Triad Group Research Articles

Analysis of clinical features of 193 Chinese patients with McCune-Albright syndrome through a literature review

To retrospectively analyze the clinical characteristics of 193 Chinese patients with McCune-Albright syndrome (MAS). By using keywords "McCune-Albright syndrome", "Albright syndrome", or " fibrous dysplasia " as the search terms, 193 cases of MAS reported in China from January 1990 to November 2022 from the Wanfang data, CNKI, VIP, PubMed, and Embase databases were obtained, and their clinical data was retrospectively analyzed. Intergroup comparisons were carried out by using t test, Mann-Whitney U test, and X2 test. The 193 MAS patients had included 42 males and 151 females, with the median first-visit age of females being younger than males. The typical triad group had accounted for 46.1% of patients, and the middle first-visit and diagnosis age was younger than the atypical group. The primary reason for first-visit in males of MAS was fibrous dysplasia (FD), whilst that in females of MAS was peripheral precocious puberty (PPP). FD has occurred in 84.5% of the patients, with an average age of onset age being 6.1 years old, and 90% was ≤ 16 years of age. Endocrine hyperfunction was found in 79.3% of the patients, with a higher proportion in females compared with males (P < 0.05). Pituitary involvement was seen in 21.8% of the patients, and the incidence of craniofacial FD and cranial nerve compression was significantly higher in those with elevated growth hormone (GH) than without (P < 0.05). Café-au-Lait Spots were noted in 86.5% of the patients, and 28.3% (28/99) had located on the different side of FD. Most MAS patients had atypical manifestations and multi-systemic involvement. It is more common and occurs earlier in females. The most common reasons for initial diagnosis in male and female patients were FD and PPP, respectively. Patients with elevated GH should be examined for cranial nerve compression.

Acute cholecystitis, obesity, and steatohepatitis constitute the lethal triad for bile duct injury (BDI) during laparoscopic cholecystectomy.

The most feared complication during laparoscopic cholecystectomy remains a bile duct injury (BDI). Accurately risk-stratifying patients for a BDI remains difficult and imprecise. This study evaluated if the lethal triad of acute cholecystitis, obesity, and steatohepatitis is a prognostic measure for BDI. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) registry was performed. All laparoscopic cholecystectomy cases within the main NSQIP database for 2012-2019 were queried. Two study cohorts were constructed. One with the lethal triad of acute cholecystitis, BMI ≥ 30, and steatohepatitis. The other cohort did not have the full triad present. Multivariate analysis was performed via logistic regression modeling with calculation of odds ratios (OR) to identify independent factors for BDI. An uncontrolled and controlled propensity score match analysis was performed. A total of 387,501 cases were analyzed. 36,887 cases contained the lethal triad, the remaining 350,614 cases did not have the full triad. 860 BDIs were identified resulting in an overall incidence rate 0.22%. There were 541 BDIs within the lethal triad group with 319 BDIs in the other cohort and an incidence rate of 1.49% vs 0.09% (P < 0.001). Multivariate analysis identified the lethal triad as an independent risk factor for a BDI by over 15-fold (OR 16.35, 95%CI 14.28-18.78, P < 0.0001) on the uncontrolled analysis. For the controlled propensity score match there were 29,803 equivalent pairs identified between the cohorts. The BDI incidence rate remained significantly higher with lethal triad cases at 1.65% vs 0.04% (P < 0.001). The lethal triad was an even more significant independent risk factor for BDI on the controlled analysis (OR 40.13, 95%CI 7.05-356.59, P < 0.0001). The lethal triad of acute cholecystitis, obesity, and steatohepatitis significantly increases the risk of a BDI. This prognostic measure can help better counsel patients and potentially alter management.

