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Objectives: The purpose of the study is to investigate body awareness and body image perception of patients with type 2 diabetes mellitus (T2DM) and to explore the association between clinical parameters and body awareness. Methods: A total of 92 participants with T2DM (38 women and 54 men) aged 36–76 years were recruited. Biochemical measurements, including fasting blood glucose, postprandial blood glucose and hemoglobin A1c (HbA1c), were obtained from the patients’ blood sample records. The Body Awareness Questionnaire (BAQ), Body Cathexis Scale (BCS) and Awareness Body Chart (ABC) were filled in by all subjects. Results: Most participants had an above-average BAQ (81.5%) and BCS (87%) score. There was a significant correlation between body mass index and ABC pain subscale. HbA1c was significantly associated with the duration of diabetes and sleep-wake cycle, process domains and total BAQ score. The body awareness score for the lower leg and foot regions (ABC parts) was negatively correlated with fasting blood glucose and HbA1c levels, while body awareness in the foot region was negatively correlated with the duration of diabetes. There was no association between BCS and any clinical parameters. Conclusion: This study showed that body awareness is associated with diabetes-related clinical parameters, such as fasting blood glucose and HbA1c levels, and duration of diabetes in patients with T2DM. Following diabetes progression and an increase in blood glucose levels, body awareness tended to decrease, particularly in the lower leg and foot regions. These findings highlighted the importance of evaluating body awareness in patients with T2DM. © 2023 Elsevier Ltd

BACKGROUND High levels of inflammation pre- and post-percutaneous coronary intervention (PCI) are associated with worse outcomes. Recent trials have suggested a benefit from treating inflammation with colchicine in coronary artery disease. In this randomised pilot COPE-PCI sub-study, we aimed to determine if administration of colchicine pre-PCI, would attenuate the inflammatory effect of PCI. METHODS PCI patients were randomised to colchicine or placebo, 6 to 24-hours pre-procedure. Study blood samples were taken immediately pre-PCI, and 24-hours post-procedure. Samples were tested for a broad array of inflammatory biomarkers including high-sensitive(hs)-CRP, leucocyte counts, and hs-troponin-. Periprocedural Myocardial Injury (PM-Injury) was defined as per the ESC Third Universal Definitions of Myocardial Infarction. RESULTS Thirty-six were randomised to colchicine and 39 to placebo. Treatment groups were similar for baseline variables. The median time from drug administration to pre-PCI blood sampling was 18-hours. Overall inflammation was low across the patient population, pre- & post-PCI hsCRP was

Background Intravascular imaging has defined various vulnerable plaque (VP) phenotypes that predict future clinical events. Atherosclerosis is an inflammatory process and inflammation, measured by systemic biomarkers can also predict events and anti-inflammatory therapy is beneficial. We were interested to assess the relationship between plaque phenotypes and key inflammatory biomarkers, measured close to the coronary. Methods Ninety-two patients scheduled for elective percutaneous coronary intervention (PCI) underwent virtual histology intravascular ultrasound, optical coherence tomography, pressure wire and blood sampling from the guide catheter (GC), coronary sinus (CS) to determine trans-myocardial gradient (TMG = CS-GC) and from peripheral blood. Procedure related troponin release was assessed at 6-hours post-PCI from peripheral venous blood. Biomarker data were analysed and compared with coronary data. Results Interleukin (IL)-6 was associated with increased levels of tumour necrosis factor (TNF)-α and C-reactive protein (CRP) and the pre-PCI IL-6 TMG correlated with plaque features of vulnerability: plaque burden - PB (r = 0.253, p = 0.04) and minimal lumen area - MLA (r = −0.438, p = 0.007), although no relationship existed for thin-capped fibroatheroma defined by either imaging modality. Peripheral IL-6 levels had no correlation with post PCI troponin, although the pre-PCI IL-6 TMG was related (r = 0.334, p = 0.006), as was PB (r = 0.27, p = 0.029). Conclusion IL-6 TMG pre-PCI correlates with plaque burden and MLA that have been shown to predict future clinical events and is correlated with post-PCI troponin release. These associations were not apparent from peripheral blood and suggest that local coronary biomarker signatures may help further define vulnerability and risk.

Background Dried blood spot (DBS) microsampling has gained interest in different clinical fields, owing to its many advantages compared to conventional blood sampling. However, whilst being applied for decades for screening purposes, some challenges, such as the hematocrit (Hct) effect, hinder further widespread use of DBS for quantitative purposes in clinical practice. Amongst the approaches that were developed to cope with this issue, is the Hct prediction of DBS using near-infrared (NIR) spectroscopy. Methods Using left-over EDTA-anticoagulated patient samples, the accuracy and precision, stability, and robustness were assessed. Furthermore, applicability of the method on capillary DBS was evaluated via finger prick samples. Results A maximal bias, respectively CV, of 0.012 L/L and 4.5% were obtained. The method was robust towards several aspects, including storage (except for storage at 60°C), measurement location, type of filter paper and spotted volume. Furthermore, the potential to predict the Hct of capillary DBS was demonstrated. Conclusion A commercially available NIR set-up was extensively and successfully validated, allowing non-contact Hct prediction of DBS with excellent accuracy and precision. This allows to correct for the Hct-based bias observed in partial-punch DBS analysis and the set-up of blood-plasma conversion factors, increasing the application potential of patient-centric sampling.

