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Heliyon Jun 2024Cluster of differentiation 38 (CD38) has been found to be highly expressed in various solid tumours, and its expression level may be associated with patient prognosis...
BACKGROUND
Cluster of differentiation 38 (CD38) has been found to be highly expressed in various solid tumours, and its expression level may be associated with patient prognosis and survival. This study aimed to evaluate the prognostic value of CD38 expression for patients with epithelial ovarian cancer (EOC) and construct two computed tomography (CT)-based radiomics models for predicting CD38 expression.
METHODS
A total of 333 cases of EOC were enrolled from The Cancer Genome Atlas (TCGA) database for CD38-related bioinformatics and survival analysis. A total of 56 intersection cases from TCGA and The Cancer Imaging Archive (TCIA) databases were selected for radiomics feature extraction and model construction. Logistic regression (LR) and support vector machine (SVM) models were constructed and internally validated using 5-fold cross-validation to assess the performance of the models for CD38 expression levels.
RESULTS
High CD38 expression was an independent protective factor (HR = 0.540) for overall survival (OS) in EOC patients. Five radiomics features based on CT images were selected to build models for the prediction of CD38 expression. In the training and internal validation sets, for the receiver operating characteristic (ROC) curve, the LR model reached an area under the curve (AUC) of 0.739 and 0.732, while the SVM model achieved AUC values of 0.741 and 0.700, respectively. For the precision-recall (PR) curve, the LR and SVM models demonstrated an AUC of 0.760 and 0.721. The calibration curves and decision curve analysis (DCA) provided evidence supporting the fitness and net benefit of the models.
CONCLUSIONS
High levels of CD38 expression can improve OS in EOC patients. CT-based radiomics models can be a new predictive tool for CD38 expression, offering possibilities for individualised survival assessment for patients with EOC.
PubMed: 38948050
DOI: 10.1016/j.heliyon.2024.e32910 -
Heliyon Jun 2024For approximately 1.5 million healthcare practitioners working and registered within the United Kingdom there exists a mandatory requirement to undertake Continued...
BACKGROUND
For approximately 1.5 million healthcare practitioners working and registered within the United Kingdom there exists a mandatory requirement to undertake Continued Professional Development. Internationally, healthcare Continued Professional Development is fundamental for frontline staff to practice safely, effectively and maintain up to date skills combined with knowledge. A generally accepted purpose for these regulations is to help nurses and midwives maintain an updated skill set to care for patients safely and competently. This qualitative paper presents the findings from the first phase of, "Converting Willingness to Engagement" project conducting focus groups and interviews with stakeholder nurses in England, UK. This study used a phenomenological approach to draw on the lived experiences of the nurse participants who organise, manage and budget Continued Professional Development activities.
OBJECTIVES
To explore ways to capture and retain nursing staff in postgraduate training and education to facilitate professional advancement, maintenance of registration and improve patient care.
DESIGN
Phase one involved a series of qualitative online (virtual) focus group discussions and interviews with stakeholder nurses who commission Continued Professional Development.
SETTINGS
A series of online (virtual) focus group discussions and interviews were then conducted between February and May 2021.
METHODS
A purposive sample was identified consisting of clinical service leads, advanced practitioners and matrons involved in workforce development as stakeholders.
RESULTS
Three key themes were identified; the role of the healthcare providers in staff development, staff support provision requirements, and the university's provision including Continued Professional Development.
CONCLUSION
Partnership working allows academic partners in universities and healthcare institutions to support nurses in their endeavors to maintain their registrations, develop professionally through further education and Continued Professional Development.
PubMed: 38948029
DOI: 10.1016/j.heliyon.2024.e32582 -
World Journal of Clinical Pediatrics Jun 2024Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings... (Review)
Review
Apart from listening to the cry of a healthy newborn, it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents. The global incidence of children born with congenital anomalies has been reported to be 3%-6% with more than 90% of these occurring in low- and middle-income group countries. The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons. These children are operated under several surgical disciplines, viz, paediatric-, plastic reconstructive, neuro-, cardiothoracic-, orthopaedic surgery . These conditions may be life-threatening, , trachea-oesophageal fistula, critical pulmonary stenosis, . and require immediate surgical intervention. Some, , hydrocephalus, may need intervention as soon as the patient is fit for surgery. Some, , patent ductus arteriosus need 'wait and watch' policy up to a certain age in the hope of spontaneous recovery. Another extremely important category is that of patients where the operative intervention is done based on their age. Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery (many as multiple stages of correction) at appropriate ages. There are advantages and disadvantages of intervention at different ages. In this article, we present a review of optimal timings, along with reasoning, for surgery of many of the common congenital anomalies which are treated by plastic surgeons. Obstetricians, paediatricians and general practitioners/family physicians, who most often are the first ones to come across such children, must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.
