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Abstract Background Estrogen receptors express in nearly 70% of breast cancers (ER-positive). Estrogen receptor alpha plays a fundamental role as a significant factor in breast cancer progression for the early selection of therapeutic approaches. Accordingly, there has been a surge of attention to non-invasive techniques, including circulating Cell-free DNA (ccfDNA) or Cell-Free DNA (cfDNA), to detect and track ESR1 genotype. Therefore, this study aimed to examine the diagnosis accuracy of ESR1 mutation detection by cell-free DNA in breast cancer patientsthrough a systematic review and comprehensive meta-analysis. Methods PubMed, Embase, and Web of Science databases were searched up to 6 April 2022. Diagnostic studies on ESR1 measurement by cfDNA, which was confirmed using the tumour tissue biopsy, have been included in the study. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were considered to analyse the data. Results Out of 649 papers, 13 papers with 15 cohorts, including 389 participants, entered the meta-analyses. The comprehensive meta-analysis indicated a high sensitivity (75.52, 95% CI 60.19–90.85), specificity (88.20, 95% CI 80.99–95.40), and high accuracy of 88.96 (95% CI 83.23–94.69) for plasma ESR1. We also found a moderate PPV of 56.94 (95% CI 41.70–72.18) but a high NPV of 88.53 (95% CI 82.61–94.44). We also found an NLR of 0.443 (95% CI 0.09–0.79) and PLR of 1.60 (95% CI 1.20–1.99). Conclusion This systematic review and comprehensive meta-analysis reveal that plasma cfDNA testing exhibits high sensitivity and specificity in detecting ESR1 mutations in breast cancer patients. This suggests that the test could be a valuable diagnostic tool. It may serve as a dependable and non-invasive technique for identifying ESR1 mutations in breast cancer patients. However, more extensive research is needed to confirm its prognostic value.

Abstract Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010–2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users’ function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users’ needs.

Abstract Background The exponential spread of COVID-19 has caused a huge threat to public health worldwide. Providing care for patients with COVID-19 is a stressful experience for ICU nurses, which can affect their protective reactions. The present study was conducted to explore the protective reactions of ICU nurses providing care for patients with COVID-19. Methods This qualitative descriptive study was conducted to discover the protective reactions of nurses providing care for patients with COVID-19. A total of 14 ICU nurses were selected by purposive sampling. Data were collected using individual semi-structured face-to-face interviews. All interviews were recorded, and then codes and themes were extracted using content analysis method. Finding Seventeen subcategories, six categories and two themes were extracted from the analysis of data. These themes include “Unbalanced self-protective reactions” and “Responsible self-protective reactions”. Conclusion During the COVID-19 epidemic and crisis, ICU nurses exhibit different self-protective reactions when providing care for patients with COVID-19, which include unbalanced and responsible reactions. Nursing managers can mitigate these unbalanced reactions by identifying them and their roots. Identifying the protective reactions of ICU nurses in providing care for patients with COVID-19 could assist in developing the necessary interventions to promote positive reactions and reduce unbalanced reactions by finding their root causes.

Abstract Background In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis. It is important to address mental health needs and not to ignore the psychological dimension in this group of patients. In this regard, the first practical step is to have a clear understanding of patients’ psychological issues. Therefore, this study aimed to explore the psychological disturbances of COVID-19 survivors throughout the disease crisis. Method This qualitative study was conducted using a phenomenological approach through 14 individual semi-structured in-depth interviews with patients recovered from COVID-19. Data were analyzed using Colaizzi’s seven-step method. Results Three themes of “living in limbo”, “psychological distress behind the wall” and “psychological burden of being a carrier” were extracted as the psychological disturbances of COVID-19 survivors throughout the disease crisis. Conclusion This study portrayed a better understanding of psychological disturbances of COVID-19 survivors throughout the disease crisis based on their lived experiences. Given the ambiguity in the time of the disease eradication and its continuing course, a deep understanding of these experiences in the current critical situation can help healthcare officials to make appropriate decisions and take measures to assess and identify psychological traumas and perform interventions to improve the mental state of these patients.