A metro smart card data-based analysis of group travel behaviour in Shanghai, China

Group travel behaviour widely exists in cities, but has not been well investigated by researchers. To fill this gap, this paper develops a co-existence-based methodological framework to systematically explore the spatiotemporal characteristics of group travel behaviour. We apply our framework to a case study of Shanghai, China, using a one-month tranche of metro smart card data. Results show that most travellers perform a small number of group trips, together with a small number of co-travellers. They usually travel in a dyad or triad group and form far more small social communities than large ones. Group travel behaviour is distinctly different from individual travel in terms of both time and space: group travellers are more likely to travel during weekends, on holidays, and in the afternoons and evenings. They also prefer to perform group behaviour near stations located in the city centre or the centres of new towns in suburban areas, and close to attractions and public facilities. The analysis we present has various potential applications such as improving the management of public events and supporting the design of group ticket policy.

Forest Gardening on Abandoned Agricultural Land Contribute to Ground Cover Change and Food Security

Various forest products such as nuts, mangoes, bananas, lime, silk from mulberry leaves,essential oil, timber, animal food, perfume from tree blossoms, mulch and biochar, possess high potential to increase rural income. However, farming families in Nepal can hardly afford the investment to create such productive ecosystems. Connecting to the global market through Carbon dioxide (CO2)– certificates could serve to finance the creation of forest gardens. To test and demonstrate such approach, a project on ‘building village economies through climate farming and forest gardening (BeChange)’ has been implemented by 276 farming families in fourdistricts (Tanhun, Lamjung, Gorkha and Kaski) of Nepal. Using Global Positioning System (GPS) point survey, household surveys, focus group discussions (FGDs), a triad group system, field observation and reports, the success of establishing privately owned forest gardens was assessed. A total of 42,205 mixed tree species such as Michelia, Elaeocarpus, and Cinnamomum tamala were planted on abandoned agriculture land of 276 families. The set-up and maintenance of the forest gardens was financed with advanced payments for the carbon sink services of the planted trees. Farmers who succeeded with tree survival rates above 70 per cent received anadditional yearly carbon sink fee. This activity was linked to other income generating activities such as cultural eco-tourism, cinnamon leaf essential oil distillation, and intercropping of high value shade loving crops such as ginger, turmeric, and lentils. The outcomes of the project show significant improvements of the livelihood and food security in the project villages.

Does group size matter during collaborative skills learning? A randomised study.

BackgroundCollaborative skills learning in the form of dyad learning compared with individual learning has been shown to lead to non‐inferior skills retention and transfer. However, we have limited knowledge on which learning activities improve collaborative skills training and how the number of collaborators may impact skills transfer. We explored the effects of skills training individually, in dyads, triads or tetrads on learning activities during training and on subsequent skills transfer.MethodsIn a randomised, controlled study, participants completed a pre‐post‐transfer‐test set‐up in groups of one to four. Participants completed 2 hours of obstetric ultrasound training. In the dyad, triad and tetrad group participants took turns actively handling the ultrasound probe. All performances were rated by two blinded experts using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale and a Global Rating Scale (GRS). All training was video recorded, and learning activities were analysed using the Interactive‐Constructive‐Active‐Passive (ICAP) framework.ResultsOne hundred one participants completed the simulation‐based training, and ninety‐seven completed the transfer test. Performance scores improved significantly from pre‐ to post‐test for all groups (p < 0.001, ηp2 = 0.55). However, group size did not affect transfer test performance on OSAUS scores (p = 0.13, ηp2 = 0.06) or GRS scores (p = 0.23, ηp2 = 0.05). ICAP analyses of training activities showed that time spent on non‐learning and passive learning activities increased with group size (p < 0.001, ηp2 = 0.31), whereas time spent on constructive and interactive learning activities was constant between groups compared with singles (p < 0.001, ηp2 = 0.72).ConclusionCollaborative skills learning in groups of up to four did not impair skills transfer despite less hands‐on time. This may be explained by a compensatory shift towards constructive and interactive learning activities that outweigh the effect of shorter hands‐on time.

