Seroprevalence and trends of transfusion transmissible infections among retrospective blood donors in Western Azerbaijan Regional Blood Transfusion Center,Iran: A ten-years evaluation

Transfusion transmissible infections (TTIs) have been a public health challenge for the accessibility, quality and safety of blood transfusion. The present study aimed to consider the prevalence and the trends of hepatitis B virus (HBV), hepatitis C virus (HCV), Human T-cell leukemia virus type 1 (HTLV-1), human immunodeficiency virus (HIV) and syphilis across the ten years among retrospective blood donors. A retrospective investigation of blood donors’ data covering the period from 22 May 2009 to 22 May 2019 was done. Data was accumulated and analyzed from Blood Transfusion Center records, pertaining to all donors who were screened for various TTIs using respective immunological techniques. Out of the 682,171 screened donors in the 2009–2019 study period, 2470 (0.36 %) were infected with at least one infectious agent. The overall prevalence of HBV, HCV, HTLV-1, HIV and syphilis were 1700 (0.25 %), 184 (0.027 %), 335 (0.05 %), 4 (0.0.05 %) and 247 (0.036 %), respectively. The study showed male dominated donor pool (96.79 %) with higher prevalence (0.34 %) of TTIs compared to female donors (0.02 %) with 3.21 % population. Despite the low prevalence of TTIs in our study, HBV, HCV, syphilis and HIV have remained a big threat to safe blood transfusion in Iran. Strict adherence to selection criteria, algorithm of donor screening, use of highly sensitive and specific methods for detection of TTIs, regular consultation and health education programs, prevention and sanitization strategies to reduce the risk of TTIs are recommended to reduce the risk of TTIs and ensure the safety of blood transfusion for recipient.     

Part 4: Value-informed nursing practice depends on nursing innovation

With the adoption of value-based payments which tie reimbursement to patient outcomes and costs, days when nursing is viewed primarily as a cost to hospitals will soon be over. Already the backbone of high-quality care delivery and patient outcomes, nurses are becoming key drivers of health care organizations' financial outcomes, too. The first three articles published in this 6-part series on value-informed nursing practice—practice that considers both the outcomes and the cost of producing the outcomes—described what value-informed nursing practice means, its economic, policy, and ethical impetuses, and how value-informed nursing practice helps improve environmental sustainability of health systems. Here, in Part 4, we focus on the importance of nursing innovation in implementing value-informed nursing practice. We begin by discussing how innovation is connected to value and then examine the false dichotomy, perceived by many, between innovation and evidence-based care. Following this, we examine how health care organizations and systems can support nursing innovation, before concluding with recommendations for nursing educators.     

Cirrhosis is independently associated with complications and mortality following operative treatment of acetabular fractures

IntroductionPatients with cirrhosis are at higher risk for morbidity after injury. Acetabular fractures represent a highly morbid injury pattern. Few studies have specifically examined an effect of cirrhosis on risk of complications after acetabular fracture. We hypothesized that cirrhosis is independently associated with increased risk of inpatient complications following operative treatment of acetabular fractures.MethodsAdults patients with acetabular fracture who underwent operative treatment were identified from Trauma Quality Improvement Program data from 2015 to 2019. Patients with and without cirrhosis were matched on a propensity score predicting cirrhotic status and inpatient complications based on patient, injury, and treatment characteristics. The primary outcome was overall complication rate. Secondary outcomes included serious adverse event rate, overall infection rate, and mortality.ResultsAfter propensity score matching, 137 cirrhosis+ and 274 cirrhosis- remained. No significant differences existed in observed characteristics after matching. Compared to cirrhosis- patients, cirrhosis+ patients experienced 43.4% (83.9 vs 40.5%, p < 0.001) greater absolute risk difference of any inpatient complication, 29.9% (51.8 vs 21.9%, p < 0.001) greater absolute risk difference of serious adverse events, 28.5% (41.6 vs 13.1%, p < 0.001) greater absolute risk difference of any infection, and 2.9% (2.9% vs 0.0%, p = 0.02) greater absolute risk difference of inpatient mortality.ConclusionCirrhosis is associated with higher rates of inpatient complications, serious adverse events, infection, and mortality among patients undergoing operative repair of acetabular fracture.Level of EvidencePrognostic Level III.     

股骨转子间骨折的稳定性重建概念演化与研究进展

目的总结近年来股骨转子间骨折在稳定性重建方面的概念演化&#x04e0e;研究进展。方法查阅国内外相关文献并结合自身经验，&#x04ece;股骨转子间骨折的解剖特点、稳定型骨折&#x04e0e;&#x04e0d;稳定型骨折分类、稳定性复&#x04f4d;&#x04e0e;&#x04e0d;稳定性复&#x04f4d;、术&#x04e2d;加压初始稳定&#x04e0e;术后滑动&#x04e8c;次稳定、内固定术后稳定性评&#x04f30;、早期&#x04e0b;地站立负重等方面进行总结分析。结果股骨转子间骨折发生&#x04e8e;股骨颈干骺端转换区，具有天然的内翻&#x04e0d;稳定倾向。骨折复&#x04f4d;质量是影响后续内固定物安放的最重要前提因素。判断骨折复&#x04f4d;质量有对线和对&#x04f4d;&#x04e24;方面，对线采用 Garden 指数；在对&#x04f4d;方面，随着皮质对&#x04f4d;理念（正性、&#x04e2d;性、负性）的提出，特别强调前内&#x04fa7;皮质的相&#x04e92;砥&#x04f4f;支撑（解剖、正性），是获得骨折稳定性复&#x04f4d;的关键，而&#x04e0d;再强调后内&#x04fa7;小转子骨块的&#x04f5c;用。术后影像学的稳定性评分&#x04e3a;早期&#x04e0b;地站立负重提&#x04f9b;&#x04e86;量化指标。&#x04f46;术&#x04e2d;的前内&#x04fa7;皮质支撑复&#x04f4d;，在术后头颈骨块滑动获得&#x04e8c;次稳定的过程&#x04e2d;，&#x04ecd;有皮质对&#x04f4d;&#x04e22;失现象，需研究其危险因素和防范措施。结论股骨转子间骨折在取得良好对线的基础&#x04e0a;，只要获得&#x04e86;前内&#x04fa7;皮质的相&#x04e92;砥&#x04f4f;和支撑，并用内固定器械维持&#x04f4f;，就获得&#x04e86;术后稳定性。术后稳定性评分&#x04f18;良者，可&#x04ee5;安全地早期&#x04e0b;地负重、站立行走活动。     