Background and aims: An association between hypoglycaemia and adverse cardiovascular events has been suggested from longitudinal and retrospective cohort studies. The complement pathway proteins in hypoglycemia are not well studied. Here, we hypothesized that these circulating proteins would be elevated in response to hypoglycemia in type 2 diabetes (T2D) through the inflammatory response. Methods: A prospective, parallel study in T2D (n = 23) and controls (n = 23). Subjects underwent insulin-induced hypoglycemia with blood sampling at baseline, hypoglycemia and post-hypoglycemia; SOMAscan proteomic analysis of complement pathway-related proteins, cytokines and inflammatory proteins was undertaken. Results: At baseline: Complement C2 (p

Objective The study was performed to investigate the effect of two different lancets and heel warming during blood sampling from the heel on procedure duration and crying. Methods This was a randomized controlled trial study. The data were obtained from the Newborn Intensive Care Unit of a hospital in Istanbul between January 2015 and January 2016. One hundred twenty newborns were randomly assigned to four groups — automatic lancet with/without warming and manual lancet with/without warming. The newborns were administered heel puncture for routine blood bilirubin monitoring. Result There was no statistically significant difference between the four groups in terms of the characteristics that could affect the outcome of the study. The infants in the manual lancet group without warming were found to have longer duration of crying and longer procedure durations than the other groups. The procedure durations of infants in the manual lancet group with warming were significantly longer than those in the automatic lancet group with warming. Conclusion This study show that both heel warming and using automatic lancet are effective in reducing the durations of the procedure and crying during blood sampling from the heel.

Introduction Nurses' use of evidence-based pain treatments for newborns during needle-related procedures in China was unknown. This study aimed to ascertain knowledge and use of pain management strategies and usefulness of a publicly accessible 'BSweet2Babies' video, produced in Mandarin, demonstrating the use of breastfeeding, skin-to-skin care (SSC), and sweet solutions during painful procedures. Methods An online survey was conducted during six nursing conferences in China ascertaining nurses' previous viewing of the video and knowledge and use of the demonstrated strategies. Results 221 nurses participated. Only 25 (11.3%) had previously seen the video. Over half knew that breastfeeding (n = 138, 62.4%) and SSC (n = 173, 78.3%) reduced pain, and 89 (40.3%) knew that sucrose reduced pain, but these strategies were infrequently used. Most intended to use the strategies in the future. Discussion A knowledge-to-action gap for newborn pain management was identified. Future research is needed to improve the implementation of effective pain treatment for newborns.

Introduction Arachidonoyl ethanolamide (AEA) and 2-arachidonoyl glycerol (2-AG) are central lipid mediators of the endocannabinoid system. They are highly relevant due to their involvement in a wide variety of inflammatory, metabolic or malign diseases. Further elucidation of their modes of action and use as biomarkers in an easily accessible matrix, like blood, is restricted by their susceptibility to deviations during blood sampling and physiological co-dependences, which results in high variability of reported concentrations in low ng/mL ranges. Objectives The objective of this review is the identification of critical parameters during the pre-analytical phase and proposal of minimum requirements for reliable determination of endocannabinoids (ECs) in blood samples. Methods Reported physiological processes influencing the EC concentrations were put into context with published pre-analytical research and stability data from bioanalytical method validation. Results The cause for variability in EC concentrations is versatile. In part, they are caused by inter-individual factors like sex, metabolic status and/or diurnal changes. Nevertheless, enzymatic activity in freshly drawn blood samples is the main reason for changing concentrations of AEA and 2-AG, besides additional non-enzymatic isomerization of the latter. Conclusion Blood samples for EC analyses require immediate processing at low temperatures (>0 °C) to maintain sample integrity. Standardization of the respective blood tube or anti-coagulant, sampling time point, applied centrifugal force and complete processing time can further decrease variability caused by sample handling. Nevertheless, extensive characterization of study participants is needed to reduce distortion of clinical data caused by co-variables and facilitate research on the endocannabinoid system.