Pancreatic cancer risk to siblings of probands in bilineal cancer settings

PurposePancreatic cancer (PC) risk is increased in families, but PC risk and risk perception have been understudied when both parents have cancer. MethodsAn unbiased method defining cancer triads (proband with PC and both parents with cancer) in a prospective registry estimated risk of PC to probands’ siblings in triad group 1 (no parent with PC), group 2 (1 parent with PC), and group 3 (both parents with PC). We estimated standardized incidence ratios (SIRs) using a Surveillance, Epidemiology, and End Results (SEER) reference. We also estimated the risk when triad probands carried germline pathogenic/likely pathogenic variants in any of the 6 PC-associated genes (ATM, BRCA1, BRCA2, CDKN2A, MLH1, and TP53). PC risk perception/concern was surveyed in siblings and controls. ResultsRisk of PC was higher (SIR = 3.5; 95% CI = 2.2-5.2) in 933 at-risk siblings from 297 triads. Risk increased by triad group: 2.8 (95% CI = 1.5-4.5); 4.5 (95% CI = 1.6-9.7); and 21.2 (95% CI = 4.3-62.0). SIR in variant-negative triads was 3.0 (95% CI = 1.6-5.0), whereas SIR in variant-positive triads was 10.0 (95% CI = 3.2-23.4). Siblings’ perceived risk/concern of developing PC increased by triad group. ConclusionSibling risks were 2.8- to 21.2-fold higher than that of the general population. Positive variant status increased the risk in triads. Increasing number of PC cases in a triad was associated with increased concern and perceived PC risk.

The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury

BackgroundChest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury. MethodsPatients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality. ResultsA total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%). ConclusionsLethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic “lethal triad”, there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality.

Social disruption-induced stress pre-exposure aggravates, while the presence of conspecifics diminishes, acetic acid-induced writhing.

This study was undertaken to assess the modulating effects of (1) pre-exposure to repeated social disruption and (2) group testing on writhing associated with visceral pain induced by intraperitoneal administration of acetic acid. Six consecutive days of social disruption were used to prime for stress, while group testing referred to 3 mouse cage-mates receiving the acetic acid-induced writhing test as a group. Social disruption-induced stress-pre-exposed mice displayed a greater number acid-induced writhes compared to mice not receiving the pre-exposure. However, mice displayed fewer acid-induced writhes in a triad group vs. individually, suggesting group-mediated writhing-reducing effects. Likewise, group testing prevented the stress pre-exposure escalation in acid-induced writhes. Additional studies revealed that the stress-pre-exposed mice had increased expression in accumbal TRPV1 receptors. Systemic (0.25mg/kg) and bilateral intra-accumbal (0.2ng/0.2µl/side) administration of SB366791, a TRPV1 receptor antagonist, reliably prevented the stress pre-exposure escalation in acid-induced writhing; SB366791 treatment alone did not affect acid-induced writhing, stress pre-exposure anxiety-like behavior, or the group testing effects. Furthermore, lower neuronal activation was found in the medial septal nucleus in group vs. individual tested mice. Intra-medial septum (0.2µg/0.5µl) infusion with bicuculline, a GABAA receptor antagonist, effectively prevented group-mediated writhing-reducing effects, but not individual acid-induced writhing effects. These findings suggest that social disruption-induced stress pre-exposure may upregulate accumbal TRPV1 receptor expression and consequently aggravate acid-induced writhing. Group testing prevents such stress pre-exposure escalation of acid-induced writhing most likely by strengthening the GABAergic inhibition on local neural activity in the medial septum.

A proinflammatory marker in chronic rhinosinusitis: serum calprotectin.

Studies have shown that calprotectin has a strong pro-inflammatory effect. Elevated calprotectin levels in the serum can be used as a strong clinical marker indicating the presence of inflammation. To investigate serum calprotectin levels in patients with chronic rhinosinusitis (CRS) and to determine the applicability of calprotectin as a potential molecular pro-inflammatory biomarker for CRS. The study consisted of three groups: chronic rhinosinusitis with polyps (CRSwNP group), chronic rhinosinusitis without polyps (CRSwoNP), and healthy control. CRS patients with polyps were further divided into two groups depending on the presence/absence of Samter's triad. The Nose Obstruction Symptom Evaluation (NOSE) scale score and serum calprotectin value were evaluated in all participants. The mean serum calprotectin value was 79.5±11.8 ng/ml for the CRSwNP group, 71.3±16 ng/ml for the CRSwoNP group, and 61.9±11.6 ng/ml for the control group (p<0.001). The Samter's triad group had a significantly higher calprotectin value than the non-Samter's triad group (p=0.03). There was a significant correlation between the NOSE scores and calprotectin levels (rho=0.734, p<0.001). Serum calprotectin values were correlated with the severity of symptoms in patients with CRS; thus, it seems to be a valuable pro-inflammatory biomarker for the diagnosis of the disease and determining its severity. Further studies with larger series are needed to evaluate the preoperative and postoperative serum calprotectin values ​​in patients undergoing surgery.

