Significant Reduction In Number Research Articles

Anticoccidial and jejunum-protective effects of Krameria lappacea roots extract on experimental Eimeria papillata infection.

Coccidiosis is a protozoan parasitic disease caused by Eimeria species and affects wild and domestic animals. Coccidiostats are currently available to control this disease, although drug resistance has been confirmed for all of them. As a result, there is an urgent need to identify eco-friendly agents to control and treat this disease. This study aimed to investigate the ameliorative role of the Krameria lappacea roots extract (KLRE) on the outcome of coccidiosis induced by Eimeria papillata. Male C57BL/6 mice were divided into seven groups (5 mice/group), as follows: Group 1: noninfected-nontreated (control group), Group 2: noninfected-treated group with KLRE (200 mg/kg), Group 3: infected-nontreated group, Group 4: infected-treated group with KLRE (50 mg/kg), Group 5: infected-treated group with KLRE (100 mg/kg), Group 6: infected-treated group with KLRE (200 mg/kg), and Group 7: infected-treated group with amprolium (120 mg/kg). Groups (3-7) were inoculated orally with 1 × 103 sporulated E. papillata oocysts. One hour after infection, groups (4-6) were daily treated for 5 days with KLRE and amprolium. On day 5 postinfection, oocyst output was determined, and mice were euthanized for the collection of jejuna then preparation of histological sections and jejunal homogenate was used for the determination of biochemical and oxidative damage markers. The coccidial infection induced weight loss of mice by 3.971%, which improved after KLRE to -1.512%. After KLRE treatment, the rate of feed intake was improved to be 52.21 ± 2.30 than those in infected group (40.47 ± 2.25). Oocyst output was significantly reduced in mice treated with KLRE (1.308 × 106 oocysts/g.feces) compared with those in the infected group (5.387 × 106 oocysts/g.feces). E. papillata infection induced marked histological alterations within jejunum tissue. After treatment, KLRE was able to impair the development of parasite stages (meronts, gamonts, and developing oocysts) in the jejunum through a significant reduction of number and size in comparison with the infected group. Infection with E. papillata induced a disturbance in the nutrient absorption in the jejunal mice tissue, which improved after the treatment with KLRE and amprolium. Also, KLRE counteracted significantly the E. papillata-induced loss of reduced glutathione and total antioxidant capacity. Our findings indicate that KLRE could be used as an alternative to the available coccidiostats currently available. RESEARCH HIGHLIGHTS: Krameria lappacea exhibit significant anticoccidial and antioxidant activities induced by E. papillata infection. Krameria lappacea exhibit significant improvement in the pathological alterations of the jejunal tissue induced by E. papillata infection.

Impact of rapid on-site evaluation in expediting the fast investigative lung cancer pathway.

EBUS-TBNA is a method of acquiring tissue samples from intrathoracic lymph nodes and central intrathoracic tumours in patients suspected of having lung cancer. Rapid on-site evaluation (ROSE) denotes assessing tissue samples during EBUS (or bronchoscopy), providing instant feedback on sample adequacy and provisional cytomorphological diagnosis. Sector multidisciplinary team (MDT) discussion can then make informed treatment decisions, with confirmatory immunohistochemistry being finalised before provision of final treatment. Currently, impact of ROSE on length of time patients spend on the lung cancer diagnostic pathway remains unclear. We retrospectively evaluated the impact of ROSE on the length of time between patients' EBUS/bronchoscopy procedures and discussion at sector MDT, referred to as time to treatment decision (TTD), at our institution. Additionally, we assessed impact of ROSE on number of passes (number of times nodes/masses were sampled) per procedure. The mean TTD was 77.9% shorter (p = 0.001) with ROSE present than when absent. Patients who received ROSE spend 34.3% less time (p = 0.028) on lung cancer diagnostic pathway overall. There was a significant reduction in number of passes in non-malignant nodes with ROSE present (2.23) than when absent (3.14) (p < 0.001). With ROSE present there was a significantly greater number of passes at malignant sites (5.07) than non-malignant sites (2.23) (p < 0.001). These findings support conclusions made in our institution's previous study, that utilisation of ROSE reduces TTD. ROSE also allows safe advancement through nodes with low suspicion of malignant involvement, focusing time on sampling nodes/masses of greater suspicion.