Introduction:\ud Malignant pleural mesothelioma (MPM) is difficult to diagnose. An accurate blood biomarker could prompt specialist referral or be deployed in future screening. In earlier retrospective studies, SOMAscan proteomics (Somalogic, Boulder, CO) and fibulin-3 seemed highly accurate, but SOMAscan has not been validated prospectively and subsequent fibulin-3 data have been contradictory.\ud \ud Methods:\ud A multicenter prospective observational study was performed in 22 centers, generating a large intention-to-diagnose cohort. Blood sampling, processing, and diagnostic assessment were standardized, including a 1-year follow-up. Plasma fibulin-3 was measured using two enzyme-linked immunosorbent assays (CloudClone [used in previous studies] and BosterBio, Pleasanton, CA). Serum proteomics was measured using the SOMAscan assay. Diagnostic performance (sensitivity at 95% specificity, area under the curve [AUC]) was benchmarked against serum mesothelin (Mesomark, Fujirebio Diagnostics, Malvern, PA). Biomarkers were correlated against primary tumor volume, inflammatory markers, and asbestos exposure.\ud \ud Results:\ud A total of 638 patients with suspected pleural malignancy (SPM) and 110 asbestos-exposed controls (AECs) were recruited. SOMAscan reliably differentiated MPM from AECs (75% sensitivity, 88.2% specificity, validation cohort AUC 0.855) but was not useful in patients with differentiating non-MPM SPM. Fibulin-3 (by BosterBio after failed CloudClone validation) revealed 7.4% and 11.9% sensitivity at 95% specificity in MPM versus non-MPM SPM and AECs, respectively (associated AUCs 0.611 [0.557–0.664], p = 0.0015) and 0.516 [0.443–0.589], p = 0.671), both inferior to mesothelin. SOMAscan proteins correlated with inflammatory markers but not with asbestos exposure. Neither biomarker correlated with tumor volume.\ud \ud Conclusions:\ud SOMAscan may prove useful as a future screening test for MPM in asbestos-exposed persons. Neither fibulin-3 nor SOMAscan should be used for diagnosis or pathway stratification.

Background Personal glucose meters, primarily designed for self-control of glucose concentration in patients with diabetes, are frequently used in clinical practice as point-of-care equipment. The procedure of washing hands with water and soap before testing, as recommended by the manufacturer of personal glucose meters, in hospital wards is often difficult to fulfil and is replaced by disinfecting the place of blood sampling with isopropyl alcohol. Aim The purpose of the research was to evaluate the effect of different disinfecting procedures on glycemia measurement in capillary blood using personal glucose meters. Materials and methods Four measurements of glycemia were taken in each of 50-volunteer group using Accu-Check Performa (Roche, Swiss) glucose meter using different procedures: washing hands with soap and drying them (1), disinfection with isopropyl alcohol and waiting for the disinfectant to evaporate (2) and the immediate puncture after disinfection. In the latter case two kind of single-use lancets were use – typical for adult (3) and smaller preferred by diabetics or children (4). Results Paired T-student test showed no statistically significant difference between measurements 1st and 2nd 95% CI (−4.282 to 0.322), p = 0.09. However, the comparison between 1st/3rd and 1st/4th showed statistically significant difference, 95% CI (−4.964 to −0.796), p = 0,0077 (p Conclusions The procedure of disinfection when fluid completely evaporates has no effect on glucose measurements. Sampling the wet finger influences results of glucose measurement but observed changes were clinically irrelevant.

Objective To understand whether polycystic ovarian morphology (PCOM) represents a transient phase, and whether an increased stroma could help to characterize the phenotype of the ovary in adolescence. Methods Cross-sectional population-based study on high-school students in Cagliari, Italy. The study population consisted of 257 normocyclic non-hyperandrogenic girls selected from a sample of 600 healthy volunteers recruited from 2012 to 2016. Clinical examination, medical history, blood sampling, and pelvic ultrasound (US) were performed. Postmenarchal years and body mass index (BMI) were estimated. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β estradiol (E2), total testosterone (tT), delta-4-androstenedione (A), and 17-hydroxyprogesterone (17-OHP) were measured. Ovarian volume, follicular number per section (FNPS), and S/A ratio were measured by pelvic US. Results Following the Rotterdam guidelines for US PCOS diagnosis and setting the normal S/A ratio at ≤0.3, subjects were categorized into 3 groups: (1) normal ovarian morphology (NOM; n = 154, 60%); (2) polycystic ovarian morphology (PCOM) with normal S/A ratio (PCOM-NS; n = 70, 27%); and (3) PCOM with increased S/A ratio (PCOM-IS; n = 33, 13%). The NOM group had more postmenarchal years and a lower LH than both the PCOM groups, and lower A and tT than the PCOM-IS group. The PCOM-NS group had fewer postmenarchal years and lower A than the PCOM-IS group. Interestingly, unlike NOM and PCOM-NS, the prevalence of PCOM-IS remained constant among the 3 phases of postmenarchal age (10% vs 16% vs 15%, P = not significant). Conclusion This study demonstrates that PCOM can be a transient condition, whereas a high S/A ratio is a stable US alteration present from early postmenarchal years.

