Adherence to COVID-19 Nutrition Guidelines Is Associated with Better Nutritional Management Behaviors of Hospitalized COVID-19 Patients

Good nutritional support is crucial for the immune system to fight against coronavirus disease 2019 (COVID-19). However, in the context of a pandemic with a highly transmissible coronavirus, implementation of nutrition practice may be difficult. A multicenter electronic survey involving 62 dieticians was conducted, in order to understand barriers associated with dieticians’ adherence to nutrition guidelines for hospitalized COVID-19 patients in Indonesia. 69% of dieticians felt under stress when performing nutrition care, and 90% took supplements to boost their own immunity against the coronavirus. The concerns related to clinical practice included a lack of clear guidelines (74%), a lack of access to medical records (55%), inadequate experience or knowledge (48%), and a lack of self-efficacy/confidence (29%) in performing nutritional care. Half (52%) of the dieticians had performed nutrition education/counseling, 47% had monitored a patient’s body weight, and 76% had monitored a patient’s dietary intake. An adjusted linear regression showed that guideline adherence independently predicted the dieticians’ nutrition care behaviors of nutrition counselling (ß: 0.24 (0.002, 0.08); p = 0.04), and monitoring of body weight (ß: 0.43 (0.04, 0.11); p = 0.001) and dietary intake (ß: 0.47(0.03, 0.10); p = 0.001) of COVID-19 patients. Overall, adherence to COVID-19 nutrition guidelines is associated with better nutritional management behaviors in hospitalized COVID-19 patients.     

In vivo imaging of neuroblastomas using GD2-targeting graphene quantum dots

BackgroundPatients with neuroblastoma, a common childhood malignancy, often have poor prognosis. It is mandatory to develop an accurate and efficient diagnostic tool for neuroblastomas, so that the treatment can be started early. Graphene quantum dot (GQD), a nanomaterial, can be used to carry proteins, genetic materials, or drugs. GD2, a disialoganglioside, is a surface antigen expressed on neuroblastoma. This study investigated the in vivo targeting and imaging of neuroblastomas using GD2-targeting GQDs.MethodsGQDs were synthesized and conjugated with anti-GD2 antibody (anti-GD2/GQDs). In vitro cytotoxicity of GQDs and anti-GD2/GQDs was studied in human neuroblastoma cells by 3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyltetrazolium bromide)-based colorimetric assay. The tumor tracking and imaging of anti-GD2/GQDs in mice were investigated by in vivo imaging system (IVIS).ResultsTreatment with GQDs or anti-GD2/GQDs induced no or mild cytotoxicity in fibroblasts and neuroblastoma cells. After co-incubation, GQDs and anti-GD2/GQDs were located in the cytoplasm and nucleus of neuroblastoma cells, with GQDs showing a blue fluorescence and anti-GD2/GQDs an orange/red emission. The IVIS images demonstrated accumulation of the fluorescence of anti-GD2/GQDs in the subcutaneous tumors in mice 24 h after intravenous injection of anti-GD2/GQDs.ConclusionsAnti-GD2/GQDs may potentially be used for the targeting and imaging of neuroblastomas in vivo.     

Measuring patient perceptions of surgeon communication performance in the treatment of thyroid nodules and thyroid cancer using the communication assessment tool

BackgroundThyroid surgeons are offering their patients less aggressive diagnostic and therapeutic management strategies for thyroid nodules and low-risk thyroid cancer in an effort to decrease overdiagnosis and overtreatment of indolent disease. Explaining the rationale for less aggressive management plans requires physicians to be effective communicators. We aimed to assess the communication skills of thyroid surgeons with the Makoul Communication Assessment Tool and to identify risk factors for poor communication.MethodsNew adult patients with thyroid nodules or thyroid cancer presenting to a single tertiary-referral endocrine surgery clinic were enrolled from July 2018 through December 2019. Patients were administered the Communication Assessment Tool immediately after their clinical encounter. Outlier communication scores were identified, and clinical characteristics were compared between outlier and nonoutlier groups.ResultsA total of 107 patients completed the Communication Assessment Tool. Mean (standard deviation) total and top box scores were 67 (6) and 86% (29%), respectively. Twenty-five patients (23%) were in the low-outlier group, defined by a total score below 67.5/70 or top box score below 82.25%. Other race and non-Hispanic patients (versus white race) were more likely low outliers (odds ratio 3.58, P = .048). The lowest scoring Communication Assessment Tool item overall was “the doctor encouraged me to ask questions” (78.5% top box).ConclusionWe found communication to be perceived as excellent in the majority of patients; however, an opportunity for improvement was identified in 29% of participants. Significant differences in race and ethnicity between low outlier and nonoutlier communication score patients were observed, which warrants additional investigation. These findings support the utility of the Communication Assessment Tool in studying the effectiveness of communication improvement initiatives.     

