cette méthode étant souvent de qualité inégale en termes de précision, nous avons pris le parti de raisonner non sur des valeurs déterminées ais sur des classes d'appartenance modélisées sous forme de sous-ensembles flous.Software packages developed for the design of urban storm drainage networks allow several solutions to be proposed for the same problem. It then falls to the designer to choose which solution to use, the main problem being the evaluation of the efficiency (quality) of each solution. A multi-criteria approach represents one theoretical solution to the problem. This necessitates the determination of which criteria to use and how to evaluate them. In this paper, we present a method of evaluation of the criteria related directly to the functioning of an urban storm drainage network after its extension. This method is developed on the basis of hydraulic simulations of the network. These simulations produce results (histograms of discharge, water levels, rates of filling, hydraulic head, ...) for each pipe. Given these results, the designer must be able to assess whether the proposed solution is satisfactory, and then compare it with other solutions. The problem is therefore to be able to evaluate a complete network, whereas the results of conventional simulations present a fragmented and partial view of its functioning (pipe by pipe). A solution to this problem is proposed in the form of a tool, able to calculate a single combined value from the simulation results. The following calculation steps are proposed:1. First we model the effectiveness of each pipe. To do that, we determine the "return period of failure" of a pipe which is the return period of a rainfall for which the pipe passes a certain level of failure (in this paper, we take the level of failure as the state of overflow). The rainfall model used is the same one used for the design of the network. Then we attribute a numerical value (S) for the operation of a pipe according to its return period of failure by way of a satisfaction function. 2. Secondly we model the weighting given to each pipe. This weighting is constructed from the discharge capacity of the pipe and the sensitivity of the urban fabric (in proximity to the pipe) to system failure. The discharge capacity is calculated using Manning's formula on the basis of diameter, slope and internal roughness. The value of the coefficient (R), which indicates the sensitivity, necessitates a good knowledge of the urban fabric. Among the important variables related to this factor, we can identify the population density, the traffic density and the density of land use -DLU- (this variable is identified by the density of residential land use, the density of commercial land use, ...). We can then write R=f(density of population, density of traffic, DLU,...). Considering the difficulty of the identification of (f), we preferred to explore an expert approach. The rules have been identified from a bibliographical analysis and limited expertise. An example of theses rules is presented here : IF density of population is high and density of commercial land use is average THEN the degree of sensibility is average. The examination of the identified rules shows the use of words like low, average and high. To model this linguistic qualifying information, we have chosen fuzzy sets. Also the inferences of fuzzy information are treated by using operations of fuzzy logic. 3. Finally, we aggregate the results with the following equation:     nC=∑QaixRix∆Si  i=1where DSi=Si - Si' represents a measure of the effect of network modification upon the operation of the pipe i (Si and Si' are the effectiveness of the pipe respectively before and after the proposed modification), Qai is the discharge capacity of the pipe i, Ri is the coefficient of sensitivity of the area to failure associated with pipe i and C is a factor which quantifies the effect on the general operation of the network. With the coefficient C, the designer is now able to classify the different solutions of extension of an existing urban drainage network according to their impacts on its functioning and to introduce this classification order in a multi-criteria method

Inducible Nitric Oxide Synthase Provides Protection Against Injury-Induced Thrombosis in Female Mice

Nitric oxide (NO) is an important vasoactive molecule produced by three NO synthase (NOS) enzymes: neuronal (nNOS), inducible (iNOS) and endothelial NOS (eNOS). While eNOS contributes to blood vessel dilation that is generally thought to protect against the development of hypertension, iNOS has been primarily implicated as a disease-promoting isoform leading to protein-bound 3-nitrotyrosine formation in aortic lesions and select organs during atherogenesis. Despite this, iNOS may also play a physiological role, via the modulation of cyclooxygenase and thromboregulatory eicosanoid production. Herein, we examined the role of iNOS in a murine model of thrombosis. Blood flow was measured in carotid arteries of male and female wild-type (WT) and iNOS-deficient mice following ferric chloride-induced thrombosis. Female WT mice were less susceptible to thrombotic occlusion than male counterparts, but this protection was lost upon iNOS deletion. In contrast, male mice (with and without iNOS deletion) were equally susceptible to thrombosis. The protective effect that iNOS affords female WT mice was not associated with a change in the balance of thromboxane A2 (TxA2) and antithrombotic prostacyclin (PGI2). Our findings, however, suggest that iNOS generates a protective source of NO in female WT mice that attenuates the effects of vascular injury. Thus, although iNOS is likely detrimental during atherogenesis, physiological iNOS levels may play a protective role in preventing thrombotic occlusion, a phenomenon that may be enhanced in female mice

