Short length of stay and the discharge process: Preparing breast cancer patients appropriately

ObjectiveBreast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients’ satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation.MethodsData of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses.ResultsThe majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge.ConclusionAs hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient’s rating of LOS.Practice ImplicationsThe study results underscore the importance of ensuring the quality and thoroughness of the discharge process.     

A protocol for quantifying cardiogenic oscillations in dynamic 129Xe gas exchange spectroscopy: The effects of idiopathic pulmonary fibrosis

The spectral parameters of hyperpolarized ¹²⁹Xe exchanging between airspaces, interstitial barrier, and red blood cells (RBCs) are sensitive to pulmonary pathophysiology. This study sought to evaluate whether the dynamics of ¹²⁹Xe spectroscopy provide additional insight, with particular focus on quantifying cardiogenic oscillations in the RBC resonance. ¹²⁹Xe spectra were dynamically acquired in eight healthy volunteers and nine subjects with idiopathic pulmonary fibrosis (IPF). ¹²⁹Xe FIDs were collected every 20 ms (T_E = 0.932 ms, 512 points, dwell time = 32 μs, flip angle ≈ 20°) during a 16 s breathing maneuver. The FIDs were pre‐processed using the spectral improvement by Fourier thresholding technique (SIFT) and fit in the time domain to determine the airspace, interstitial barrier, and RBC spectral parameters. The RBC and gas resonances were fit to a Lorentzian lineshape, while the barrier was fit to a Voigt lineshape to account for its greater structural heterogeneity. For each complex resonance the amplitude, chemical shift, linewidth(s), and phase were calculated. The time‐averaged spectra confirmed that the RBC to barrier amplitude ratio (RBC:barrier ratio) and RBC chemical shift are both reduced in IPF subjects. Their temporal dynamics showed that all three ¹²⁹Xe resonances are affected by the breathing maneuver. Most notably, several RBC spectral parameters exhibited prominent oscillations at the cardiac frequency, and their peak‐to‐peak variation differed between IPF subjects and healthy volunteers. In the IPF cohort, oscillations were more prominent in the RBC amplitude (16.8 ± 5.2 versus 9.7 ± 2.9%; P = 0.008), chemical shift (0.43 ± 0.33 versus 0.083 ± 0.05 ppm; P < 0.001), and phase (7.7 ± 5.6 versus 1.4 ± 0.8°; P < 0.001). Dynamic ¹²⁹Xe spectroscopy is a simple and sensitive tool that probes the temporal variability of gas exchange and may prove useful in discerning the underlying causes of its impairment.     

Single breath‐hold measurement of pulmonary gas exchange and diffusion in humans with hyperpolarized 129Xe MR

Pulmonary diseases usually result in changes of the blood‐gas exchange function in the early stages. Gas exchange across the respiratory membrane and gas diffusion in the alveoli can be quantified using hyperpolarized ¹²⁹Xe MR via chemical shift saturation recovery (CSSR) and diffusion‐weighted imaging (DWI), respectively. Generally, CSSR and DWI data have been collected in separate breaths in humans. Unfortunately, the lung inflation level cannot be the exactly same in different breaths, which causes fluctuations in blood‐gas exchange and pulmonary microstructure. Here we combine CSSR and DWI obtained with compressed sensing, to evaluate the gas diffusion and exchange function within a single breath‐hold in humans. A new parameter, namely the perfusion factor of the respiratory membrane (SVR_d/g), is proposed to evaluate the gas exchange function. Hyperpolarized ¹²⁹Xe MR data are compared with pulmonary function tests and computed tomography examinations in healthy young, age‐matched control, and chronic obstructive pulmonary disease human cohorts. SVR_d/g decreases as the ventilation impairment and emphysema index increase. Our results indicate that the proposed method has the potential to detect the extent of lung parenchyma destruction caused by age and pulmonary diseases, and it would be useful in the early diagnosis of pulmonary diseases in clinical practice.     

A comprehensive compilation of 1001 nucleotide sequences coding for proteins from the yeast Saccharomyces cerevisiae (=ListA2)

Summary The amount of nucleotide sequence data is increasing exponentially. We therefore continued our effort to make a comprehensive database for the yeast Saccharomyces cerevisiae. In this database (ListA2) we have compiled 1001 protein coding sequences from this organism. Each sequence has been attributed a single genetic name and in the case of allelic duplicated sequences, synonyms are given, if necessary. For the nomenclature we have introduced a standard principle for naming gene sequences based on priority rules. We have also applied a simple method to distinguish duplicated sequences of one and the same gene from non-allelic sequences of duplicated genes. By using these principles we have sorted out a lot of confusion in the literature and databanks. Along with the genetic name, the mnemonic from the EMBL databank, the codon bias, reference of the publication of the sequence and the EMBL accession numbers are included for each entry. The database is available on request.     

优化密码促进HPV 6b E7蛋白表达及DNA疫苗诱导的细胞免疫反应

目的：探讨优化密码对人乳头瘤病毒6b型（HPV 6b）基因表达及免疫原性的影响，为治疗性DNA疫苗的研究奠定基础。方法：设计合成含优化密码及pRB结合位点突变的HPV 6bE7(humE7）全长基因。测序验证无误后，定向克隆于pcDNA3的Kpn I和EcoR I位点，成功构建真核表达质粒pcDNA3-hu-mE7。体外转染COS－1细胞，免疫荧光检测其E7蛋白表达。C57BL／6小鼠胫前肌内接种裸DNA，观察其诱导的细胞免疫反应。结果：pcDNA3-hu-mE7在COS－1细胞获得明显表达，表达产物主要位于细胞核中。DNA免疫结果显示，与含有野生型E7基因的表达质粒pcDNA3-wtE7比较，pcDNA3-hu-mE7免疫小鼠脾细胞培养上清中IFN-γ产生明显升高，CD8^ 和CD4^ 淋巴细胞活性增强。结论：优化密码能促进HPV 6b E7蛋白表达及DNA疫苗诱导的细胞免疫反应。