Daridorexant (ACT-541468) is a new dual orexin receptor antagonist being evaluated for the treatment of insomnia, which is a common comorbidity of depression and anxiety. Therefore, daridorexant is likely to be administered concomitantly with agents (e.g., citalopram) used to treat these disorders. In this single-centre, single-blind, randomized, placebo-controlled, sequential design Phase 1 study with the inclusion of two double-blind crossover parts, the pharmacokinetic (PK; blood sampling at regular intervals) and pharmacodynamic (PD; battery of objective and subjective PD tests performed at regular intervals) interactions between daridorexant (50 mg) and citalopram (20 mg, single dose and at steady state) as well as the safety/tolerability in healthy subjects were investigated. There were no relevant effects of citalopram (single dose/steady state) on daridorexant exposure and vice versa. PD variables measured after morning administration of daridorexant alone showed effects consistent with a sleep-promoting compound. Only co-administration of daridorexant with citalopram at steady state led to relevant changes in objective (unstable tracking) and subjective (visual analogue scale alertness and Karolinska Sleepiness Scale) PD endpoints compared to daridorexant alone. No serious or severe adverse events were reported, while no clinically relevant treatment-emergent effects on ECG parameters, clinical laboratory, or vital signs were observed. In conclusion, the co-administration of daridorexant and citalopram lead to only minor changes in PK parameters, while performance of PD assessments following co-administration were mainly driven by the expected central nervous system effects of daridorexant. Doses up to 50 mg daridorexant can be safely co-administered with citalopram.

International audience; Few studies have examined the impact of a preseason training intervention through systematic measures in Pro D2 rugby union (RU). Therefore, this study aimed to describe the effects of 12 weeks of preseason training (three blocks) on body composition, running performance, biochemical markers, and workload (WL) variation in professional RU players. Physiological (physical and biochemical) responses to preseason WL were analyzed by examining changes in anthropometric characteristics, Yo-Yo intermittent recovery level 1 (Yo-Yo IR1) test, blood samples (BS), Hooper index (1–7), the 10-Hz global positioning system (GPS), and session rating of perceived exertion (s-RPE) in nineteen elite male players. Changes throughout the preseason were analyzed using the one-way and mixed-model analysis of variance. Significant (p < 0.01) improvements occurred in anthropometry and Yo-Yo IR1 running performance in forwards and backs. Total distance (p < 0.01) and impact (p < 0.05) during the second block were meaningfully higher than the other two blocks, with backs showing higher values than forwards. As expected, WL decreased significantly (p < 0.01) during the last training block. The WL variations were correlated with changes in biochemical markers over the preseason period. The collected data can be used for i) profiling French Pro D2 rugby championships players, ii) establishing effective training strategies, and iii) setting preseason WL expectations.

Background Peripheral intravenous cannulas are commonly used for blood sampling. Conflicting evidence on the safety and reliability of blood sampling from peripheral intravenous cannulas provides little support to guide practice of clinicians. Aim To elicit views of nurses working in acute care of their opinions on the safety and efficacy of obtaining blood samples from peripheral intravenous cannulas. Methods A cross-sectional electronic survey was utilised. Participants included nurses working in Australian acute care services nationally. The STROBE checklist was followed. The survey was distributed by two professional nursing bodies to their members between September and December 2017. Content analysis was used to analyse open-ended responses. Findings Of the 338 participants who completed the survey, 269 provided comments. Themes supporting the use of peripheral intravenous cannulas for blood sampling included ‘efficiency’, ‘patient care’, ‘last resort’, and ‘other’. Reasons for not using a peripheral intravenous cannula for sampling provided themes of ‘PIVC use’, ‘dwell time’, ‘test type required’, ‘patency/insertion site care’, ‘preference’, and ‘other’. Discussion The choice regarding method of blood sampling is left to the discretion of individual practitioners. Diverse rationales were provided by respondents to support their practice in sampling blood. This may be influenced by variations in hospital policies and conflicting research evidence to support or refute the practice. Conclusion Blood sampling from peripheral intravenous cannulas or venepuncture is practiced differently between nurses based on multiple rationales. Research is needed to provide evidence for safe practice and support hospital policies.

Background The Fetal Blood Sample (FBS) is used as an indicator of fetal acidosis during labor. Its place is discussed through the lack of randomized trials, as well as the limitations related to the technical procedure. An alternative could be the Fetal Scalp Stimulation (FSS). Aim Our objective was to describe the FSS diagnostic value to predict fetal wellbeing defined from FBS. Methods The FSS consisted in a digital scalp stimulation for 15 s. Test was negative when an acceleration and/or a normal variability were elicited in the 2 min following. FSS was performed before each FBS which was classified as normal when pH was > 7.25. The diagnostic value was assessed by sensibility, specificity, positive and negative predictive values. Findings 148 women were included in our center from February to December 2019. Of the 191 FBS procedures, when accelerations were elicited sensibility was 58,3 (36.8–77.1), specificity was 67,5 (59.3–75), positive predictive value was 20,9 (12.5–32.9) and negative predictive value was 91.7 % (95 %CI, 85–95.5). Discussion FBS is considered as the gold standard in our study which could be discussed as it is abandoned in some countries because of its questioned reliability and the lack of controlled randomized trials. Conclusion This study suggests that FSS could be an interesting alternative adjunctive test to perform in the first instance as it seems to be reliable, non-invasive and easy to perform in order to limit FBS only to absence of acceleration after FSS.