Computed Tomography Findings in Patients with Samter's Triad: An Observational Study.

Samter’s Triad is a disorder characterized by chronic rhinosinusitis (CRS) with nasal polyps (NPs), asthma, and intolerance to cyclooxygenase-1 inhibitors. However, there have been no studies investigating the prediction of Samter’s Triad using imaging findings. Therefore, the authors aimed to investigate whether there is a difference in computed tomography (CT) findings between patients who have CRS with NPs and those with Samter’s Triad. Patients were classified into a CRS group and a Samter group. Opacification was measured using data from CT scans by scoring each sinus on a numerical rating scale ranging from 0 to 4. The opacification scores of the ethmoid and frontal sinuses were significantly higher in the Samter’s Triad group. Furthermore, Samter’s Triad was more common in patients who scored ≤ 2 for maxillary opacification (7/16) than in those who scored ≥3 (4/45, p=0.005). Patients with Samter’s Triad exhibited a tendency toward higher opacification scores for the ethmoid and frontal sinuses, with a relatively lower opacification score for the maxillary sinus. These findings could be helpful in distinguishing patients with Samter’s Triad from those who have CRS with NPs, and to plan treatment strategies without having to perform additional laboratory or radiological tests.

Combination of CT mulitplane 3D reconstruction, radial endobronchial ultrasound and rapid on-site evaluation for diagnosing peripheral solitary pulmonary nodules

Objective: To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN). Methods: A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017. According to different methods, all the patients were divided into four groups: EG (i.e. R-EBUS+Guiding sheath (GS))group, CTE (i.e. CT-3DR+R-EBUS) group, RE (i.e. ROSE+R-EBUS) group, and triad (i.e. CT-3DR+ROSE+R-EBUS) group. Sampling was performed by transbronchial lung biopsy. The diagnostic yield and complications, procedure time and influencing factors in these four groups were retrospectively analyzed. The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated. Results: The diagnostic yield for total SPNs among four groups were 70.5% in EG group, 70.0% in CTE group, 69.0% in RE group and 74.0% in triad group, respectively. There was no significant difference among four groups (all P>0.05). The procedure time of EG group, CTE group, RE group and triad group were (34.0±6.3), (26.6±6.8), (27.2±7.8) and (19.4±5.4) min, respectively. The procedure time was the shortest in triad group compared with the other three groups (all P<0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P<0.001). The coincidence rates of CT-3DR navigation position with target bronchus were 87.5% in CTE group and 90.0% in triad group with no significant difference between these two groups (P>0.05). The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter<2 cm in all four groups (all P<0.05). The positive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P<0.05). In EG and RE groups, for those SPNs with the distance between the lesion and pleura≥2 cm, the diagnostic yield were higher than those withe the distance<2 cm (P<0.05) but no similar phenomenon was observed in CTE and triad groups. No significant correlation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P>0.05). ROSE was used in RE and triad groups. The coincidence rate of ROSE with histopathology was 82.6% and the value of Kappa was 0.608. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of ROSE were 0.818, 0.846, 0.931 and 0.647, respectively. Conclusions: CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN. Combination of CT-3DR, R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.

