Circadian Rhythmicity as a Predictor of Quality of Life in Allogeneic Hematopoietic Cell Transplant Patients

Context

Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.

Assessment and management of the predicted difficult airway in babies and children

Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.     

Contraception in autoimmune diseases

Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course.Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditions in which they are contraindicated. Early studies indicated a positive effect on rheumatoid arthritis (RA), whereas more recent trials failed to do so, possibly because of the lowering of oestrogen content. Evidence of effects on multiple sclerosis (MS) is conflicting: risk may vary depending on the progestin used. Minor adverse effects may exist on inflammatory bowel diseases, and no significant effect was found on autoimmune thyroid diseases. Women can become sensitised to sex hormones.Progestin-only contraceptives may be used, although copper-releasing intra-uterine devices represent the best option.Finally, several organisations have issued guidelines for contraceptive use in women with AIDs.     

Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis

Aim: Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis.

Material: From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed.

Results: Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count Conclusion: Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.     

Delivery of an inactivated avian influenza virus vaccine adjuvanted with poly(D,L-lactic-co-glycolic acid) encapsulated CpG ODN induces protective immune responses in chickens

In poultry, systemic administration of commercial vaccines consisting of inactivated avian influenza virus (AIV) requires the simultaneous delivery of an adjuvant (water-in-oil emulsion). These vaccines are often limited in their ability to induce quantitatively better local (mucosal) antibody responses capable of curtailing virus shedding. Therefore, more efficacious adjuvants with the ability to provide enhanced immunogenicity and protective anti-AIV immunity in chickens are needed. While the Toll-like receptor (TLR) 21 agonist, CpG oligodeoxynucleotides (ODNs) has been recognized as a potential vaccine adjuvant in chickens, poly(D,L-lactic-co-glycolic acid) (PLGA) nanoparticles, successfully tested as vaccine delivery systems in other species, have not been extensively explored. The present study, therefore, assessed both systemic and mucosal antibody-mediated responses following intramuscular vaccination (administered at 7 and 21 days post-hatch) of chickens with PLGA encapsulated H9N2 AIV plus encapsulated CpG ODN 2007 (CpG 2007), and nonencapsulated AIV plus PLGA encapsulated CpG 2007 vaccine formulations. Virus challenge was performed at 2 weeks post-secondary vaccination using the oculo-nasal route. Our results showed that chickens vaccinated with the nonencapsulated AIV vaccine plus PLGA encapsulated CpG 2007 developed significantly higher systemic IgY and local (mucosal) IgY antibodies as well as haemagglutination inhibition antibody titres compared to PLGA encapsulated AIV plus encapsulated CpG 2007 vaccinated chickens. Furthermore, chickens that received CpG 2007 as an adjuvant in the vaccine formulation had antibodies exhibiting higher avidity indicating that the TLR21-mediated pathway may enhance antibody affinity maturation qualitatively. Collectively, our data indicate that vaccination of chickens with nonencapsulated AIV plus PLGA encapsulated CpG 2007 results in qualitatively and quantitatively augmented antibody responses leading to a reduction in virus shedding compared to the encapsulated AIV plus PLGA encapsulated CpG 2007 formulation.     

硬膜外阻滞麻醉对临床无痛分娩效果与分娩方式及母婴健康影响

目的分析硬膜外阻滞麻醉对临床无痛分娩效果与分娩方式及母婴健康影响。方法选取2016年12月～2017年10月在本院妇产科进行分娩的初产孕妇226例,随机分为对照组与研究组,对照组孕妇113例,进行自然分娩,即不采取麻醉止痛措施。研究组孕妇113例,对其硬膜外阻滞麻醉进行无痛分娩。比较两组初产孕妇的镇痛分娩效果、分娩方式、血流动力学动态、母婴健康情况,并在手术前1 d、2 d、3 d使用简易精神状态量表评分对初产孕妇进行认知功能评估。结果两组初产孕妇在镇痛前、宫口开3 cm、6 cm、全开时以及胎儿出生时的无痛分娩效果显示,研究组在各时点的镇痛效果与对照组比较,差异有统计学意义(P0.05);研究组中阴道助产、自然分娩与剖宫产例数与对照组比较,差异有统计学意义(P0.05);记录两组初产孕妇宫口开3 cm、6 cm、全开时以及胎儿出生时的HR、MAP及SpO_2等血流动力学指标,结果显示研究组中各指标与对照组比较,差异均无计学意义(P0.05);研究组婴儿脐静脉血血气中pH值、PO_2、PCO_2、HCO~(3-)与对照组比较,差异均无统计学意义(P0.05),研究组婴儿Apgar评分与对照组比较较,差异无统计学意义(P0.05);研究组初产孕妇中出现产后出血、产后4 h排尿、会阴裂伤情况与对照组比较,差异均有统计学意义(P0.05);研究组的MMSE评分与对照组比较,差异无统计学意义(P0.05)。结论硬膜外阻滞麻醉对临床无痛分娩效果更为显著,剖宫产概率低,无认知功能障碍且不影响母婴健康。     