The promise of using induced pluripotent stem cells (iPSCs) for cellular therapies has been hampered by the lack of easily isolatable and well characterized source cells whose genomes have undergone minimal changes during their processing. Blood-derived late-outgrowth endothelial progenitor cells (EPCs) are used for disease modeling and have potential therapeutic uses including cell transplantation and the translation of induced pluripotent stem cell (iPSC) derivatives. However, the current isolation of EPCs has been inconsistent and requires at least 40-80 mL of blood, limiting their wider use. In addition, previous EPC reprogramming methods precluded the translation of EPC-derived iPSCs to the clinic. Here a series of clinically-compatible advances in the isolation and reprogramming of EPCs is presented, including a reduction of blood sampling volumes to 10 mL and use of highly efficient RNA-based reprogramming methods together with autologous human serum, resulting in clinically relevant iPSCs carrying minimal copy number variations (CNVs) compared to their parent line.

Relatively little is known about associations between peripheral inflammation and neural function in humans. Neuroimaging studies in adults have suggested that elevated peripheral inflammatory markers are associated with altered resting state functional connectivity (rsFC) in several brain networks associated with mood and cognition. Few studies have examined these associations in adolescents, yet scarce data from adolescents point to different networks than adult studies. The current study examined the associations between peripheral inflammation and rsFC in a community sample of adolescents (n = 70; age, 12–15 years; 32 female, 36 male, 2 nonbinary). After blood sampling, an fMRI scan was performed to assess rsFC. Assay for serum inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP), was performed. Results indicated that higher TNF-α was associated with altered rsFC between the right amygdala and left striatum and between the right inferior frontal gyrus and left parietal cortex (p < 0.05 whole-brain corrected). Associations with IL-6 and CRP were not significant. In contrast with findings in adults, inflammation may have unique links with the connectivity of the developing adolescent brain. Results have implications for understanding how peripheral inflammation may influence connectivity during adolescence, when neural networks are undergoing major developmental changes.

Background and aims: Today, Sleeve gastrectomy (SG) has recently become the most common bariatric procedure among various bariatric surgical procedures due to its advantages. The aim of this study is to investigate nutritional status, body composition and biochemical parameters following SG. Methods: This was a prospective study, the subjects were patients who underwent SG at a special obesity clinic in Istanbul, Turkey, between 01.05.2017 and 01.11.2017. The mean body mass index (BMI) of the participants was 42.15 +/- 4.84 kg/m(2) for men and 41.44 +/- 4.34 kg/m(2) for women, preoperatively. Nutritional status, some anthropometric measurements and blood sampling were taken at each visit. Data were collected and analyzed for the present study at the following periods: pre-operation (pre-op), 1 month, 3 months and 6 months after surgery. Results: A total of 47 SG patients (20 men, 27 women) were evaluated. The mean BMI was 30.23 +/- 3.56 kg/m(2) for men and 30.35 +/- 4.36 kg/m(2) for women after 6 months and the amount of excess weight loss (EWL) increased in the 3 months (p