The emergence of human Powassan virus infection in North America

Powassan virus (POWV) is a tickborne flavivirus discovered in Ontario, Canada in 1958 that causes long-term neurological sequelae in about half the reported cases and death in a little more than 10 % of cases. The incidence of POWV disease is rising in the United States but there is limited understanding of the scope and causes of recent changes in POWV epidemiology. We focus on quantifying the increase in human POWV disease incidence and infection prevalence in the United States. We also examine differences in the frequency of symptomatic cases and asymptomatic or mildly symptomatic cases, as well as limitations in national and state surveillance for POWV infection. We searched SCOPUS for all articles containing original POWV prevalence research, case studies, or literature reviews published in English. Case studies were supplemented by Morbidity and Mortality Weekly Report POWV data from the Centers for Disease Control and Prevention (CDC) and surveillance information from state health department websites. An increase in the number of POWV cases has been reported in the United States over the past 50 yr, and the geographic range of human POWV cases has expanded. The age distribution of symptomatic POWV cases has shifted, with significantly more individuals over 40 yr old being diagnosed after 1998. The emergence of POWV is due in large part to: (i) a change in transmission of POWV from a vector that rarely bites people (Ixodes cookei) to a new vector that often bites people (Ixodes scapularis) and has expanded its geographic range, (ii) enhanced surveillance efforts for arboviruses, and (iii) a greater awareness of POWV infection.     

负载IL-4及BMP-2的氧化石墨烯-羧甲基壳聚糖凝胶对骨免疫和骨修复的早期影响研究

目的探讨负载 IL-4 和 BMP-2 的氧化石墨烯（graphene oxide，GO）-羧甲基壳聚糖（carboxymethyl chitosan，CMC）凝胶诱导巨噬细胞 M2 型分化及对 BMSCs 成骨分化的影响。方法取 CMC、GO 制备混合溶液后，分别添加 PBS、IL-4、BMP-2 或 IL-4+BMP-2，在&#x04ea4;联剂&#x04f5c;用&#x04e0b;制备单纯或负载&#x04e0d;同因子的 GO-CMC 凝胶支架；取单纯 GO-CMC 凝胶表征观测，包括大&#x04f53;、扫描电镜及傅里叶变换红外吸收光谱&#x04eea;（Fourier transform infrared spectroscopy，FTIR）检测，&#x04ee5;单纯 CMC 凝胶&#x04f5c;&#x04e3a;对照；取负载&#x04e0d;同因子的 GO-CMC 凝胶行&#x04f53;外缓释实验。取 4～5 周龄 SPF 级 SD 雌性大鼠分离培养巨噬细胞，分别&#x04e0e;单纯&#x04ee5;及负载&#x04e0d;同因子的 GO-CMC 凝胶培养，24 h 后行 CD206 免疫荧光检测巨噬细胞分化情况；取第 3 &#x04ee3;大鼠 BMSCs 分别&#x04e0e;单纯&#x04ee5;及负载&#x04e0d;同因子的 GO-CMC 凝胶成骨诱导培养，10 d 后行 ALP 染色观测早期成骨，21 d 行茜素红染色观测晚期成骨。结果大&#x04f53;观察 GO-CMC 凝胶呈棕色、半透明状；扫描电镜观察示，GO-CMC 凝胶孔径及孔壁厚度&#x04e0e;单纯 CMC 凝胶相&#x04f3c;，&#x04f46;内壁粗糙度增加；FTIR 检测显示 CMC 发生聚合形成凝胶。&#x04f53;外缓释实验示 3 种负载&#x04e0d;同因子的 GO-CMC 凝胶缓释性能相&#x04f3c;，均呈线性缓慢释放因子。CD206 免疫荧光检测示 GO-CMC 凝胶可诱导巨噬细胞 M2 型分化，ALP 及茜素红染色示 GO-CMC 凝胶可诱导 BMSCs 成骨分化；其&#x04e2d;负载 IL-4+BMP-2 的 GO-CMC 凝胶&#x04f5c;用最显著（P<0.05）。 结论负载 IL-4 和 BMP-2 的 GO-CMC 凝胶可诱导巨噬细胞 M2 型分化，增强 BMSCs 成骨分化能力，&#x04e3a;后期骨缺损&#x04fee;复及骨免疫调节研究提&#x04f9b;&#x04e86;新的策略。