PubMed: 38947997
DOI: 10.5409/wjcp.v13.i2.90583 -
Contemporary Clinical Trials... Aug 2024Localized prostate cancer treated with radical prostatectomy is highly effective, though severe side-effects are common after the surgery. Prehabilitation is an approach...
BACKGROUND
Localized prostate cancer treated with radical prostatectomy is highly effective, though severe side-effects are common after the surgery. Prehabilitation is an approach to optimize patient's physical and mental resources before surgery, to improve postoperative outcomes. The feasibility of a multi-modal home-based prehabilitation program, delivered using telehealth in patients awaiting radical prostatectomy is unknown. This paper describes the development of a prehabilitation program for patients awaiting radical prostatectomy.
METHOD
A model by The Medical Research Council for developing and evaluating complex interventions (MRC Framework) was used in the development process. The Template for Intervention Description and Replication (TIDieR) checklist was applied for ensuring sufficient description of the interventions. A total of 40 patients will be randomized to either intervention or control group. Patients in the control group will follow standard care. The 4-week prehabilitation programme consists of exercise, pelvic floor exercise, sexual counseling, stress management and nutritional support. The interventions are home-based and delivered using telehealth. Feasibility outcomes will include recruitment, attrition rates, adherence, safety and suitability.
CONCLUSION
We have developed a multimodal prehabilitation programme, which has the potential to bring tangible health benefits to men with prostate cancer awaiting radical prostatectomy. The results of the feasibility study will inform the design of a fully powered randomized controlled trial.
PubMed: 38947984
DOI: 10.1016/j.conctc.2024.101319 -
World Journal of Transplantation Jun 2024The number of solid organ transplantations performed annually is increasing and are increasing in the following order: Kidney, liver, heart, lung, pancreas, small bowel,...
The number of solid organ transplantations performed annually is increasing and are increasing in the following order: Kidney, liver, heart, lung, pancreas, small bowel, and uterine transplants. However, the outcomes of transplants are improving (organ survival > 90% after the 1 year). Therefore, there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen. Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems. The perioperative regulation of immunosuppression, the treatment of accompanying problems of immunosuppression, the administration of cortisol and, above all, the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients. The perioperative assessment and preparation includes evaluation of the patient's cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis, or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes. Immunosuppression in transplant patients is associated with the use of calcineurin inhibitors, corticosteroids, and antiproliferation agents. Many times, the clinical picture is atypical, resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality. Multidetector computed tomography is of utmost importance for early diagnosis and management. Transplant recipients are prone to infections, especially specific infections caused by cytomegalovirus and , and they are predisposed to intraoperative or postoperative complications that require great care and vigilance. It is necessary to follow evidence-based therapeutic protocols. Thus, it is required that the clinician choose the correct therapeutic plan for the patient (conservative, emergency open surgery or minimally invasive surgery, including laparoscopic or even robotic surgery).
PubMed: 38947966
DOI: 10.5500/wjt.v14.i2.93944 -
World Journal of Transplantation Jun 2024Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and...
BACKGROUND
Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures.
AIM
To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition, as well as the impact of MDRO acquisition on intensive care unit (ICU) and hospital length of stay, and on ICU mortality and 1-year mortality post heart transplantation.
METHODS
This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period (2013-2022) in a single transplantation center. Data was collected regarding MDROs commonly encountered in critical care.
RESULTS
Among the 98 transplanted patients (70% male), about a third (32%) acquired or already harbored MDROs upon transplantation (MDRO group), while two thirds did not (MDRO-free group). The prevalent MDROs were (14%), (12%) and (11%). Compared to MDRO-free patients, the MDRO group was characterized by higher body mass index ( = 0.002), higher rates of renal failure ( = 0.017), primary graft dysfunction (10% 4.5%, = 0.001), surgical re-exploration (34% 14%, = 0.017), mechanical circulatory support (47% 26% = 0.037) and renal replacement therapy (28% 9%, = 0.014), as well as longer extracorporeal circulation time (median 210 161 min, = 0.003). The median length of stay was longer in the MDRO group, namely ICU stay was 16 9 d in the MDRO-free group ( = 0.001), and hospital stay was 38 28 d ( = 0.006), while 1-year mortality was higher (28% 7.6%, log-rank- : 7.34).
CONCLUSION
Following heart transplantation, a predominance of Gram-negative MDROs was noted. MDRO acquisition was associated with higher complication rates, prolonged ICU and total hospital stay, and higher post-transplantation mortality.