Uso del catéter de arteria pulmonar en las primeras horas posoperatorias de cirugía cardiovascular de alto riesgo

IntroductionInformation on physiological phenomena in the postoperative period of cardiac surgery, pulmonary artery catheter (PAC) use, and medical behaviors derived from its measurement, is limited. ObjectiveTo describe the patterns of PAC use and therapeutic behaviors derived from it in the first postoperative hours of high-risk cardiovascular surgery. Materials and methodsRetrospective cohort study of high-risk cardiovascular surgery patients, managed with PAC in the intensive care unit of the Hospital Universitario San Ignacio in Bogotá D.C. (Colombia). The therapeutic interventions derived from the hemodynamic evaluation with this catheter were evaluated, taking into account the patterns of use and therapeutic behaviors according to the postoperative moment. ResultsForty-two patients were included. Median age 65 years, 59.5% men, 57.1% with EuroSCORE≥6. Median time of PAC use was 63 h (RIC 45–80). The number of PAC measurements per 12 h decreased from 2.16±0.53 in the first 12 h to 1.30±0.82 after 48 h (p: 0.0003). The number of behaviors taken from each measurement decreased from 1.48±0.45 to 0.71±0.51 (p: 0.0001) in the same period. There was significant reduction in number of behaviors associated with fluid, vasoactive, and vasodilator administration over time. ConclusionsOur data suggest that with the passage of hours the number of PAC measurements is decreasing, as well as the number of behaviors taken based on these measurements. These data suggest that many of the patients who maintained the pulmonary artery catheter for up to 48–72 h no longer required it. Further studies will be needed to clarify which patients benefit from pulmonary artery catheterization beyond 48 h.

Blockade of connexin hemichannels with tonabersat protects against mild hypoxic ischemic brain injury in neonatal rats

Background and purposeThere is growing evidence that infants with mild hypoxic-ischemic (HI) encephalopathy have increased risk of brain injury and adverse neurodevelopmental outcomes. Currently, there is no approved treatment for these infants. It was previously shown that blocking connexin 43 hemichannels is neuroprotective in models of moderate to severe HI injury. However, it is yet to be established whether these channels play a role in the evolution of mild HI brain injury, and whether blocking these channels after mild HI is neuroprotective. MethodsHI was induced in postnatal day 10 rats of both sexes by right carotid artery ligation followed by 80 min of hypoxia in 8% oxygen. Pups receiving HI were randomised to receive intraperitoneal injections of either saline, vehicle (2-hydroxypropyl-beta-cyclodextrin polyethylene glycol-400), or tonabersat (2 mg/kg), at 60 min, 24 h, and 48 h after hypoxia. Seven days after HI, brains were harvested for measurement of volume loss and histological analysis. ResultsHI resulted in a significant reduction in hemispheric, hippocampal, and white matter volumes, which were significantly attenuated after treatment with tonabersat. HI was also associated with a significant reduction in numbers of neurons in the CA1 and CA3 hippocampal regions, a reduction in the numbers of oligodendrocytes in the corpus callosum, and an increase in the number of astrocytes in both regions, which were significantly attenuated by tonabersat treatment. There were no differences in rectal temperatures between tonabersat- and vehicle-treated rat pups. ConclusionsBlockade of connexin hemichannels with tonabersat significantly reduced mild HI injury in the hippocampus and white matter, without causing hypothermia.

Long-term prophylaxis for hereditary angioedema: Initial experiences with garadacimab and lanadelumab.

