Comparison of a new methodology for the assessment of 3D myocardial strain from volumetric ultrasound with 2D speckle tracking

An alternative approach to extract 3D myocardial strain based on elastic registration of the ultrasound images (3DSE) was developed by our lab. The aim of the present study was to test its clinical performance by comparing strain values obtained by 3DSE with the ones obtained with 2D speckle tracking (2DST). Standard 2D B-mode and volumetric datasets were acquired in 12 patients with coronary heart disease (CHD) and in 12 control subjects. Longitudinal (ε(LL)), circumferential (ε(CC)) and radial (ε(RR)) strain values were obtained from 2D datasets using commercially available 2DST software and from volumetric datasets using the 3DSE approach. 3DSE provided lower strain values than 2DST. With both approaches global ε(LL) and ε(CC) were significantly lower in patients with CHD than in controls. Global ε(LL) and ε(CC) correlated well between both methods (R = 0.83, R = 0.86, respectively), while segmental correlations were moderate [R = 0.63 (ε(LL)), R = 0.41 (ε(CC))]. The highest differences in ε(LL) values obtained by the two methods and the highest number of erroneous ε(LL) with 3DSE were observed in the basal LV segments. This study shows that in real-life datasets our 3DSE method provides global and regional ε(LL) and ε(CC) values that are comparable with the ones obtained from 2DST, even though they are not interchangeable with each other. As only a single acquisition is required, 3D methods may offer advantages over the current 2D techniques. However, the accuracy of the 3DSE can still be improved by solving the problems that appear with deformation estimation in the basal segments.     

Discovery of novel melanocortin4 receptor selective MSH analogues

1. We synthesized a novel series of cyclic melanocyte stimulating hormone (MSH) analogues and tested their binding properties on cells transiently expressing the human melanocortin₁ (MC₁), MC₃, MC₄ and MC₅ receptors.
2. We discovered that compounds with 26 membered rings of [Cys⁴,D-Nal⁷,Cys¹¹]α-MSH(4–11) displayed specific MC₄ receptor selectivity. The preference order of the different MC receptor subtypes for the novel [Cys⁴D-Nal⁷Cys¹¹]α-MSH(4–11) analogues are distinct from all other known MSH analogues, particularly as they bind the MC₄ receptor with high and the MC₁ receptor with low relative affinities.
3. HS964 and HS014 have 12 and 17 fold MC₄/MC₃ receptor selectivity, respectively, which is much higher than for the previously described cyclic lactam and [Cys⁴,Cys¹⁰]α-MSH analogues SHU9119 and HS9510.
4. HS964 is the first substance showing higher affinity for the MC₅ receptor than the MC₁ receptor.
5. HS014, which was the most potent and selective MC₄ receptor ligand (K_i 3.2 nM, which is ∼300 fold higher affinity than for α-MSH), was also demonstrated to antagonize α-MSH stimulation of cyclic AMP in MC₄ receptor transfected cells.
6. We found that a compound with a 29 membered ring of [Cys³,Nle¹⁰,D-Nal⁷,Cys¹¹]α-MSH(3–11) (HS010) had the highest affinity for the MC₃ receptor.
7. This is the first study to describe ligands that are truly MC₄ selective and a ligand having a high affinity for the MC₃ receptor. The novel compounds may be of use in clarifying the physiological roles of the MC₃, MC₄ and MC₅ receptors.

     

Antifungal Activity of LY303366, a Novel Echinocandin B, in Experimental Disseminated Candidiasis in Rabbits

The safety and antifungal activity of LY303366 (LY), a new broad-spectrum semisynthetic echinocandin, were studied against disseminated candidiasis in persistently neutropenic rabbits. In vitro time-kill assays demonstrated that LY has concentration-dependent fungicidal activity. The pharmacokinetics of LY in the plasma of nonneutropenic rabbits suggested a linear relationship between dose and area under the curve (AUC). The times spent above the MIC during the experimental dosing interval of 24 h were 4 h for LY at 0.1 mg/kg of body weight/day (LY0.1), 8 h for LY at 0.25 mg/kg/day (LY0.25), 12 h for LY at 0.5 mg/kg/day (LY0.5), and 20 h for LY at 1 mg/kg/day (LY1). Antifungal therapy was administered to infected rabbits for 10 days starting 24 h after the intravenous (i.v.) inoculation of 10(3) Candida albicans blastoconidia. Study groups consisted of untreated controls (UCs) and animals treated with amphotericin B (AmB; 1 mg/kg/day i.v.), fluconazole (FLU; 10 mg/kg/day i.v.), and LY0.1, LY0.25, LY0.5, or LY1 i.v. Rabbits treated with LY0.5, LY1, AmB, and FLU had similarly significant clearance of C. albicans from the liver, spleen, kidney, lung, vena cava, and brain in comparison to that for UCs. There was a dose-dependent clearance of C. albicans from tissues in response to LY. Among rabbits treated with LY0.1 there was a significant reduction of C. albicans only in the spleen. In animals treated with LY0.25 there was a significant reduction in all tissues but the brain. By comparison, LY0.5 and LY1 cleared all tissues, including the brain, of C. albicans. These in vivo findings were consistent with the results of in vitro time-kill assays. A dose-dependent effect of altered cell wall morphology was observed among UCs and animals treated with LY0.1, and LY0.25, with a progressive transition from hyphal structure to disrupted yeast forms. Serum creatinine levels were higher and serum potassium levels were lower in AmB-treated rabbits than in UCs and LY- and FLU-treated rabbits. LY0.5 and LY1 were well tolerated, displayed predictable pharmacokinetics in plasma, and had activities comparable to those of AmB and FLU in the treatment of disseminated candidiasis in persistently neutropenic rabbits.     