Summary Background The efficacy and safety profiles of vaccines against SARS-CoV-2 in patients with cancer is unknown. We aimed to assess the safety and immunogenicity of the BNT162b2 (Pfizer–BioNTech) vaccine in patients with cancer. Methods For this prospective observational study, we recruited patients with cancer and healthy controls (mostly health-care workers) from three London hospitals between Dec 8, 2020, and Feb 18, 2021. Participants who were vaccinated between Dec 8 and Dec 29, 2020, received two 30 μg doses of BNT162b2 administered intramuscularly 21 days apart; patients vaccinated after this date received only one 30 μg dose with a planned follow-up boost at 12 weeks. Blood samples were taken before vaccination and at 3 weeks and 5 weeks after the first vaccination. Where possible, serial nasopharyngeal real-time RT-PCR (rRT-PCR) swab tests were done every 10 days or in cases of symptomatic COVID-19. The coprimary endpoints were seroconversion to SARS-CoV-2 spike (S) protein in patients with cancer following the first vaccination with the BNT162b2 vaccine and the effect of vaccine boosting after 21 days on seroconversion. All participants with available data were included in the safety and immunogenicity analyses. Ongoing follow-up is underway for further blood sampling after the delayed (12-week) vaccine boost. This study is registered with the NHS Health Research Authority and Health and Care Research Wales (REC ID 20/HRA/2031). Findings 151 patients with cancer (95 patients with solid cancer and 56 patients with haematological cancer) and 54 healthy controls were enrolled. For this interim data analysis of the safety and immunogenicity of vaccinated patients with cancer, samples and data obtained up to March 19, 2021, were analysed. After exclusion of 17 patients who had been exposed to SARS-CoV-2 (detected by either antibody seroconversion or a positive rRT-PCR COVID-19 swab test) from the immunogenicity analysis, the proportion of positive anti-S IgG titres at approximately 21 days following a single vaccine inoculum across the three cohorts were 32 (94%; 95% CI 81–98) of 34 healthy controls; 21 (38%; 26–51) of 56 patients with solid cancer, and eight (18%; 10–32) of 44 patients with haematological cancer. 16 healthy controls, 25 patients with solid cancer, and six patients with haematological cancer received a second dose on day 21. Of the patients with available blood samples 2 weeks following a 21-day vaccine boost, and excluding 17 participants with evidence of previous natural SARS-CoV-2 exposure, 18 (95%; 95% CI 75–99) of 19 patients with solid cancer, 12 (100%; 76–100) of 12 healthy controls, and three (60%; 23–88) of five patients with haematological cancers were seropositive, compared with ten (30%; 17–47) of 33, 18 (86%; 65–95) of 21, and four (11%; 4–25) of 36, respectively, who did not receive a boost. The vaccine was well tolerated; no toxicities were reported in 75 (54%) of 140 patients with cancer following the first dose of BNT162b2, and in 22 (71%) of 31 patients with cancer following the second dose. Similarly, no toxicities were reported in 15 (38%) of 40 healthy controls after the first dose and in five (31%) of 16 after the second dose. Injection-site pain within 7 days following the first dose was the most commonly reported local reaction (23 [35%] of 65 patients with cancer; 12 [48%] of 25 healthy controls). No vaccine-related deaths were reported. Interpretation In patients with cancer, one dose of the BNT162b2 vaccine yields poor efficacy. Immunogenicity increased significantly in patients with solid cancer within 2 weeks of a vaccine boost at day 21 after the first dose. These data support prioritisation of patients with cancer for an early (day 21) second dose of the BNT162b2 vaccine. Funding King's College London, Cancer Research UK, Wellcome Trust, Rosetrees Trust, and Francis Crick Institute.

Summary Objectives The aim of this study was to investigate the effect of eight weeks of aerobic training and training in water on oxidative stress indices and total antioxidant capacity in elderly women. Equipment and methods A total of 45 volunteered women participate as a subject for the study. Subjects were randomly divided into three groups; Aerobic (15 subjects), Training in water (15 subjects) and Control (15 subjects). Before the beginning of the training period, 8-OHdG, 8-isoprostane and total antioxidant capacity were measured. Both training groups were performed aerobic exercise on lane and water for three sessions per week with 65–75 percent of maximum heart rate. At the end of the training period, again, the blood sampling was repeated. For the statically analysis, ANOVA test was used, and for significant variables Bunferroni post hoc was used. Results Results showed significant difference in the level of OHdG, 8-isoprostane and total antioxidant capacity between trained groups and the control group after the training period (P

Summary Background Little is known about the risk of SARS-CoV-2 infection and transmission in educational settings. Public Health England initiated a study, COVID-19 Surveillance in School KIDs (sKIDs), in primary schools when they partially reopened from June 1, 2020, after the first national lockdown in England to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, seroprevalence, and seroconversion in staff and students. Methods sKIDs, an active, prospective, surveillance study, included two groups: the weekly swabbing group and the blood sampling group. The swabbing group underwent weekly nasal swabs for at least 4 weeks after partial school reopening during the summer half-term (June to mid-July, 2020). The blood sampling group additionally underwent blood sampling for serum SARS-CoV-2 antibodies to measure previous infection at the beginning (June 1–19, 2020) and end (July 3–23, 2020) of the summer half-term, and, after full reopening in September, 2020, and at the end of the autumn term (Nov 23–Dec 18, 2020). We tested for predictors of SARS-CoV-2 antibody positivity using logistic regression. We calculated antibody seroconversion rates for participants who were seronegative in the first round and were tested in at least two rounds. Findings During the summer half-term, 11 966 participants (6727 students, 4628 staff, and 611 with unknown staff or student status) in 131 schools had 40 501 swabs taken. Weekly SARS-CoV-2 infection rates were 4·1 (one of 24 463; 95% CI 0·1–21·8) per 100 000 students and 12·5 (two of 16 038; 1·5–45·0) per 100 000 staff. At recruitment, in 45 schools, 91 (11·2%; 95% CI 7·9–15·1) of 816 students and 209 (15·1%; 11·9–18·9) of 1381 staff members were positive for SARS-CoV-2 antibodies, similar to local community seroprevalence. Seropositivity was not associated with school attendance during lockdown (p=0·13 for students and p=0·20 for staff) or staff contact with students (p=0·37). At the end of the summer half-term, 603 (73·9%) of 816 students and 1015 (73·5%) of 1381 staff members were still participating in the surveillance, and five (four students, one staff member) seroconverted. By December, 2020, 55 (5·1%; 95% CI 3·8–6·5) of 1085 participants who were seronegative at recruitment (in June, 2020) had seroconverted, including 19 (5·6%; 3·4–8·6) of 340 students and 36 (4·8%; 3·4–6·6) of 745 staff members (p=0·60). Interpretation In England, SARS-CoV-2 infection rates were low in primary schools following their partial and full reopening in June and September, 2020. Funding UK Department of Health and Social Care.