With no approved long-term prophylaxis (LTP) for the prevention of hereditary angioedema (HAE) attacks in Hong Kong, patients rely on compassionate use programs and drug trials. Moreover, studies regarding the use and efficacy of LTP in Asia are lacking. Our aim was to assess 2 LTP medications for HAE in Hong Kong: lanadelumab and garadacimab. A prospective study was performed. Adult patients with a diagnosis of type I or type II HAE with 1 or more expert-confirmed attacks per month were consecutively recruited. The patients had been receiving treatment for at least 6 months. Clinical data were obtained, and questionnaires were administered before treatment periodically for at least 6 months following initiation of LTP. Almost one-third of the patients with HAE experienced frequent attacks and began receiving LTP (8 of the 11 received garadacimab and 3 of the 11 received lanadelumab). At baseline, the time-normalized number of HAE attacks was 2.5 plus or minus 1.3 per month. At month 6, there was an overall reduction of time-normalized number of attacks per month of -2.4 attacks per month (95% CI= -3.3 to -1.5. [P< .01]). The time-normalized number of HAE attacks at month 6 was 0.1 plus or minus 0.1 per month. More than 70% of the patients (8 of 11) were completely attack-free during the 6-month period while receiving LTP, and no patients required hospitalization. LTP improved patients' scores of the Angioedema Quality-of-Life Questionnaire (P < .001) and reduced activity impairment due to health (P= .008). Patients experienced significant improvement across all dimensions of the Treatment Satisfaction for Medication Questionnaire (54.5%-76.8% [P= .002]), and no adverse events were reported. The patients receiving LTP with garadacimab and lanadelumab experienced a significant reduction in number of HAE attacks and improvement in quality of life, and they were satisfied with treatment.

COVID-19 impact on pathological cancer diagnoses in Netherlands, Aotearoa New Zealand, &amp; N. Ireland

Abstract Background The COVID-19 pandemic was managed in Aotearoa New Zealand (NZ) by a COVID-19 elimination policy, involving border closure and an initial national lockdown. This was different to most other countries including Northern Ireland (NI) and the Netherlands (NED). We quantify the effect of these policies on the diagnosis of three major cancers comparing NZ with these two European countries. Methods Data from NED, NZ and NI population-based cancer registries were used to assess trends in all pathologically diagnosed (PD) lung, breast, and colorectal cancers from March to December 2020 (COVID period) and compared to the similar pre-pandemic period 2017-2019. Trend data were also collated on COVID-19 cases and deaths per 100,000 in each population. Results Comparing the pre-pandemic period to the COVID-19 period there were statistically significant reductions in numbers of lung (↓23%) and colorectal (↓15%) PD cancers in NI and numbers of breast (↓18%) and colorectal cancer (↓18.5%) diagnosed in the NED. In NZ there was no significant change in the number of lung (↑10%) or breast cancers (↑0.2%) but a statistically significant increase in numbers of colorectal cancer diagnosed (↑5%). Conclusions The impact of COVID-19 on cancer services was mitigated in NZ as services continued as usual reflecting minimal healthcare disruption and protected cancer services linked with the elimination approach adopted. The reduction in PD cases diagnosed in NED and NI were linked with higher COVID-19 rates and reflect societal restrictions which resulted in delayed patient presentation to primary and secondary care, disruption to screening and healthcare services because of COVID-19 infections on staff and the need to shift intensive care to COVID-19 patients. Key messages • Reductions in PD cancers in NI and the NED and in particularly lung cancers in NI, highlight the need for targeted public health campaigns to identify and treat ‘missing’ patients. • Protecting cancer services should be a priority in any future pandemic or systemic healthcare system disruption.

