Recombinant Clostridium difficile Toxin Fragments as Carrier Protein for PSII Surface Polysaccharide Preserve Their Neutralizing Activity

Clostridium difficile is a Gram-positive bacterium and is the most commonly diagnosed cause of hospital-associated and antimicrobial-associated diarrhea. Despite the emergence of epidemic C. difficile strains having led to an increase in the incidence of the disease, a vaccine against this pathogen is not currently available. C. difficile strains produce two main toxins (TcdA and TcdB) and express three highly complex cell-surface polysaccharides (PSI, PSII and PSIII). PSII is the more abundantly expressed by most C. difficile ribotypes offering the opportunity of the development of a carbohydrate-based vaccine. In this paper, we evaluate the efficacy, in naive mice model, of PSII glycoconjugates where recombinant toxins A and B fragments (TcdA_B2 and TcdB_GT respectively) have been used as carriers. Both glycoconjugates elicited IgG titers anti-PSII although only the TcdB_GT conjugate induced a response comparable to that obtained with CRM₁₉₇. Moreover, TcdA_B2 and TcdB_GT conjugated to PSII retained the ability to elicit IgG with neutralizing activity against the respective toxins. These results are a crucial proof of concept for the development of glycoconjugate vaccines against C. difficile infection (CDI) that combine different C. difficile antigens to potentially prevent bacterial colonization of the gut and neutralize toxin activity.     

Residual perfusion defects in patients with pulmonary embolism are related to impaired fibrinolytic capacity

Background

Few studies investigated the relationship between fibrinolysis abnormalities and residual pulmonary perfusion defects after acute pulmonary embolism (PE).

Objective

To assess the fibrinolytic profile in patients with prior PE in relation to the extent of scintigraphically detectable residual perfusion abnormalities.

Patients and methods

We studied 71 consecutive patients with a prior episode of PE, who were examined after one year of the incident embolic event, and at least one month after anticoagulation withdrawal. They underwent lung scintigraphy to assess the recovery of pulmonary perfusion, echocardiography and chest radiography to look for signs of pulmonary hypertension. Clot formation and lysis were evaluated by two turbidimetric methods: Clot and Lysis Assay and Clot Lysis Time. We also measured the in vitro plasmin-mediated lysis of fibrin from purified fibrinogen, and the circulating levels of fibrinolytic inhibitors. The sample was split in two categories based on the extent of residual perfusion defects: < 10% (n = 53), ≥ 10% (n = 18).

Results

Patients with perfusion defects > 10% had significantly longer lysis time (p < 0.05), and higher levels of plasminogen activator inhibitor-1 (p < 0.01) than those with perfusion defects < 10%. The time interval between symptoms onset and PE diagnosis (time-to-diagnosis) was significantly longer in patients with perfusion defects > 10% than in the others (p = 0.005). In multivariate logistic regression, both lysis time and time-to-diagnosis were independently associated with perfusion defects > 10% (p < 0.001). None of the sampled patients had echocardiographic or radiologic signs of pulmonary hypertension.

Conclusion

Prolonged time-to-diagnosis and fibrinolysis imbalance are independent predictors of incomplete perfusion recovery after acute PE.     

Clinical nurses' perception of continuing professional education as a tool for quality service delivery in public hospitals Calabar,Cross River State,Nigeria

This study was conducted to determine the perception of nurses on various aspects of continuing professional education (CPE). A mixed method design (quantitative/qualitative) was adopted. A self-explanatory, semi-structured questionnaire was validated and used to collect data in addition to unstructured interview. One hundred and fifty nurses were selected through stratified random sampling from two hospitals in Calabar, Nigeria and served as participants. Participants generally perceived CPE as valuable and worthwhile and participated because it is mandatory and helps them to retain their jobs. The content of CPE were perceived to be more relevant for clinicians than for nurse educators; clinical skills and quantitative research methodology were adequately covered while evidence-based practice, attitudinal issues, nursing theories and patient safety were inadequately covered. CPE was perceived to be fragmented without gaining points, follow-up monitoring and evaluation after CPE which make it difficult to objectively assess the influence of CPE on quality of care. It is recommended that nurse leaders in Nigeria should develop online CPE modules for nursing, and allocate points to them so that participation may contribute to career progression. Effective monitoring and evaluation systems should be put in place to assess impact of CPE on staff competence and patient outcomes.     