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses’ and the midwives’ opinion

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety.

Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses’ and midwives’ opinion about patient safety issues. The overall response rate in the survey was 100% (n?=?233).

Results: The analysis of the dimensions of safety on the unit level showed that the respondents’ most positive evaluations were in the Organizational Learning – Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions.

Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level – Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.     

Initial neonatal resuscitation: skill retention after the implementation of the novel 24/7 HybridLab® learning system

Background: Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique – the HybridLab^® learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later – by a remote instructor.

Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014–2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab^® technique at 6 and 12 months after the completion of the cycle.

Summary of results: After 6 and 12 months, mean changes in the subjects’ evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p?=?.2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller ?12.7% (SD: 13.8) (p?p?Discussion: The HybridLab^® learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab^® technique for long-time retention of practical skills.

Conclusion: As a result of the application of the HybridLab^® training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.     

Ultrasonography assessment of heel entheses in patients with spondyloarthritis: a comparative study with magnetic resonance imaging and conventional radiography

The aim of the present study was to determine the agreement between ultrasonography (US), magnetic resonance imaging (MRI), and conventional radiography (CR) in the detection of findings indicative of enthesopathy in spondyloarthritis (SpA) patients. A cross-sectional study was performed in 40 SpA patients. Heel entheses (Achilles tendon and plantar fascia) were bilaterally examined by US, MRI, and CR. The three imaging modalities were carried out by three independent operators blinded to the other imaging modality data. Soft tissue abnormalities indicative of enthesopathy as thickening, structural changes, and bursitis were assessed by both US and MRI, and cortical bone abnormalities indicative of enthesopathy as erosions and enthesophytes were assessed by the three imaging modalities. The unweighted kappa values between US and MRI were 0.80, 0.66, 0.69, 0.70, and 0.70 for thickening, structural changes, bursitis, enthesophytes, and bone erosions, respectively. With respect to the detection of enthesophytes, the unweighted kappa values between CR and both US and MRI were 0.78 and 0.76, respectively. At last, for the recognition of bone erosions, the unweighted kappa values between CR and both US and MRI were 0.38 and 0.45, respectively. Using MRI as standard reference method, US was more sensitive with respect to CR revealing bone erosions. The present study provides evidence about the high overall agreement between US and MRI for all abnormal comparable findings at entheseal level and between US, MRI, and CR for the detection of enthesophytes in SpA patients.     

Hepatitis C virus genotypes in injecting drug users from Romania

Due to the increasing number of infections related to injecting drug use, both the pattern of hepatitis C virus (HCV) transmission, and the circulating genotypes in Europe have changed. As there are little available data in this respect for Romania, the aim of our study was a preliminary analysis of the distribution of HCV genotypes circulating among injecting drug users (IDUs). Of the 45 IDUs evaluated (86.7% men, mean age − 27.6 ± 3.7 years, mean age at first drug use − 17.5 ± 3.9 years), 88.9% presented anti-HCV antibodies, with higher rates in those with an injecting history of more than 10 years; 57.8% of the subjects had detectable HCV viral load. Only 6.7% had markers of chronic hepatitis B infection, and none had anti-HIV antibodies. While HCV subtype 1b is still prevalent (in 50% of the viraemic subjects), other subtypes begin to emerge, especially in younger patients (1a — in 23.1%, 4 — in 11.5%, 3a — in 7.7% of the cases). These data indicate the possibility of major shifts in the distribution of the dominant subtype, underlining the need for close surveillance of HCV infections in IDUs, who can act as a bridging group toward the general population.