Evaluation of the Effects of Salinity Stress on Yield Parameters of Soybeans (Glycine max) Cultivated in Obubra Local Government Area of Cross River State, Nigeria

A pot experiment was conducted in the screen house at the Cross River University of Technology, Obubra Campus to evaluate the effect of different salt concentrations on the yield of three different varieties of soybeans (Glycine max). The experiment was laid in complete randomized design (CRD) with twenty replicates for each variety. Yield parameters which include number of pods per plant, 100 seed weight (g) and seed yield were measured, and data collected was subjected to statistical analysis using Analysis of variance (ANOVA) and means were compared using Duncan’s New Multiple Range Test (DNMRT). The results showed that salinity stress led to a significant reduction in number of pods per plant over control. At 30mM Nacl which was the highest level of saline water TGX 1987-10F had a better salt tolerance level as compared to other varieties, which might be as a result of some salt tolerance genes. 100 seed weight (g) reduced significantly under salinity stress as compared with the control, but TGX 1987-10F showed better salt tolerance level as compared with other varieties. Seed yield per plant decreased significantly with increasing salinity levels and a greater reduction was observed in TGX 1448-2E and TGX 1835-10E. It was concluded that Soybean is a sensitive plant to salinity stress, but the extent of this sensitivity varies among varieties. TGX 1987-10F showed a better tolerance level as compared with other varieties. Therefore, it is recommended that TGX 1987-10F can be cultivated in saline areas.

Comparison of two optimization algorithms (VOLOTM , SEQU) for CyberKnife® treatment of acoustic neuromas, lung metastases, and liver metastases.

Two optimization algorithms VOLO™ and sequential optimization algorithm (SEQU) are compared in the Precision® treatment planning system from Accuray® for stereotactic radiosurgery and stereotactic body radiotherapy (SBRT) treatment plans. The aim is to compare the two algorithms to assess if VOLO™ is better of SEQU in certain treatment site. Sixty clinical treatment cases were compared. Entities include Acoustic neuroma (AN), lung metastases, and liver metastases. In each entity, 10 SEQU and 10 VOLO™ treatment plans were optimized. The Ray-Tracing calculation algorithm was used for all treatment plans and the treatments were planned exclusively with fixed cones (5-50mm). The number of nodes, beams, total MU, and treatment time were compared. Conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), and target coverage were examined for agreement. Dmin , Dmean , Dmax , D100%, D98%, and D2% dose in the target volume as well as exposure to organs at risk was checked. To determine peripheral doses, the isodose volumes from V10% to V98% were evaluated. AN treatment plans showed significant differences for the number of nodes, beams, total MU, treatment time, D98%, D100% for the target volume, and the doses for all organs at risk. VOLO™ achieved better results on average. Total MU, treatment time, coverage, and D98% are significantly better for VOLO™ for lung metastases. For liver metastases, a significant reduction in number of nodes, total MU, and treatment time was observed for VOLO™ plans. The mean target coverage increased slightly with VOLO™, while the mean CI deteriorated slightly. The averages of Dmin , Dmean , D98%, D100%, and V80% resulted in a significant increase for VOLO™. The results of the present study indicate that VOLO™ should be used in place of SEQU as a standard for AN cases moving forward. Despite the lack of significance in the lung and liver cases, VOLO™ optimization is recommended because OAR sparing was similar, but coverage, Dmin , and Dmean were increased, and thus better tumor control can be expected.

Impact of COVID-19 control on lung, breast, and colorectal pathological cancer diagnoses. A comparison between the Netherlands, Aotearoa New Zealand, and Northern Ireland