Feeder-free culture of human embryonic stem cell line BG01V/hOG using magnetic field-magnetic nanoparticles system

Purpose

Human embryonic stem (hES) cells are useful tools for regenerative medicine. Maintaining hES cells for research and clinical purposes remains a challenge. The hES cells have typically been grown on a mouse or human cell feeder layer, but these methods harbor potential health problems for the recipient. A culture system using magnetic field and iron oxide nanoparticles were previously demonstrated to sustain mouse embryonic stem cells in vitro. Now, by using the BG01v/hOG cell line, we could assess the effect of this culture system on the stemness of an embryonic stem cell of human origin.

Methods

Using a variant hES cell line, BG01V/hOG, expressing an emerald green fluorescent protein (EmGFP), we grown these cells in the presence of serum-free medium supplemented with magnetic nanoparticles functionalized with citrate. The cells were positioned over a circular magnet (4000 Gauss) and monitored daily by fluorescence microscopy.

Results

We discovered that hES cells can proliferate when labeled with magnetic nanoparticles and in the presence of a magnetic field without losing pluripotency.

Conclusion

These results establish an alternative method for maintaining hES cells which would minimize health concerns as well as label cells for subsequent clinical tracking.     

Norms of German Adolescents for the Harvard Group Scale of Hypnotic Susceptibility,Form A

The Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) has not been explicitly tested on an adolescent population. In this study, the German version of the HGSHS:A was administered to 99 German adolescents aged 15 to 19. In contrast to other studies, the gender distribution was relatively balanced: 57% female and 43% male. Results were comparable to 14 earlier studies with regard to distribution, mean, and standard deviation. Some peculiarities in contrast to the 14 previous studies are pointed out. It is concluded that the HGSHS:A can be used as a valid and reliable instrument to measure hypnotic suggestibility in adolescent samples.     

The quality of work life of registered nurses in Canada and the United States: a comprehensive literature review

Background: Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses.

Objective: The aim of this paper was to perform a comprehensive literature review on nurses’ quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada.

Methods: Using publications from 2004–2014, contributing factors to American and Canadian nurses’ QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis.

Results: Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses’ quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation.

Conclusions: This review’s findings support the importance of QWL as an indicator of nurses’ broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.     

Doctors,patients and the racial mortality gap

Research in the health sciences reports persistent racial differences in health care access, utilization, and outcomes. This study investigates three potential sources of these disparities – differential quality of care, physician discrimination, and patient response to therapy. It uses a unique panel dataset of physician–patient encounters, the resulting medication therapies and the patients’ adherence to those medical recommendations. Equalizing access to quality health care will not erase the racial differences in mortality among chronically ill patients. Targeted programs aimed at improving adherence with medication therapy among disadvantaged groups must be an integral part of any policy aimed at achieving equality in health outcomes.     

Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function

Purpose

Exercise training might exert its beneficial effects on myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. We evaluated whether long-term exercise-based cardiac rehabilitation started early after ST-elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function.

Methods

Forty-six patients with recent STEMI and residual inducible hypoperfusion were randomized into two groups: 25 enrolled in a 6-month outpatient exercise-based cardiac rehabilitation programme (group T) and 21 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and dipyridamole rest gated myocardial perfusion single photon emission computed tomography within 1 week after STEMI and at 6-month follow-up.

Results

At follow-up, group T showed an improvement in peak oxygen consumption, oxygen pulse and in the slope of increase in ventilation over carbon dioxide output (all p?<?0.01) associated with a reduction of stress-induced hypoperfusion (p?<?0.01) and an improvement in resting and post-stress wall motion score indexes (both p?<?0.01), resting and post-stress wall thickening score indexes (both p?<?0.05) and resting and post-stress LV ejection fraction (both p?<?0.05). On the contrary, no changes in cardiopulmonary indexes, myocardial perfusion and LV function parameters were observed in group C at follow-up.

Conclusion

Exercise training started early after STEMI reduces stress-induced hypoperfusion and improves LV function and contractility. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with an improvement of cardiovascular functional capacity.     

Association between thromboembolic events and COVID-19 infection within 30 days: a case–control study among a large sample of adult hospitalized patients in the United States,March 2020–June 2021

Journal of Thrombosis and Thrombolysis - The association between thromboembolic events (TE) and COVID-19 infection is not completely understood at the population level in the United States. We...