Prendre en compte le lien entre la vision et la motricité dans la démarche thérapeutique – Collaboration entre professionnels

Vision and motor skills are intimately linked, both in their own development and functionally. The solicitation of one can therefore promote the development of the other. The various professionals of motor skills (physiotherapist, psychomotor therapists, occupational therapists) and the orthoptists are called upon to integrate these aspects in the follow-up of the patients, as well in the guides as in the installations.     

Innovation in Chemistry,Manufacturing, and Controls—A Regulatory Perspective From Industry

This review describes the landscape of novel modalities such as cell and gene therapies, viruses, other novel biologics, oligomers, and emerging technologies, including modern analytics. We summarize the regulatory history and recent landmark developments in some major markets and examine specific chemistry, manufacturing, and controls (CMC) challenges, including suggestions for exploration of potential science-based approaches in support of regulatory strategy development from an industry perspective. In addition, we evaluate the economic factors contributing to patient access to innovation and discuss the impact of regulation. There is a desperate need for a consistent form of regulation where global approaches to regulatory strategies can be harmonized, and specific CMC challenges can be dealt with using the appropriate science and risk-based tools. Although these tools are well described in current guidance documents, the specifics of applicability to complex novel modalities can still result in differing regulatory advice and outcomes. The future goals for efficiently regulating innovative modalities and technologies could be aided by more regulatory harmonization, regulatory education, and industry cooperation through consortia, enabling industry to supply key information to regulators in a transparent yet well-defined manner, and utilizing mutually understood risk-benefit analyses to produce drugs with appropriate safety, efficacy, and quality characteristics.     

A qualitative study on participants’ experiences with a community-based mindful walking intervention and mobile device activity measurement

BackgroundMindful walking (MW) interventions employ mindfulness training combined with physical activity. Wearable mobile devices have been increasingly used to measure outcomes of physical activity interventions. The purpose of this study was to understand MW participants’ attitudes towards MW and the use of mobile devices in health promotion interventions, including barriers and facilitators of intervention engagement and adherence. Few qualitative studies have documented participant experience with these two types of interventions.MethodThe pilot study involved a randomized MW intervention including 38 participants with self-reported inadequate physical activity. Half of them were randomized to receive MW intervention plus a FitBit device and the other received the FitBit device only. We used a qualitative thematic analysis of the narrative data collected through open-ended survey questions at three time points. Participants in the MW intervention were asked to describe their experiences with MW, while all participants were asked to describe their experience with wearing the FitBit to track their step counts. Results: Participants reported a broad range of perceived benefits and challenges related to adopting the MW intervention and using the mobile device. Participants were generally willing to try to adopt the recommended MW practice and to see value of MW in increasing physical activity and improving overall health. Participants reported using a variety of additional device features beyond goal setting and step counts, indicating using the devices may have been effective in providing additional motivation for participants in meeting physical activity goals in both the control and intervention groups. While most of the feedback about MW (in the intervention group) and the device (all participants) was overwhelmingly positive, a minority of participants reported barriers such as lack of patience with meditation and discomfort with wearing the device.ConclusionMost participants in the MW intervention see the health benefits of this program and most participants using the wearable physical activity tracking device reported the motivational benefits of this device. Issues with the MW intervention (e.g., lack of patience) and the wearable device (e.g., discomfort with wearing) need to be addressed in future interventions.     

Wearable activity trackers and health awareness: Nursing implications

PurposeWearable devices are commonly used to measure physical activity. However, it remains unclear the effect of wearing these devices on health awareness. Our aim was to provide evidence related to wearing physical activity trackers and health awareness.MethodsA quantitative comparison study design was used comparing participants who wore physical activity tracking devices (n = 108) and those who did not (n = 112). A paper-based Physical Health Knowledge survey designed for the purpose of this research was used for data collection in 2018.ResultsA difference between participants who wore physical activity tracking devices and those that did not was identified in relation to activity levels and physical health awareness. Wearable devices are suggested as an opportunity for nurses to engage people in physical activity with the potential to improve their health awareness.ConclusionsNurses are well placed in the healthcare landscape to work with patients who own an activity tracker device concerning increasing activity self-monitoring. This information the patient has from the device can also form the basis of health discussions between nurses and the people in their care.