PubMed: 38947964
DOI: 10.5500/wjt.v14.i2.93567 -
Patient Preference and Adherence 2024Psoriasis is a highly debilitating chronic inflammatory disease. Increased understanding of its pathophysiology has enabled development of targeted treatments such as...
PURPOSE
Psoriasis is a highly debilitating chronic inflammatory disease. Increased understanding of its pathophysiology has enabled development of targeted treatments such as biologics. Several medical treatments have been shown to be influenced by patients' experiences and expectations. However, only little is known about patients' experiences with and expectations towards biologics. Our objectives were to identify patients' treatment experiences and treatment expectations and assess their trajectories over the course of treatment with the IL-17A inhibitor secukinumab. Moreover, we aimed to document effects of psoriasis, factors that influence symptomatology, and prior treatment experiences.
PATIENTS AND METHODS
We conducted semi-structured interviews with = 24 patients with moderate-to-severe plaque psoriasis and employed a qualitative content analysis to derive thematic and evaluative codes. Findings were validated via peer debriefings with experienced dermatologists.
RESULTS
Patients reported burdensome physical and psychological psoriasis symptoms and identified factors that can improve or worsen symptomatology, including stress and self-efficacy. Prior treatment experiences were mostly negative. Past barriers to effective treatment included time constraints or limited access. Concerning secukinumab, patients initially expected complete to partial remission of symptoms and occurrence or absence of side effects. Closer inspection of expectations and experiences revealed three trajectories. For most patients, initial expectations were met and future expectations remained unchanged. For the other patients, however, the experience did not match their initial expectation. One group then adapted their future expectations according to their experience, while the other group did not.
CONCLUSION
To our knowledge, this is the first qualitative study to assess expectations towards treatment effectiveness and side effects, their trajectories, and interplay with experiences among psoriasis patients. Our findings highlight the value of further research on the subject in order to optimize care for psoriasis patients and to learn more about the trajectories and influence of treatment expectations in general.
PubMed: 38947870
DOI: 10.2147/PPA.S458643 -
IDCases 2024Kaposi sarcoma is an indolent angio-proliferative spindle- cell tumor derived from endothelial and immune cells infected with Human herpes virus type 8(HHV-8). In the...
Kaposi sarcoma is an indolent angio-proliferative spindle- cell tumor derived from endothelial and immune cells infected with Human herpes virus type 8(HHV-8). In the era of highly active antiretroviral (HAART), Kaposi sarcoma is a rare form of initial presentation of HIV infection [1]. The author presents a case of diffuse gingival hypertrophied Kaposi sarcoma in 18-year-old male newly diagnosed RVI patient. After confirming the diagnosis patient started on HAART and mouth care. Surgical excision is the first line of treatment with HAART, since this patient has low CD4 count of 30 cells/mm3 which will complicate the surgery. So, we are waiting for CD4 count to increase above 200 cells/mm3 to undergo surgical excision. The case is representative of HIV complexity and aimed to bring awareness of unusual presentation of HIV.This case also reminds us how important early initiation of HAART is.
PubMed: 38947560
DOI: 10.1016/j.idcr.2024.e02003 -
Clinical Case Reports Jul 2024Any patient presenting with trismus should have tetanus considered as a differential diagnosis. Early recognition, timely treatment and supportive care can improve...
Any patient presenting with trismus should have tetanus considered as a differential diagnosis. Early recognition, timely treatment and supportive care can improve patient outcomes. Treatment with tetanus immunoglobulin to neutralize the toxin, antimicrobials to treat the infection and sedation in the intensive care unit are key therapeutic options.
PubMed: 38947545
DOI: 10.1002/ccr3.9073 -
IScience Jun 2024Classic findings of impaired allocentric spatial learning and memory following hippocampal lesions indicate that the hippocampus supports cognitive maps of one's...
Classic findings of impaired allocentric spatial learning and memory following hippocampal lesions indicate that the hippocampus supports cognitive maps of one's environment. Many studies assess navigation in vista space virtual reality environments and compare hippocampal-lesioned individuals' performance to that of small control samples, potentially stifling detection of preserved and impaired performance. Using the mobile app we examined navigation in diverse complex environments in two individuals with hippocampal lesions relative to demographically matched controls ( = 17,734). We found surprisingly accurate navigation in several environments, particularly those containing a constrained set of sub-goals, paths, and/or turns. Areas of impaired performance may reflect a role for the hippocampus in anterograde memory and more flexible and/or precise spatial representations, even when the need for allocentric processing is minimal. The results emphasize the value of combining single cases with big data and illustrate navigation performance profiles in individuals with hippocampal compromise.
PubMed: 38947515
DOI: 10.1016/j.isci.2024.109977