The impact of the updated EORTC/MSG criteria on the classification of hematological patients with suspected invasive pulmonary aspergillosis

ObjectivesOur aim was to evaluate the effect of the updated European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group 2019 definitions for invasive pulmonary aspergillosis (IPA) on patient classification and the related all-cause 12-week mortality.MethodsIn this retrospective cohort study from our tertiary care centre, we reclassified patients with haematological malignancy who underwent bronchoalveolar lavage between 2014 and 2019 for suspected IPA using the novel EORTC 2019 criteria. We performed receiver operating characteristic curve analysis to define the optimal cut-off for positive PCR and galactomannan and present survival analyses and their possible association with these diagnostic criteria through post hoc comparisons with log rank and Cox regression.ResultsFrom 323 episodes of suspected IPA in 282 patients, 73 were reclassified: 31 (42.5%) from possible to probable IPA, 5 (6.8%) from EORTC criteria not met to probable IPA, and 37 (50.7%) from EORTC criteria not met to possible IPA. Probable IPA increased therefore 11.1% (64/323, 19.8% to 100/323, 30.9%), mostly due to positive PCR (31/36, 86.1%). There was no difference in mortality between newly defined possible and probable IPA (log rank p = 0.950). Mortality was higher in probable cases with lower cycle thresholds (Ct values) versus higher Ct values (p = 0.004). Receiver operating characteristic curve analysis showed an optimal Ct value cut-off of 36.8 with a sensitivity of 75% (95% CI 64.9%–85.1%) and a specificity of 61.7% (95% CI 53.5–69.9) for 12-week mortality.DiscussionThe new EORTC criteria led to 11.1% more probable IPA diagnoses, mostly due to Aspergillus PCR. Restricting positive PCR to below a certain threshold might improve the discrimination of the new EORTC IPA categories for mortality.     

基于Brown高级护理实践的癌痛专科护士岗位构建

通过文献回顾总结当前国内疼痛专科护士发展及癌痛管理中的不足,在此基础上以Brown高级护理实践理论框架为理论指导,侧重于资格要求、癌痛评估以及出院后的随访对癌痛专科护士岗位构建进行设计,旨在更好地促进癌痛专科护理的开展,提升癌痛护理水平。     

2022年上海市医师协会全科医师分会年会主题报告（一）

本文内容来源于2022年7月22日由上海市医师协会、上海市医师协会全科医师分会主办的"第二届海上全科医师论坛"，主要包括《基层医疗在整合医疗中的作用》《创建全科医学科为国家临床重点专科》《上海市基层卫生发展趋势》《拥抱变化，更好更强》四部分。其中，《基层医疗在整合医疗中的作用》从整合程度、整合层面、整合方向3个维度阐释了"整合医疗"的概念与内涵，并就整合医疗在制度、管理、支付、服务模式、技术应用5个层面的实现路径做了详细介绍；在分析基层医疗和整合医疗共性特征的基础上，阐释基层医疗在上述5个层面对整合医疗的助推作用。《创建全科医学科为国家临床重点专科》从全科医学科在卫生保健改革、满足居民卫生服务需求中的重要作用出发，阐述了创建全科医学科为国家临床重点专科的必要性，认为创建临床重点专科需做到：提高全科医学科学术地位，推进全科医学人才建设，提升全科医学科区域协同能力，形成全方位全周期健康照护专科特色，加快全科医学科研创新发展。《上海市基层卫生发展趋势》肯定了基层卫生对城市健康发展的贡献，提出在"大健康"的背景下进一步的重点工作为推进健康老龄化和实现出生人口提升计划；上海基层卫生的发展趋势在于创新，而基层卫生高质量发展工作的创新需要由全科医生作为推动者和牵头者，创造出新的健康服务模式。《拥抱变化，更好更强》，认为当前社区卫生服务的"薄弱"之处，并非发展之初的硬件或人员配置不足，而是体现在全科学科建设方面。全科医学领域工作者应主动面对和接纳当前国家健康战略的变化、健康需求的变化、医学模式的变化、自身发展/管理的变化，开展主动健康，应对多病共存，加强全-专结合，关注需方角度的服务评价，以助力全科医学学科建设。     

Positive Culture During Reimplantation Increases the Risk of Reinfection in Two-Stage Exchange Arthroplasty Despite Administrating Prolonged Antibiotics: A Retrospective Cohort Study and Meta-Analysis

Background

The significance of a positive culture at reimplantation remains an important topic of consideration given the lack of clear metrics for when reimplantation can be performed. The purpose of this study is thus to investigate the (1) association between a positive culture during reimplantation and failure following 2-stage exchange arthroplasty and the (2) influence of prolonged antibiotics on these patients.

The cultural responsibility of dance movement therapy: philosophical considerations

This paper examines the cultural situation and special responsibility of dance movement therapy, delineating certain philosophical and cultural-theoretical interpretations of the ‘corporeal turn’ and ‘therapeutic turn’ of contemporary culture. It aims to show how dance movement therapy’s theoretical horizon is inseparable from the body-mind integration of contemporary philosophies, and how corporeal turn is present in consumer culture, including some of its destructive forms of idealisation and malign regression. The question of how DMT is able to turn malignant regression to the body into benign regression is addressed, and an analysis of the correlating postmodern idea of resilience is offered. Finally, DMT groups are interpreted as social microcosms, and the way Hungarian psychodynamic movement and dance therapists apply their group therapeutic method for the development of democratic culture in the Civil Group Project is described.     