Abstract Background Measurement of serum human epidermal growth factor receptor-2 (HER-2/neu) levels might play an essential role as a diagnostic/screening marker for the early selection of therapeutic approaches and predict prognosis in breast cancer patients. We aimed to undertake a systematic review and meta-analysis focusing on the diagnostic/screening value of serum HER-2 levels in comparison to routine methods. Methods We performed a systematic search via PubMed, Scopus, Cochrane-Library, and Web of Science databases for human diagnostic studies reporting the levels of serum HER-2 in breast cancer patients, which was confirmed using the histopathological examination. Meta-analyses were carried out for sensitivity, specificity, accuracy, area under the ROC curve (AUC), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Results Fourteen studies entered into this investigation. The meta-analysis indicated the low sensitivity for serum HER2 levels (Sensitivity: 53.05, 95%CI 40.82–65.28), but reasonable specificity of 79.27 (95%CI 73.02–85.51), accuracy of 72.06 (95%CI 67.04–77.08) and AUC of 0.79 (95%CI 0.66–0.92). We also found a significant differences for PPV (PPV: 56.18, 95%CI 44.16–68.20), NPV (NPV: 76.93, 95%CI 69.56–84.31), PLR (PLR: 2.10, 95%CI 1.69–2.50) and NLR (NLR: 0.58, 95%CI 0.44–0.71). Conclusion Our findings revealed that although serum HER-2 levels showed low se nsitivity for breast cancer diagnosis, its specificity, accuracy and AUC were reasonable. Hence, it seems that the measurement of serum HER-2 levels can play a significant role as a verification test for initial negative screening test results, especially in low-income regions due to its cost-effectiveness and ease of implementation.

Abstract Objective Drilling of calcified plaque (DCP) inside the artery is a method for removing calcified plaques. This study investigated the effect of drill. To validate the maximum temperature calculated by computer simulation, this value was also measured by an experimental on a phantom model. Results Increasing drill bit diameter during drilling would increase the temperature in vascular nerves. In a drill bit with a diameter of 4 mm, the risk of thermal necrosis in vascular nerves of the artery wall decreased by 8.57% by changing the drill from WC to NT. The same value for a drill bit with a diameter of 6 mm was 10.17%. However, the trend of the generated temperature in the vascular nerves did not change significantly with change of the material and diameter of the drill bit. The results showed that for DCP with the least risk of thermal necrosis in vascular nerves and subsequently the lowest risk of restenosis, coagulation and thermal stroke of the patient, the best option is to use a drill bit with a diameter of 4 mm and NT material for drilling.

Abstract Background Neonatal hyperbilirubinemia has traditionally been screened by either total serum bilirubin or transcutaneous bilirubin. Whole blood bilirubin (TwB) by the GEM Premier 4000® blood gas analyzer (GEM) is a relatively new technology and it provides fast bilirubin results with a small sample volume and can measure co-oximetry and other analytes. Our clinical study was to evaluate the reliability of TwB measured by the GEM and identify analytical and clinical factors that may contribute to possible bias. Methods 440 consecutive healthy newborn samples that had plasma bilirubin ordered for neonatal hyperbilirubinemia screening were included. TwB was first measured using the GEM, after which the remainder of the blood was spun and plasma neonatal bilirubin was measured using the VITROS 5600® (VITROS). Results 62 samples (14%) were excluded from analysis due to failure in obtaining GEM results. Passing-Bablok regression suggested that the GEM results were negatively biased at low concentrations of bilirubin and positively biased at higher concentrations relative to the VITROS results (y = 1.43x-61.13). Bland-Altman plots showed an overall negative bias of the GEM bilirubin with a wide range of differences compared to VITROS. Both hemoglobin concentration and hemolysis affected the accuracy of the GEM results. Clinically, male infants had higher mean bilirubin levels, and infants delivered by caesarean section had lower hemoglobin levels. When comparing the number of results below the 40th percentile and above the 95th percentile cut-offs in the Bhutani nomogram which would trigger discharge or treatment, GEM bilirubin exhibited poor sensitivity and poor specificity in contrast to VITROS bilirubin. Conclusions An imperfect correlation was observed between whole blood bilirubin measured on the GEM4000® and plasma bilirubin on the VITROS 5600®. The contributors to the observed differences between the two instruments were specimen hemolysis and the accuracy of hemoglobin measurements, the latter of which affects the calculation of plasma-equivalent bilirubin. Additionally, the lack of standardization of total bilirubin calibration particularly in newborn specimens, may also account for some of the disagreement in results.