BackgroundThe COVID-19 pandemic was managed in Aotearoa New Zealand (NZ) by a COVID-19 elimination policy, involving border closure and an initial national lockdown. This was different to most other countries including Northern Ireland (NI) and the Netherlands (NED). We quantify the effect of these policies on the diagnosis of three major cancers, comparing NZ with these two European countries.MethodData from NED, NZ and NI population-based cancer registries were used to assess trends in all pathologically diagnosed (PD) lung, breast, and colorectal cancers from March to December 2020 (pandemic period) and compared to the similar pre-pandemic period (2017–2019). Trend data were also collated on COVID-19 cases and deaths per 100,000 in each population.ResultsComparing the pre-pandemic period to the pandemic period there were statistically significant reductions in numbers of lung (↓23%) and colorectal (↓15%) PD cancers in NI and numbers of breast (↓18%) and colorectal cancer (↓18.5%) diagnosed in the NED. In NZ there was no significant change in the number of lung (↑10%) or breast cancers (↑0.2%) but a statistically significant increase in numbers of colorectal cancer diagnosed (↑5%).ConclusionThe impact of COVID-19 on cancer services was mitigated in NZ as services continued as usual reflecting minimal healthcare disruption and protected cancer services linked with the elimination approach adopted. The reduction in PD cases diagnosed in NED and NI were linked with higher COVID-19 rates and reflect societal restrictions which resulted in delayed patient presentation to primary and secondary care, disruption to screening and healthcare services as a result of COVID-19 infections on staff and the need to shift intensive care to COVID-19 patients. Reductions in PD cancers in NI and the NED and in particularly lung cancers in NI, highlight the need for targeted public health campaigns to identify and treat ‘missing’ patients. Protecting cancer services should be a priority in any future pandemic or systemic healthcare system disruption.

Reduction in urinary tract infections in patients treated with fecal microbiota transplantation for recurrent Clostridioides difficile infection.

We performed an updated study to investigate the rates of urinary tract infections (UTIs) in patients with recurrent Clostridioides difficile infection (CDI) who received fecal microbiota transplantation (FMT) for CDI. We found a significant reduction in number of UTIs after FMT compared to patients who received antibiotics for CDI treatment. After FMT, we also observed a trend towards reduction of antibiotic resistance in organisms causing UTI.

Progression of the Deep Inferior Epigastric Perforator Flap Breast Reconstruction Technique at a Dedicated New Zealand Tertiary Plastic Surgery Unit: a Case Series Analysis

AbstractThe deep inferior epigastric perforator (DIEP) flap is the gold standard in post-mastectomy breast reconstruction. Improved patient outcomes, reduced operating time and reduced complication rates are reportedly observed over consecutive DIEP series within surgical centres. The aim of this study is to investigate whether outcomes following DIEP flap reconstruction improve over time, by assessing two patient cohorts undergoing the procedure at a microsurgical unit seven years apart. A case analysis was undertaken to identify all patients who underwent primary DIEP flap reconstruction in 2011 and 2018. Outcomes recorded included clinic appointments, operating time, number of primary operations, additional operations and procedures, along with co-morbidities, BMI and radiotherapy rates. Immediate versus delayed and unilateral versus bilateral breast reconstruction was also recorded. Seven patients underwent primary DIEP reconstruction in 2011 and 29 in 2018. There was a significant reduction in additional operations performed in 2018 (p-value = 0.007) and a significant reduction in number of procedures (p-value = 0.043). When adjusted for an outlier, the total operating time for unilateral DIEP reconstruction was significantly shorter in 2018 (p-value = 0.018), along with reduced primary and total operating time for 2018 bilateral reconstructions. The 2018 cohort also had lower complication rates and fewer clinic appointments. This study illustrates how outcomes can improve with experience of DIEP flap reconstruction. The more complex DIEP flap requires investment in terms of skill acquisition and operative time, but is balanced by improvement in patient outcomes.

The Impact of Kiwifruit Consumption on the Sleep and Recovery of Elite Athletes.

Poor sleep and resultant under-recovery can negatively impact training adaptations, increase the risk of injury and reduce subsequent performance. Due to the 'food first' approach adopted by many athletes, there is scope for investigation of 'functional food' based interventions (i.e., kiwifruit contains melatonin which plays a role in circadian rhythm regulation) designed to promote athlete recovery and/or enhance sleep quality and quantity. Following the baseline assessment (Week 1) all subjects began the intervention (Weeks 2-5). During the 4-week intervention, participants were asked to consume 2 medium-sized green kiwifruit (Actinidia Deliciosa) an hour before bed. Participants completed a questionnaire battery at baseline and post-intervention, and a daily sleep dairy for the duration of the study. The results demonstrated a positive impact of kiwifruit consumption on key aspects of sleep and recovery in elite athletes. From baseline to post-intervention, there were clinically significant improvements in sleep quality (i.e., improved PSQI global scores and sleep quality component scores) and improvements in recovery stress balance (reduced general stress and sports stress scales). Moreover, the intervention improved sleep as evidenced by significant increases in total sleep time and sleep efficiency % and significant reductions in number of awakenings and wake after sleep onset. The findings broadly suggested that kiwifruit does impact positively on sleep and recovery in elite athletes.