Does Religiosity Affect Stock Investors’ Herding Behaviour? Global Evidence

We investigate if religiosity promotes herding among stock market investors. In a global sample of 21 markets over the period 2006–2018, increasing religiosity fosters herding only when the absolute religiosity level is relatively high. At low levels, an increase in religiosity has the opposite effect, promoting anti-herding. Our finding that changes in religiosity, depending on its level (high versus low), exert opposing effects on herding helps to understand contradictory findings in prior literature. Religiosity further induces more herding when economic freedom is low and the state is either impotent or corrupt, and promotes anti-herding when institutional quality is high

The effect of short-chain fatty acids on glycemic control in humans: A systematic review and meta-analysis

Background: Non-communicable disease development is related to impairments in glycaemic and insulinemic response, which can be modulated by fiber intake. Fiber's beneficial effect upon metabolic health can be partially attributed to the production of short-chain fatty acids (SCFAs) via microbial fermentation of fiber in the gastrointestinal tract. Objective: We aimed to determine the effect of the SCFAs, acetate, propionate, and butyrate on glycemic control in humans. Methods: CENTRAL, Embase, PubMed, Scopus and Web of Science databases were searched from inception to the 07/12/2021. Papers were included if they reported a randomized, controlled trial measuring glucose and/or insulin compared to a placebo in adults. Studies were categorized by the type of SCFA and intervention duration. Random effects meta-analyses were performed for glucose and insulin for those subject categories with ≥3 studies, or a narrative review was performed. Results: We identified 43 eligible papers, with 46 studies within those records (n = 913), 44 studies were included in the meta-analysis. Vinegar intake decreased acute glucose response, standard mean difference (SMD) and (95% CI) –0.53 (–0.92, –0.14) (n = 67) in individuals with impaired glucose tolerance or type 2 diabetes and in healthy (SMD) –0.27 (–0.54, 0.00) (n = 186). The meta-analyses for acute acetate as well as acute and chronic propionate studies had no significant effect. Conclusions: Vinegar decreased glucose response acutely in healthy and non-healthy. Acetate, propionate, butyrate, and mixed SCFAs had no effect on blood glucose and insulin in humans. Significant heterogeneity, risk of bias, and publication bias were identified in several study categories, including acute vinegar glucose response. As evidence was very uncertain, caution is urged when interpreting these results. Further high-quality research is required to determine the effect of SCFAs on glycemic control

Prevention of Ventricular Arrhythmias With Sarcoplasmic Reticulum Ca2+ ATPase Pump Overexpression in a Porcine Model of Ischemia Reperfusion

Background— Ventricular arrhythmias are life-threatening complications of heart failure and myocardial ischemia. Increased diastolic Ca2+ overload occurring in ischemia leads to afterdepolarizations and aftercontractions that are responsible for cellular electric instability. We inquired whether sarcoplasmic reticulum Ca2+ ATPase pump (SERCA2a) overexpression could reduce ischemic ventricular arrhythmias by modulating Ca2+ overload.Methods and Results— SERCA2a overexpression in pig hearts was achieved by intracoronary gene delivery of adenovirus in the 3 main coronary arteries. Homogeneous distribution of the gene was obtained through the left ventricle. After gene delivery, the left anterior descending coronary artery was occluded for 30 minutes to induce myocardial ischemia followed by reperfusion. We compared this model with a model of permanent coronary artery occlusion. Twenty-four–hour ECG Holter recordings showed that SERCA2a overexpression significantly reduced the number of episodes of ventricular tachycardia after reperfusion, whereas no significant difference was found in the occurrence of sustained or nonsustained ventricular tachycardia and ventricular fibrillation in pigs undergoing permanent occlusion. Conclusions— We show that Ca2+ cycling modulation using SERCA2a overexpression reduces ventricular arrhythmias after ischemia-reperfusion. Strategies that modulate postischemic Ca2+ overload may have clinical promise for the treatment of ventricular arrhythmias

Role of antiseptics in the prevention and treatment of infections in nursing homes

