Efficacy of patient questionnaire in predicting renal dysfunction in outpatients older than 60 years of age prior to contrast-enhanced computed tomography

Introduction: Contrast‐induced nephropathy (CIN), a common iatrogenic cause of acute renal failure, is preventable. Identification of impaired renal function prior to intravenous contrast is important. Questionnaire screening has been useful to negate the need for cumbersome and costly renal function testing on all patients prior to contrast‐enhanced CT (CECT). The Royal Australian and New Zealand College of Radiologists guidelines include age older than 60 as a risk marker requiring renal function testing. The aim of this retrospective study is to assess the efficacy of the pre‐CT questionnaire in identifying patients with pre‐existing renal impairment even in this older than 60 age group. Methods: All outpatients were given questionnaires containing 11 CIN risk markers prior to CECT. Radiographers documented age, gender, serum creatinine and/or estimated glomerulofiltration rate (eGFR mL/min/1.72 m²) within 3 months of CT. Questionnaires of all patients older than 60 years were collated. The data was tabulated and analyzed. Incomplete questionnaires were excluded. Results: 134/171 (78.4%) patients had eGFR ≥ 60 and 37/171 (21.6%) had eGFR < 60, with 31/171 (18.1%) having eGFR between 30 and 60 and 3/171 (1.8%) having eGFR < 30. 47/171 (27.5%) circled ‘no’ to all risk markers. Percentage for sensitivity is 81.1% (95% confidence interval (CI) 64.8–92%), for specificity 29.9% (95% CI 22.3–38.4%), for positive predictive value 24.2% (95% CI 17–32.7%) and for negative predictive value 85.1% (95%CI 71.7–93.8%). Kidney disease, anaemia, myeloma and vasculitis seem to be statistically significant risk factors (P < 0.05). All three true‐positive patients with eGFR < 30 indicated known kidney disease. Seven false‐negative patients had eGFR 30–60, with 4/7 (57.1%) having CIN risk markers in their medical records. Conclusion: Questionnaire screening for CIN risk has a high negative predictive value (85.1%) even in patients older than 60 years.     

The effect of minimal concentration of ethylene glycol (EG) combined with polyvinylpyrrolidone (PVP) on mouse oocyte survival and subsequent embryonic development following vitrification

Purpose

Vitrification techniques employ a relatively high concentration of cryoprotectant in vitrification solutions. Exposure of oocytes to high concentrations of cryoprotectant is known to damage the oocytes via both cytotoxic and osmotic effects. Therefore, the key to successful vitrification of oocytes is to strike a balance between the usage of minimal concentration of cryoprotectant without compromising their cryoprotective actions.

Methods

The minimal concentration of ethylene glycol (EG) on mouse oocyte survival and subsequent embryonic development was evaluated following vitrification-warming and parthenogenetic activation. Polyvinylpyrrolidone (PVP) combined with EG on mouse oocyte survival and subsequent embryonic development as well as morphology of the spindle and chromosome alignment were also evaluated. Vitrification system was adapted with JY Straw and the cooling rate was approximately 442–500 °C/min. In contrast, the warming rate was approximately 2,210–2,652 °C/min.

Results

Survival rate of oocytes increased significantly when 15 % EG was combined with 2 % PVP in vitrification solution (VS). The effect of combination of EG and PVP was not significant when the concentration of EG was 20 % and higher. Although there were no significant differences in embryonic development, the percentage of abnormal spindle and chromosome alignment was significantly higher in the oocytes without 2 % PVP in VS.

Conclusions

Our data provide a proof of principle for oocyte vitrification that may not require a high concentration of cryoprotectant. There are synergic effects of EG combined with PVP for oocyte vitrification, which may provide important information to the field in developing less cytotoxic VS.     

Asia Pacific Consensus Statements on Crohn's disease. Part 1: Definition,diagnosis, and epidemiology

Inflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology with the goal of developing best management practices, coordinating research, and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis with specific relevance to the Asia‐Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis, and management of Crohn's disease. The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia‐Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses, and treatment availability. It does not intend to be all comprehensive and future revisions are likely to be required in this ever‐changing field.     