COVID-19 pandemic: Impact on the cardiac implantable electronic devices' implantation rates in Croatia.

Coronavirus disease 2019 (COVID-19) pandemic has influenced health-care organization worldwide, including management of non-communicable diseases. The aim of this study was to determine the impact of COVID-19 pandemic on cardiac implantable electronic devices' (CIEDs) implantation rates in Croatia. A retrospective, observational, national study was conducted. The data on CIEDs' implantation rates from 20 Croatian implantation centres, between January 2018 and June 2021, were extracted from the national Health Insurance Fund registry. Implantation rates before and after COVID-19 pandemic started, were compared. The overall numbers of CIED implantations in Croatia during COVID-19 pandemic were not different in comparison to 2 years pre-COVID-19 time (2618 vs. 2807, p = .081). The pacemaker implantation rates decreased significantly (by 45%) during April (122 vs. 223, p < .001) and May 2020 (135 vs. 244, p = .001), as well as during November 2020 (177 vs. 264, p = .003), but significantly increased during summer months 2020 comparing to 2018 and 2019 (737 vs. 497, p<0.001). The ICD implantation rates decreased significantly by 59% in April 2020 (26 vs. 64, p = .048). To the authors best knowledge this is a first study including complete national data on CIED implantation rates and COVID-19 pandemic impact. A significant reduction in number of both pacemaker and ICD implants during specific months of the COVID-19 pandemic was determined. However, afterwards compensation in implants resulted in similar total number when the complete year was evaluated.

Platelet Transfusions in a Multi-Neonatal Intensive Care Unit Health Care Organization Before and After Publication of the PlaNeT-2 Clinical Trial

To evaluate whether implementing more restrictive neonatal intensive care unit (NICU) platelet transfusion guidelines following the Platelets for Neonatal Transfusion - Study 2 randomized controlled trial (transfusion threshold changed from 50 000/μL to 25 000/μL for most neonates) was associated with fewer NICU patients receiving a platelet transfusion, without adversely affecting outcomes. Multi-NICU retrospective analysis of platelet transfusions, patient characteristics, and outcomes during 3 years before vs 3 years after revising system-wide guidelines. During the first period, 130 neonates received 1 or more platelet transfusions; this fell to 106 during the second. The transfusion rate was 15.9/1000 NICU admissions in the first period vs 12.9 in the second (P=.106). During the second period, a smaller proportion of transfusions was administered when the platelet count was in the 50 000-100 000/μL range (P=.017), and a larger proportion when it was <25 000/μL (P=.083). We also saw a fall in the platelet counts that preceded the order for transfusion from 43 100/μL to 38 000/μL (P=.044). The incidence of adverse outcomes did not change. Changing platelet transfusion guidelines in a multi-NICU network to a more restrictive practice was not associated with a significant reduction in number of neonates receiving a platelet transfusion. The guideline implementation was associated with a reduction in the mean platelet count triggering a transfusion. We speculate that further reductions in platelet transfusions can safely occur with additional education and accountability tracking.