The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip

Summary In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken.

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Anatomie chirurgicale du nerf glutéal supérieur et bases anatomo-radiologiques de l'abord latéral direct de la hanche

Résumé Les recours de plus en plus fréquent à la voie latérale directe de la hanche pour les prothèses totales ou cervico céphaliques nous a conduit à étudier la localisation du nerf glutéal supérieur (SGN) qui est exposé lors de l'incision transglutéale. Les rapports du SGN avec le sommet du grand trochanter (TT) et avec la crête iliaque ont été étudiés sur 20 cadavres embaumés. Nous avons eu recours à l'étude macroscopique, microscopique ainsi qu'au scanner. Dans 13 cas nous avons mis en évidence une branche très inférieure, donc plus distale, située 1 cm en moyenne en dessous de la branche inférieure habituelle de bifurcation du tronc principal. Il existait des variations importantes dans les trajets de ces deux branches inférieures. Afin de prévenir une lésion chirurgicale du nerf, l'incision transglutéale ne doit pas aller au delà de 3 cm du sommet du grand trochanter, de plus l'incision doit être confinée en dessous du tiers distal de la ligne joignant le grand trochanter à la crête iliaque.

     

Allosteric effects of mutations in the extracellular S5-P loop on the gating and ion permeation properties of the hERG potassium channel

The hERG channel has an unusually long (39 amino acids) extracellular loop between the transmembrane S5 segment and the pore region that may play a role in channel function. We explored this possibility by mutating two histidine residues in this region (H578 and H587, referred to as H1 and H2) to various residues and examined the resulting changes in channel function. Both positions could tolerate drastic changes in side-chain properties (proline, cysteine, glutamate and lysine), indicating that they are solvent exposed. None of the H1 mutations affected hERG channel function. On the other hand, although replacing H2 with glutamate had little or no effect on hERG properties, putting a proline or lysine at this position disrupted the C-type inactivation process and the pore's K selectivity. There was also a hyperpolarizing shift in the voltage dependence of activation. The phenotype of the H2C mutant was similar to that of H2P or H2K. However, dithiothreitol (DTT, a thiol-reducing agent) treatment converted the H2C phenotype to that of the wild-type channel. These observations suggest that the peptide backbone conformation around position 587 in the extracellular S5-P loop of hERG channel can affect the channel's gating and ion selectivity functions.     

Inflammatory cloacogenic polyp of anus: report of three cases

The term of "cloacogenic anal carcinoma", "cloacogenic zone" and "cloacal membrane" have been widely used, but the term of "inflammatory cloacogenic polyp" (ICP) was first applied and published by Lobert PF and Henry DA in 1981. Here we present three cases of ICP to stress its inflammatory property, predilection to invade cloacogenic zone of anus and polypoid shape, and to differentiate it from its related lesions as concise as possible.     

Vertical root fracture in endodontically versus nonendodontically treated teeth: a survey of 315 cases in Chinese patients

OBJECTIVE: The purpose of this study was to compare endodontically versus nonendodontically treated teeth with respect to clinical features, including patient age and gender and tooth types of vertical root fractures. STUDY DESIGN: A total of 315 consecutive cases of vertical root fracture occurring in 274 Chinese patients during a 1 3-year period were reviewed. Age and gender, as well as tooth type and root distribution of vertical root fractures, were presented and compared in endodontically versus nonendodontically treated teeth. RESULTS: Most patients (87%) had 1 fractured tooth; the others had 2 or 3 fractured teeth. Of all vertical root fractures, 40% occurred in nonendodontically treated teeth. In comparison with those in endodontically treated teeth, vertical root fractures in nonendodontically treated teeth tended to occur in patients with a higher mean age (55 years vs. 51 years) and were more frequent in male patients (78% vs. 58%). Vertical root fractures occurred in nonendodontically treated teeth more often in molars (84% vs. 53%), less often in premolars (16% vs. 33%), and seldom in anteriors (1 tooth vs. 27 teeth). CONCLUSIONS: Vertical root fractures in nonendodontically treated teeth are not uncommon and comprise a large proportion of such fractures in Chinese patients. Differences between endodontically and nonendodontically treated teeth in patient age and gender, as well as in tooth types of vertical root fractures, were demonstrated.