Background Associations between sugar consumption and cardiometabolic health, taking into account the physical form of sugar-containing foods (liquid vs. solid) and the type of sugars consumed [free sugars (FSs) vs. naturally occurring sugars (NOSs)], remain to be thoroughly documented. Objective The objective was to examine whether FS and NOS intakes from drinks and solid foods are associated with cardiometabolic risk factors in a sample of French-speaking adults from the province of Quebec, Canada. Methods Data were collected as part of the cross-sectional PREDISE (PREDicteurs Individuels, Sociaux et Environnementaux) study (n = 1019, 18-65 y old; 50% women). FS and NOS intakes were assessed by three 24-h dietary recalls using a self-administered, web-based application. Diet quality was assessed using the Alternative Healthy Eating Index-2010. Participants underwent on-site clinical assessment of cardiometabolic risk factors, including blood pressure, waist circumference, BMI, and fasting blood sampling (glucose, insulin, C-reactive protein, blood lipids). Multivariable linear regression models were performed to examine the associations between sugar intake and cardiometabolic risk factors with sociodemographic characteristics, lifestyle variables, and diet quality entered as covariates. Results In fully adjusted models, FS intake from drinks was associated with fasting insulin (1.06%; 95% CI: 0.30%, 1.84%; P = 0.006) and with insulin resistance as estimated using the HOMA model (1.01%; 95% CI: 0.19%, 1.84%; P = 0.02). All metabolic variables that were significantly associated with NOS intake from solid foods in minimally adjusted models were no longer significant after entering sociodemographic and lifestyle variables (e.g., educational and income levels, smoking, physical activity, daily energy intake) and diet quality in the models. Conclusions Our data from an adult sample showed that unfavorable and favorable associations with cardiometabolic risk factors observed, respectively, for FS intake from drinks and NOS intake from foods are mostly explained by sociodemographic and lifestyle variables, as well as by diet quality.

Objective To compare values of haemoglobin concentration (SpHb), arterial haemoglobin saturation (SpO2) and calculated arterial oxygen content (SpOC), measured noninvasively with a pulse co-oximeter before and after in vivo adjustment (via calibration of the device using a measured haemoglobin concentration) with those measured invasively using a spectrophotometric-based blood gas analyser in anaesthetized dogs. Study design Prospective observational clinical study. Animals A group of 39 adult dogs. Methods In all dogs after standard instrumentation, the dorsal metatarsal artery was catheterised for blood sampling, and a pulse co-oximeter probe was applied to the tongue for noninvasive measurements. Paired data for SpHb, SpO2 and SpOC from the pulse co-oximeter and haemoglobin arterial oxygen saturation (SaO2) and arterial oxygen content (CaO2) from the blood gas analyser were obtained before and after in vivo adjustment. Bland–Altman analysis for repeated measurements was used to evaluate the bias, precision and agreement between the pulse co-oximeter and the blood gas analyser. Data are presented as mean differences and 95% limits of agreement (LoA). Results A total of 39 data pairs were obtained before in vivo adjustment. The mean invasively measured haemoglobin–SpHb difference was –2.7 g dL−1 with LoA of –4.9 to –0.5 g dL−1. After in vivo adjustment, 104 data pairs were obtained. The mean invasively measured haemoglobin–SpHb difference was –0.2 g dL−1 with LoA of –1.1 to 0.6 g dL−1. The mean SaO2–SpO2 difference was 0.86% with LoA of –0.8% to 2.5% and that between CaO2–SpOC was 0.66 mL dL–1 with LoA of –2.59 to 3.91 mL dL–1. Conclusions Before in vivo adjustment, pulse co-oximeter derived values overestimated the spectrophotometric-based blood gas analyser haemoglobin and CaO2 values. After in vivo adjustment, the accuracy, precision and LoA markedly improved. Therefore, in vivo adjustment is recommended when using this device to monitor SpHb in anaesthetised dogs.