Sonication of Antibiotic Loaded Cement Spacers: A Valuable Technique for Detection of Infection Persistence in Two-stage Revision for Infected Joint Arthroplasty

We evaluated the diagnostic utility of sonication of antibiotic loaded cement spacers comparing with periprosthetic tissue cultures for the detection of persisting infection in 14 patients undergoing staged procedures. Sonication improved microbial detection of intraoperative cultures from 14.2% to 28.5% (P = 0.481). Routine sonication of spacers is recommended.     

Development of suspension adapted Vero cell culture process technology for production of viral vaccines

Vero cells are considered as the most widely accepted continuous cell line by the regulatory authorities (such as WHO) for the manufacture of viral vaccines for human use. The growth of Vero cells is anchorage-dependent. Scale-up and manufacturing in adherent cultures are labor intensive and complicated. Adaptation of Vero cells to grow in suspension will simplify subcultivation and process scale-up significantly, and therefore reduce the production cost.Here we report on a successful adaptation of adherent Vero cells to grow in suspension in a serum-free and animal component-free medium (IHM03) developed in-house. The suspension adapted Vero cell cultures in IHM03 grew to similar or better maximum cell density as what was observed for the adherent Vero cells grown in commercial serum-free media and with a cell doubling time of 40–44 h. Much higher cell density (8 × 10⁶ cells/mL) was achieved in a batch culture when three volume of the culture medium was replaced during the batch culture process.Both adherent and suspension Vero cells from various stages were tested for their authenticity using short tandem repeat analysis. Testing result indicates that all Vero cell samples had 100% concordance with the Vero DNA control sample, indicating the suspension cells maintained their genetic stability. Furthermore, suspension Vero cells at a passage number of 163 were assayed for tumorigenicity, and were not found to be tumorigenic.The viral productivity of suspension Vero cells was evaluated by using vesicular stomatitis virus (VSV) as a model. The suspension cell culture showed a better productivity of VSV than the adherent Vero cell culture. In addition, the suspension culture could be infected at higher cell densities, thus improving the volumetric virus productivity. More than one log of increase in the VSV productivity was achieved in a 3L bioreactor perfusion culture infected at a cell density of 6.8 × 10⁶ cells/mL.     

Control the fate of human umbilical cord mesenchymal stem cells with dual‐enzymatically cross‐linked gelatin hydrogels for potential applications in nerve regeneration

Stem‐cell‐based therapy is a promising strategy to treat challenging neurological diseases, while its application is hindered primarily by the low viability and uncontrolled differentiation of stem cell. Hydrogel can be properly engineered to share similar characteristics with the target tissue, thus promoting cell viability and directing cell differentiation. In this study, we proposed a new dual‐enzymatically cross‐linked and injectable gelatin hydrogel for regulating survival, proliferation, and differentiation of human umbilical cord mesenchymal stem cells (hUC‐MSCs) in a three‐dimensional matrix. This injectable gelatin hydrogel was formed by oxidative coupling of gelatin–hydroxyphenyl acid conjugates catalyzed by hydrogen horseradish peroxidase (HRP) and choline oxidase (ChOx). Modulus and H₂O₂ release can be well controlled by ChOx activity. Results from calcein‐AM/PI staining and Ki67 immunofluorescence tests demonstrated that the survival and proliferation behavior of hUC‐MSCs were highly enhanced in HRP_1UChOx_0.25U hydrogel with lower modulus and less H₂O₂ release compared with other groups. Attractively, the expression of neuron‐specific markers β‐III tubulin, neurofilament light chain (NFL), and synapsin‐1 was significantly increased in HRP_1UChOx_0.25U hydrogel as well. Additionally, in vitro hemolysis test and in vivo HE staining data highlighted the good biocompatibility. Undoubtedly, this injectable gelatin hydrogel's ability to control hUC‐MSCs' fate holds enormous potentials in nervous disorders' therapy and nerve regeneration.     

Cyclical strain improves artificial equine tendon constructs in vitro

Tendon injuries are a common cause of morbidity in humans. They also occur frequently in horses, and the horse provides a relevant, large animal model in which to test novel therapies. To develop novel cell therapies that can aid tendon regeneration and reduce subsequent reinjury rates, the mechanisms that control tendon tissue regeneration and matrix remodelling need to be better understood. Although a range of chemical cues have been explored (growth factors, media etc.), the influence of the mechanical environment on tendon cell culture has yet to be fully elucidated. To mimic the in vivo environment, in this study, we have utilised a novel and affordable, custom‐made bioreactor to apply a cyclical strain to tendon‐like constructs generated in three‐dimensional (3D) culture by equine tenocytes. Dynamic shear analysis (DSA), dynamic scanning calorimetry (DSC) and Fourier‐transform infrared (FTIR) spectroscopy were used to determine the mechanical and chemical properties of the resulting tendon‐like constructs. Our results demonstrate that equine tenocytes exposed to a 10% cyclical strain have an increased amount of collagen gel contraction after 7 and 8 days of culture compared with cells cultured in 3D in the absence of external strain. While all the tendon‐like constructs have a very similar chemical composition to native tendon, the application of strain improves their mechanical properties. We envisage that these results will contribute towards the development of improved biomimetic artificial tendon models for the development of novel strategies for equine regenerative therapies.