Advances and critical assessment of machine learning techniques for prediction of docking scores

AbstractHere we present three distinct machine learning (ML) approaches (TensorFlow, XGBoost, and SchNetPack) for docking score prediction. AutoDock Vina is used to evaluate the inhibitory potential of ZINC15 in‐vivo and in‐vitro‐only sets towards the SARS‐CoV‐2 main protease. The in‐vivo set (59 884 compounds) is used for ML training (max. 80%), validation (5%), and testing (15%). The in‐vitro‐only set (174 014 compounds) is used for the evaluation of prediction capability of the trained ML models. Contributions to the prediction error are analyzed with respect to compounds' charge, number of atoms, and expected inhibitory potential (docking score). Methods for the prediction error estimation of new compounds are considered, yet critically rejected. The ML input weighted with respect to the desired property (i.e., low docking score) in the machine learning models shows to be a promising option to improve the ML performance. Proposed models provide significant reduction in number of intriguing compounds that need to be investigated.

Evaluation of the antinociceptive effect of valerian and hops combination in experimental animal models: Involvement of the opioid system

Pain is a common undertreated worldwide complaint. The need to explore the antinociceptive potential of alternative herbal products is essential. Although used as a mild sedative, limited evidence focused on the potential antinociceptive effect of valerian and hops combination. The present study was carried out to evaluate the in vivo anti-nociceptive effect of the valerian-hops combination to justify its use as an effective and safe analgesic agent. Anti-nociceptive effects of valerian-hops combination (50, 100, and 200 mg/kg) were assessed in swiss albino mice for performing the acetic acid-induced writhing test, the paw licking test using formalin, the paw licking test using glutamate, and the tail immersion test. The effects were compared to those of diclofenac or morphine in the presence or absence of the opioid receptor antagonist naloxone. Valerian-hops” extract of 100 and 200 mg/kg demonstrated a significant reduction in the number of writhing episodes induced by acetic acid compared to the control (p < 0.05), a significant reduction in the licking number at doses of 100 and 200 mg/kg in the late phase formalin-induced paw licking, significantly reduced the number of lickings after glutamate injection compared to control (p < 0.05). And significantly increased pain reaction after 60 and 90 min of tail immersion test, this effect was opposed by naloxone treatment. The valerian-hops combination produced a significant antinociceptive effect that involved the opioid system. Further studies are required to fully uncover the underlying active constituents and their mechanisms.

A VIRTUAL FRACTURE CLINIC AUDIT: ARE WALES MATCHING THE OUTCOMES IN ENGLAND?

IntroductionVirtual fracture clinics (VFC's) aim to reduce the number of outpatient appointments while improving the clinical effectiveness and patients experience through standardisation of treatment pathways. With 4.6% of ED admissions due to trauma the VFC prevents unnecessary face to face appointments providing a cost savings benefit to the NHS.MethodsThis project demonstrates the importance of efficient VFC process in reducing the burden on the fracture clinics. We completed preformed a retrospective cross-sectional study, analysing two cycles in May (n=305) and September (n=332) 2021. We reviewed all VFC referrals during this time assessing the quality of the referral, if they went on to require a face to face follow up and who the referring health care professional was. Following the cycle in May we provided ongoing education to A&amp;E staff before re-auditing in September.ResultsBetween the two cycles there was an average 19% improvement in quality of the referrals, significant reduction in number of inappropriate referrals for soft tissue knee and shoulder injuries from 15.1% (n=50) to 4.5% (n=15) following our intervention. There was an 8% increase in number of fracture clinic appointments to 74.4% (n=247), primarily due to an increase number of referrals from nurse practitioners. Radial head fractures were targeted as one group that were able to be successfully managed in VFC, despite this 64% (n=27) of patients were still seen in the outpatient department following VFC referral.ConclusionDespite the decrease in the number of inappropriate referrals, and the increase in quality of referrals following our intervention. The percentage of VFC referrals in CAVUHB is still higher than other centres in with established VFCs in England. This possibly highlights the need for further education to emergency staff around describing what injuries are appropriate for referral, specifically soft tissue injuries and radial head fractures. In order to optimise the VFC process and provide further cost savings benefits while reducing the strain on fracture clinics.