Group work as the way of organising and motivating students

The article is devoted to the analysis of group work as specific way of organizing students at all the stages of an English lesson. Various kinds of group work are taken into consideration as alternative to the traditional teaching format. They are described as the form of work designed for motivating students, encouraging their active participation, use of imagination, creativity and cooperation between a teacher and learners. It is shown that well-organised group work is the essential component of role playing activities. The types of group format, introduced by N. Mcclver, are taken into consideration. The peculiarities of pair work are revealed. Such group format may be used in groups where there are discipline problems. Triad group format is analyzed as the alternative to pair work. The role play activities designed for pairs and triads are introduced. It is proved that short role playing exercises can be especially helpful. Group format Pyramid can be an excellent way of practicing the language of persuasion and having discussion. It is shown that activities of interview type can be successfully organized by means of a pyramid group format. It is proved that in the foreign language classroom interviews are useful because they force students to listen carefully, to practice new grammar structures as well as recycle vocabulary. Interviews give students the opportunity to improve their general knowledge and to be able to communicate on various subjects. Pairs and triads can be easily transformed into group format Pyramid, which requires participation of at least eight students. It is shown that group format Mingles is considered to be the most challenging and the most effective type of group work. It requires much preparation and greater workload from the teacher. It is proved that Mingles group format is fruitful for advanced learners as activities, organized by means of this format can occupy a lot of time and require acting skills. The use of all types of group format is aimed at creating relaxed and friendly atmosphere in a foreign language class. It is pointed out that Pyramid and Mingles group formats usually require more preparation than work in pairs and Triads format. Pyramids and Mingles group formats make use of variety of techniques and contribute to the development of group feeling that helps the teacher to motivate students and to create happy learning environment. The interactive exercises offered in the article are easily adaptable to different group format and different learners` needs.

Early Clinical Outcomes of Tricuspid Ring Annuloplasty Using the New Three-dimensional Annuloplasty Ring, Tri-Ad

We evaluated the early clinical outcomes of tricuspid ring annuloplasty using the Tri-Ad ring and compared the results of the Tri-Ad ring with those of MC3 ring, a widely used three-dimensional (3D) ring. From 2007 to 2017, 227 patients underwent tricuspid ring annuloplasty (TAP) for functional tricuspid regurgitation using the new 3D ring, Tri-Ad. In total, 191 patients underwent TAP with a MC3 ring and 36 patients underwent TAP with a Tri-Ad ring. Tri-Ad rings have been used since January 2015. Propensity score-matched analysis was performed (n = 36 in each group). Mean ± SD duration of follow-up was 67 ± 37 months. Operative mortality occurred in nine patients and postoperative complications in 39, which included atrial fibrillation (n = 9), low cardiac output syndrome (n = 15), and bleeding requiring reoperation (n = 15). There were no significant differences in operative mortality and postoperative complications (p = .650 and p = .423, respectively). In the Tri-Ad group, both tricuspid regurgitation grade and systolic pulmonary artery pressure significantly decreased compared with its preoperative values in predischarge echocardiography (from 2.00 ± 1.19 mmHg to 1.17 ± 0.81 mmHg [p < .001] and from 43.11 ± 13.21 mmHg to 38.58 ± 8.61 mmHg [p < .001], respectively). There were no ring-related complications, such as atrioventricular block or ring dehiscence during follow-up in Tri-Ad group. In matched patients, there were no significant differences in in-hospital mortality, postoperative complications, or tricuspid valve-related events (p = .310, p = .502, and p = .1.00, respectively). The Tri-Ad ring, a new 3D ring, showed comparable early clinical outcomes and echocardiographic results to the MC3 ring. However, a long-term follow-up study is required to confirm the safety and efficacy of this new device.

Incidencia de una estrategia comunicativa en el fortalecimiento de las competencias del emprendimiento en estudiantes de quinto grado