In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations

STATEMENT OF PROBLEM: The in vitro effectiveness of a uniform circumferential ferrule has been established in the literature; however, the effect of a nonuniform circumferential ferrule height on fracture resistance is unknown. PURPOSE: This in vitro study investigated the resistance to static loading of endodontically treated teeth with uniform and nonuniform ferrule configurations. MATERIAL AND METHODS: Fifty extracted intact maxillary human central incisors were randomly assigned to 1 of 5 groups: CRN, no root canal treatment (RCT), restored with a crown; RCT/CRN, no dowel/core, restored with a crown; 2 FRL, 2-mm ferrule, cast dowel/core and crown; 0.5/2 FRL, nonuniform ferrule (2 mm buccal and lingual, 0.5 mm proximal), cast dowel/core and crown; and 0 FRL, no ferrule, cast dowel/core and crown. The teeth were prepared to standardized specifications and stored for 72 hours in 100% humidity prior to testing. Testing was conducted with a universal testing machine with the application of a static load, and the load (N) at failure was recorded. Statistical analysis was performed with a 1-way analysis of variance and the Tukey Honestly Significant Difference test (alpha=.05). The mode of fracture was noted by visual inspection for all specimens. RESULTS: There was strong evidence of group differences in mean fracture strength ( P <.0001). Following adjustment for all pairwise group comparisons, it was found that the lack of a ferrule resulted in a significantly lower mean fracture strength (0 FRL: 264.93 +/- 78.33 N) relative to all other groups. The presence of a nonuniform (0.5 to 2-mm vertical height) ferrule (0.5/2 FRL: 426.64 +/- 88.33 N) resulted in a significant decrease ( P =.0001) in mean fracture strength when compared with the uniform 2-mm vertical ferrule (2 FRL: 587.23 +/- 110.25 N), the group without RCT (CRN: 583.67 +/- 86.09 N), and the RCT-treated tooth with a crown alone (CRN/RCT: 571.04 +/- 154.86 N). The predominant mode of failure was an oblique fracture extending from the lingual margin to the facial surface just below the insertion of the tooth into the acrylic resin. CONCLUSION: The results demonstrated that central incisors restored with cast dowel/core and crowns with a 2-mm uniform ferrule were more fracture resistant compared to central incisors with nonuniform (0.5 to 2 mm) ferrule heights. Both the 2-mm ferrule and nonuniform ferrule groups were more fracture resistant than the group that lacked a ferrule.     

In-vitro maturation of human oocytes

Immature human oocytes can be matured and fertilized in vitro. However, subsequent embryonic development is different when the immature oocytes are retrieved in different situations. Exposure to the LH surge in vivo may be important for the oocytes to acquire the competence for maturation and subsequent embryonic development. The size of the follicles may also be an important feature for subsequent embryonic development. However, the developmental competence of oocytes derived from small antral follicles does not seem to be adversely affected by the presence of a dominant follicle. Oocyte maturation in vitro is profoundly affected by culture conditions. Gonadotrophins are required for oocyte maturation in vivo, but any requirement in vitro is still unclear. Recent clinical results from in-vitro matured (IVM) human oocytes are promising, although further research remains to be done in order to address the mechanisms of oocyte maturation and to improve culture conditions and also the implantation rate of embryos generated from IVM oocytes.     

COVID-19-related fear,stress and depression in school principals: impacts of symptoms like COVID-19, information confusion,health-related activity limitations,working hours,sense of coherence and health literacy

BackgroundSchool principals have been reported to have a higher prevalence of burnout and psychological problems than their colleagues. During the pandemic, extra workload and pressure from unprecedented situations potentially cause fear, stress and depression. Therefore, we aimed to explore associated factors of stress, fear of COVID-19 (F-CoV-19S) and depressive symptoms among school principals.MethodsA cross-sectional online survey was conducted in Taiwan from 23 June to 16 July 2021. Data of 413 school principals were collected, including socio-demographic factors, COVID-19-related factors, work-related information, health status, sense of coherence (SoC), health literacy (HL), F-CoV-19S, stress and depression. Multiple linear and logistic regression models were utilized to explore associations.ResultsSchool principals with symptoms like COVID-19 (S-COVID-19-S), or with health-related activity limitations had a higher score of stress (B = 0.92; p = .039) (B = 1.52; p < .001) and a higher depression likelihood (OR = 3.38; p < .001) (OR = 3.06; p < .001), whereas those with a better SoC had a lower stress score (B = −1.39; p < .001) and a lower depression likelihood (OR = 0.76; p = .020). School principals confusing about COVID-19-related information had a higher score of stress (B = 2.47; p < .001) and fear (B = 3.77; p < .001). The longer working time was associated with a higher fear score (B = 1.69; p = .006). Additionally, school principals with a higher HL score had a lower stress score (B = −1.76; p < .001), a lower fear score (B = −1.85; p < .001) and a lower depression likelihood (OR = 0.53; p = .043).ConclusionsHealth-related activity limitations, S-COVID-19-S, COVID-19-related information confusion and longer working hours were positively associated with at least one mental health problem (e.g. stress, fear and depression), whereas better SoC and HL showed the benefits to mitigate fear, stress and depressive symptoms in school principals. Our study provides evidence for appropriate strategies to improve principals’ mental health during the pandemic.

Key messages:

• School principals with health-related activity limitations or with symptoms like COVID-19 were more likely to be stressed and depressed.
• Higher levels of stress and fear were observed in school principals who confused about COVID-19-related information, and who had longer working time than before the pandemic.
• Better sense of coherence and higher health literacy could potentially mitigate the fear, stress and depressive symptoms in school principals.