Inadequate infection control, wound care, and oral hygiene protocols in nursing homes provide challenges to residents’ quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can cause resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.N/

Laparoscopic rectal resections: practical aspects

Abordul laparoscopic in chirurgia cancerului de rect este o considerat standardul de aur ce ofera rezultate oncologice similar cu o recuperare postoperatorie imbunatatita, si o rata minimala de complicatii. Pe fondul complexitatii crescute, cu toate astea, abordul laparoscopic ar trebui efectuat in centre tertiare, fiind rezervat chirurgilor cu o curba de invatare adecvata. O selectie atenta a cazurilor si o planificare adecvata ar trebui luata in considerare in cadrul acestui abord. Prezentarea de fata surprinde aspectele practice de baza precum si variatii tatice in cadrul rezectiilor de rect laparoscopice, precum si pasii potentiali in atingerea curbei de invatare.Laparoscopic approach is an already established procedure in rectal cancer which offers a similar oncological outcome, with improved postoperative recovery and fewer complications. Due to its increased complexity, however, the laparoscopic approach should be reserved for high-volume centers and for experienced surgeons with an adequate learning curve. Appropriate patient selection and planning must be carefully considered when opting for this approach. In this presentation, the primary practical aspects as well as certain tactical approaches will be covered regarding the laparoscopic rectal resections as well as the potential steps in achieving the learning curve

Classic vs laparoscopic approach in colorectal cancer. Experience of a tertiary center, Surgery No 3 Clinic, Cluj-Napoca

Clinica Chirurgie 3, Cluj-Napoca, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Cancerul colorectal este unul dintre cele mai frecvente cancere și cu tendință în creștere la nivel global. Majoritatea studiilor recente au demonstrat non inferioritatea și chiar o ușoară superioritate în abordul laparoscopic prin prisma rezultatelor obținute și a supraviețuirii la distanță. Material și metode: Au fost selectate retrospectiv 2186 de cazuri din baza de date completată prospectiv a Clinicii Chirurgie 3 pentru perioada ian 2013-dec 2018 (6 ani). Din acestea s-au exclus 76 cazuri laparoscopie/laparotomie exploratorie, 154 cazuri colostomii, 51 derivații interne; în final au fost analizate 1905 cazuri de cancer colorectal. Rezultate: Din 1905 cazuri s-au efectuat rezecții laparoscopice la un număr de 310 (16.27%) și clasice la un număr de 1595 cazuri (83.73%). Au fost analizați între cele două loturi următorii parametri: pregătire preoperatorie, durata operației, pierderi sangvine, complicații postoperatorii (fistulă, abces, hemoragie, ocluzie, complicații generale), supurații de plagă, zile spitalizare, necesar antibiotic, mobilizare postoperatorie, mortalitate. Concuzii: Abordul laparoscopic prezintă avantaje privind recuperarea postoperatorie, pierderi sangvine, zile spitalizare, necesar antialgice/antibiotic, lipsa supurațiilor de plagă. Dezavantajele sunt curba de învățare, aparatura specifică și dificultatea păstrării principiilor oncologice.Introduction: Colorectal cancer remains one of the most frequently diagnosed malignant pathologies with a continuously increasing rate worldwide. Most of the recent studies have shown the non-inferiority and slight superiority in the laparoscopic approach through obtained results. Material and methods: 2186 cases were selected retrospectively from a prospectively completed database of the Surgical no 3 Clinic in Cluj-Napoca over the course of 6 years (ian 2013 – dec 2018). Out of these cases, 76 cases were excluded for exploratory laparoscopy/laparotomy, 154 which underwent only colostomy, and 51 which underwent internal derivation. At the end of the study, 1905 cases were eligible. Results: Out of 1905 cases, 310 underwent a laparoscopic approach (16.27%) and 1595 cases underwent a classic approach (83.73%). Between the two approaches, a series of parameters were analyzed: preoperative care, duration of the surgery, intraoperative blood loss, postoperative complications (fistula, abscess, hemorrhage, occlusion, general complications), antibiotic necessity, postoperative mobilization, mortality, prevalence of surgical site infection. Conclusions: The laparoscopic approach proves many advantages regarding postoperative care, blood loss, hospitalization care, necessity of antibiotics and painkillers, and surgical site infection, cosmetic advantages. Disadvantages are the learning curve, specific instruments requirements, difficulty of maintaining the oncology principles