En el presente artículo se documentan los aspectos más relevantes de un trabajo de investigación que buscó analizar la influencia de una estrategia comunicativa en el fortalecimiento de las competencias en emprendimiento de los estudiantes de quinto grado del colegio Panamericano IED. El estudio utiliza un enfoque de investigación mixto cuali-cuantitativo que usa como instrumentos de recolección de información una prueba estandarizada, encuesta tipo Likert, cuestionario con validación semántica y diarios de campo. Se realizó en el período marzo–noviembre de 2015, con una muestra de 25 estudiantes en edades de 10 a 14 años, que corresponden al 45% de la población, quienes pertenecen a los estratos 1, 2 y 3, de la ciudad de Bogotá. La investigación también se propuso determinar la relación existente entre competencias comunicativas, desarrollo del emprendimiento y herramientas neuropedagógicas tricerebrales. Dentro de los resultados se determinó que los estudiantes tienen mejor desarrollo de las competencias interpretativa y propositiva, mientras que en la competencia argumentativa existen dificultades relacionadas con la construcción de proposiciones que soporten y apoyen ideas centrales. En cuanto al emprendimiento, se evidencia que los estudiantes pueden ser buenos emprendedores y que tienen el perfil de un emprendedor, por lo que se hace importante potenciar las competencias en emprendimiento. También se concluyó que la estrategia comunicativa permitió fortalecer en el grupo la triada cerebral para nivelar los elementos del saber, hacer y ser.

A family based triad study evaluating the role of MTHFR gene polymorphisms in spontaneous abortions

ObjectiveTo explore the combined association of MTHFR gene polymorphisms (C677T, A1298C) with spontaneous abortions in a triad group from Telangana State of South Indian population. MaterialsA total of 80 case families with spontaneous abortions and 100 control families with medically terminated pregnancies were considered. Fetal tissue with <20weeks of gestational age and peripheral blood from their respective parents were collected. MethodsDNA was isolated by phenol-chloroform method from both tissue and peripheral blood samples and then genotyped using Amplification Refractory Mutation System–Polymerase Chain Reaction followed by agarose gel electrophoresis. Genotype and allelic frequencies of MTHFR polymorphisms were determined by Odds Ratio with 95% Confidence Intervals and level of significance was considered at p value<0.05. The mRNA secondary structures were predicted and the transcription factor binding sites were determined. ResultsStatistically significant association was observed with 677C/T polymorphism in case fetal (p=0.006), maternal (p<0.001) and paternal (p=0.03) groups compared to their respective control groups. A significant difference in the genotypic distribution of 1298 A/C polymorphism was observed only in the maternal group (p=0.005) compared to controls. The combined frequencies of 677TT/1298AC genotypes revealed a significant association with an increased risk in all the case triad groups compared to their respective controls. The in silico analysis revealed the structural change and transcription factor binding site deviations in the variant allele compared to wild type allele in the mRNA regulation of MTHFR protein. ConclusionThe present study supports the major role of MTHFR gene polymorphisms in the etiology of spontaneous abortions.

An evaluation of a leadership development coaching and mentoring programme

PurposeThe purpose of this paper was to determine the value and impact of the Leadership Development – Coaching and Mentoring Programme at Counties Manukau Health and understand how the skills gained are applied.Design/methodology/approachMixed-methods approach including surveys of programme participants and senior staff and semi-structured interviews with programme participants.FindingsThe survey response rate was 24.4 per cent for programme participants and 30 per cent for senior staff. Eight programme participants participated in semi-structured interviews. Of the 70 programme participants, 69 utilised their learning from the programme; 45 of 70 changed their approach to managing staff; and 40 of 68 programme participants reported that meeting with peers for triad group coaching was the most challenging aspect of the programme. Key themes identified through interviews included: working with others; not owning others’ problems; professional support and development; coaching and mentoring; future participants.Practical implicationsThe majority of participants changed their leadership behaviours as a result of the programme, which has resulted in improved communication, a more supportive culture and distributed leadership. These changes contribute to better patient care.Originality valueThere is a paucity of evidence in the literature about the impact of coaching and mentoring programme on leadership development and how the skills gained in such programmes are applied in practice in a healthcare context. This evaluation helps to address that gap.

Expressions of miR-30c and let-7a are inversely correlated with HMGA2 expression in squamous cell carcinoma of the vulva.