Urethral Pain Syndrome: Treatment with Oxygen and Hyaluronic Acid

AIM: The aim of our clinical study has been to evaluate the efficacy of the association between high concentration oxygen and hyaluronic acid (HA) for the treatment of urethral pain syndrome (UPS). MATERIALS AND METHODS: Twenty women (45–65 years old) with suspected UPS diagnosis appealing to our Second Opinion Medical Consultation Network signed an informed consent form and were treated with oxygen/HA therapy treatment, 7 times a week, for a total of 5 weeks at the outpatient clinic (Clinic Ester Veronesi, Modena, Italy).The physicians of the Second Opinion Network followed up weekly from remote (WhatsApp, Skype) each treated patient as to state the effectiveness, tolerability, and side effects of the treatment. RESULTS: We observed significant reductions in number of urgency urinary incontinence (−25.37 vs. −12.01 mean value), nocturia episodes (−24.01 vs. −11.23 mean value), volume voided in each micturition (−127.79 vs. −98.20 mean value), and micturitions per 24 h (−44.01 vs. −20.12 mean value). Analyses of the pre- and post-treatment scores showed a statistically significant improvement in Vaginal assessment scale, pain urgency frequency, and patient perception of bladder condition scale scores (p &lt; 0.0305, p &lt; 0.0001, and p &lt; 0.0001, respectively). No side effects associated with the treatment were reported by the patients. CONCLUSIONS: We can highlight that Caressflow® is effective and very well tolerated in UPS syndrome: The oxygen flow mixed with HA gives immediately a sense of freshness and urethro-bladder relaxation that lasts several hours. Further studies including larger sample sizes, placebo, and or challenge with other local and systemic treatments and different administration schedules versus longer follow-up are recommended.

Reduced Number and Immune Dysfunction of CD4+ T Cells in Obesity Accelerate Colorectal Cancer Progression

Obesity, a known risk factor for various types of cancer, reduces the number and function of cytotoxic immune cells in the tumor immune microenvironment (TIME). However, the impact of obesity on CD4+ T cells remains unclear. Therefore, this study aimed to clarify the impact of obesity on CD4+ T cells in the TIME. A tumor-bearing obese mouse model was established by feeding with 45% high-fat diet (HFD), followed by inoculation with a colon cancer cell line MC38. Tumor growth was significantly accelerated compared to that in mice fed a control diet. Tumor CD4+ T cells showed a significant reduction in number and an increased expression of programmed death-1 (PD-1), and decreased CD107a expression and cytokine such as IFN-γ and TNF-α production, indicating dysfunction. We further established CD4+ T cell-depleted HFD-fed model mice, which showed reduced tumor infiltration, increased PD-1 expression in CD8+ T cells, and obesity-induced acceleration of tumor growth in a CD4+ T cell-dependent manner. These findings suggest that the reduced number and dysfunction of CD4+ T cells due to obesity led to a decreased anti-tumor response of both CD4+ and CD8+ T cells to ultimately accelerate the progression of colorectal cancer. Our findings may elucidate the pathogenesis for poor outcomes of colorectal cancer associated with obesity.

Condom Use Behaviors, Risk Perception, and Partner Communication Following Oral HIV Self-testing Among Adolescents and Young Adults in Kenya: A Cohort Study.

HIV self-testing (HIVST) can improve testing completion among adolescents and young adults (AYA), although its influence on sexual behaviors is unclear. We evaluated whether HIVST was associated with changes in talking with sexual partners about HIVST, condom use, and HIV risk perception among AYA ages 15-24years in a study of HIVST distribution through homes, pharmacies, and nightclubs in Nairobi, Kenya. All participants had negative HIVST results. Regression models were used to evaluate changes between pre-HIVST and 4months post-HIVST. Overall, there was a significant increase in talking with sexual partners about HIVST. There was a significant reduction in number of condomless sex acts among AYA recruited through pharmacies and homes. Unexpectedly, among females, there was a significant decrease in consistent condom use with casual partners. HIVST services for AYA may benefit from including strategies to support condom use and partner communication about self-testing adapted to specific populations and partnerships.