Malignant tumors of the vulva, most of them squamous cell carcinomas, account for only 5% of cancers of the female genital tract. Though little is known about the genetic features of these tumors, the Fragile Histidine Triad (FHIT) and High Mobility Group AT-hook 2 (HMGA2) genes were found deregulated. We wanted to gain more knowledge about the expression of HMGA2-related miRNAs such as miR-30c and let-7a, and whether a correlation exists between the expression of FHIT and HMGA2, in this tumor type. An inverse correlation was found in-as-much as HMGA2 was highly expressed (mean fold change 8.8) whereas miR30c and let-7a were both downregulated (mean fold change -3.9 and -2.3, respectively). The consistent overexpression of HMGA2 found in all tumors adds to the likelihood that this gene is of importance in SCC pathogenesis. Moreover, we came to the conclusion that miRNAs may be the cause of the deregulation of HMGA2. Our results also show that SCC of the vulva presents a characteristic molecular pattern with FHIT being downregulated whereas HMGA2 is upregulated.

Ankle Arthroscopy, Lateral Ligament Repair and Peroneal Tendon Reefing for Chronic Lateral Ankle Instability: The Triad vs Arthroscopy with Ligament Repair

Peroneal tendon and retinacular pathology contributes to chronic lateral ankle instability. The “gold standard” surgical treatment for chronic lateral ankle instability has been the Brostrom-Gould procedure with its modifications. An ankle arthroscopy is an adjuvant procedure to address any intra-articular pathology. We review our results of two study groups. The first group underwent an ankle arthroscopy and a Brostrom-Gould procedure. The second group (triad) underwent an ankle arthroscopy, the Brostrom-Gould procedure and excision of low lying peroneal muscle belly with tightening of the inferior peroneal retinaculum. The triad technique was performed on 97 patients and results compared to 71 ankle arthroscopies with the Brostrom-Gould procedure. The patients were contacted at a mean follow-up time of 30 months for postoperative ACFAS scores, VAS scores, and overall satisfaction. Patients were also asked to report incidence of ankle sprain recurrence. The average postoperative ACFAS hindfoot and ankle score was 92 for the triad group and 89 for the arthroscopic debridement and Brostrom-Gould group. The average overall satisfaction was 98% in the triad group and 91% in the scope and Brostrom group. There were 4 (4.3%) recurrences in the triad group and 12 (17.6%) in the Brostrom-Gould with scope group. Each group had a similar incidence of wound healing complications. Peroneal tendon and retinacular pathology contributes to continued ankle instability and pain. We believe that the triad procedure is superior to the Brostrom-Gould procedure.

Transforming care through leadership and research alignment

Transforming care through leadership and research alignment

Aspirin sensitivity does not compromise quality‐of‐life outcomes in patients with samter's triad

To demonstrate that quality-of-life outcomes after endoscopic sinus surgery are not compromised in patients with Samter's triad (asthma, nasal polyps, aspirin sensitivity) when compared to patients with eosinophilic chronic rhinosinusitis with nasal polyposis (eCRSwP) who are not aspirin sensitive. Retrospective review of prospectively collected data. Thirty-two patients with Samter's triad were identified from a prospectively collected patient database from 2003 to 2012. Preoperative and postoperative symptom and endoscopy scores were compared to those of 37 consecutive patients with eCRSwP who were not aspirin sensitive (control). Student t test and Fisher exact test were used to examine for differences between the two groups. Symptom scores were assessed using the 20-item Sino-Nasal Outcome Test (SNOT-20). Endoscopy findings were scored according to the Lund-Kennedy methodology. Samter's triad patients had significantly worse disease preoperatively when compared to the control group: SNOT-20 (31.1 vs. 22.1, P = .004), endoscopy score (10.9 vs. 7.6, P = .0005), and Lund-Mackay computed tomography score (18.9 vs. 13.9, P = .0001). Although postoperative endoscopy scores remained worse in the Samter's triad group, postoperative SNOT-20 scores were comparable to those of the control group at ≥ 3 years follow-up (22.8 vs. 17.3, P = .43). Although Samter's triad patients present with more severe disease and are more likely to undergo revision surgery, they have postoperative quality-of-life outcomes that are comparable to patients with eCRSwP who are not aspirin sensitive. This is the first study to utilize a disease-specific, validated outcomes instrument in comparing Samter's triad patients with aspirin-tolerant patients who have nasal polyposis and tissue eosinophilia.