Objectives To investigate the relationship between vitamin D deficiency and the risk of asymptomatic uterine fibroids (UFs). Design Cross-sectional study. Setting University hospital. Patient(s) The present analysis recruited 133 asymptomatic patients with UFs and 80 normal control subjects from October 2017 to June 2020. Age matching created 61 pairs. Intervention(s) Medical history, transvaginal or transabdominal genital ultrasound scan, blood sampling, and measurement of vitamin D concentrations. Main Outcome Measure(s) Evaluation of the impact of vitamin D level on the risk of newly diagnosed asymptomatic UFs in premenopausal Han Chinese women. Result(s) Vitamin D levels of UF-positive patients were lower than those of healthy control subjects in unmatched samples (12.1 ng/mL vs. 16.8 ng/mL) and in matched samples (11.4 vs. 17.5 ng/mL). Younger patients (≤40 years) had a lower vitamin D level than older subjects in healthy control group (15.1 ng/mL vs. 19.0 ng/mL). We did not observe any age–vitamin D interactive effect in unmatched samples. Multivariate logistic regression revealed that asymptomatic patients presented a lower level of vitamin D than did normal groups in both unmatched and matched sample. In addition, the optimal threshold vitamin D level for having asymptomatic UFs was 14.34 ng/mL. Conclusion(s) Vitamin D deficiency may be associated with increased risk of asymptomatic UFs in premenopausal Han Chinese women.

Background Parathyroid hormone (PTH) and vitamin D plays a major role in calcium (Ca) homeostasis and bone turnover . The purpose of this study was to assess which factors (sex, age, time of blood sampling, season of the year, temperature and sunshine hours (SHH)) had the greatest impact on plasma PTH, 25-OH-VitD, and Ca levels, and then whether these effects were clinically acceptable in a large number of Southwestern Chinese subjects. Method The data was from West China Hospital Health Examination Center, Sichuan University from April 1, 2018 to June 30, 2019. A total of 18,664 physical examination subjects were included. PTH and 25-OH-VitD were measured by a Roche Cobas e 601, and Ca was measured by a Roche Cobas 8000. Linear regression models were used to assess correlations between PTH, 25-OH-VitD, Ca and the above factors. Results The concentrations of serum PTH in females were significantly higher than those in males, while the 25-OH-VitD and Ca were opposite. The concentration of PTH in data collection decreased in summer and increased in spring. The concentration of 25-OH-VitD decreases in spring and increases in autumn. PTH concentrations were negatively correlated with last month temperature and SHH, while 25-OH-VitD were opposite. Linear regression showed that season may be the main factor affecting serum PTH and 25-OH-VitD levels, and these effects were not clinically acceptable. Conclusion In order to avoid influencing clinicians' investigation of suspected hyperparathyroidism and hypovitaminosis, reference intervals for PTH, 25-OH-VitD, and Ca should be established, taking into account sex, age and the season.

Background Most causes of hyperbilirubinemia is babies born premature. Their bilirubin levels should be checked regularly, this causes the baby to feel pain. Newborns may experience a greater sensitivity to pain and are more susceptible to the long-term effects of painful stimulation. Pain management is needed for decreased clinical complications and decreased mortality. Breastfeeding and massage were the options for treating mild pain because they were safe, non-invasive, inexpensive and could be done independently. Objective The aim of this study was to compare the effects of breastfeeding and massage on neonatus pain during intravenous blood sampling procedures. Methods Post test-only non equivalent control group design with non-probability sampling technique. The sample were 40 respondents divided into control and intervention groups. The neonatus was taken intraveinous blood sampling for the first time. The intervention group was given breast feeding and massage. Breast milk was given 2 min before intravenous puncture and massage was carried out on the back to the lower extremities for 2 min. Measurement of pain scores using NIPS. Data analysis used independent t-test. Results The mean of neonatus pain in the intervention group was 1.60 SD 1.562 and control group 5.20, SD 1.361. There was significant difference in mean neonatal pain when intravenous blood sampling procedures in the intervention and control groups with a difference of 3.60. The paired samples test was p = 0,000 ( Conclusions According to the findings of this study, the lowest pain score was in intervention group. Breastfeeding and massage was reduce the scale of pain neonatus during intraveinous blood sampling procedures. Breast feeding and massage are recommended to reduce the pain in neonatus during painful procedures administrated.

Aim To examine the effect of the mother's heartbeat sound on physiological parameters and pain intensity after blood sampling in neonates in the intensive care unit. Methods A randomized controlled clinical trial was conducted on 60 neonates admitted to the intensive care unit. They were assigned to intervention and control groups (n = 30 in each group). The intervention group listened to the mother's heartbeat sound, 10 min before up to 10 min after taking arterial blood samples. Pain intensity was measured every 10 min in 3 steps using the neonatal infant pain scale 10 min before the intervention, immediately after and 10 min after the intervention. At the same time, physiologic parameters including oxygen saturation, respiratory rate, heart rate and mean arterial blood pressure were recorded. Data were analyzed using descriptive and inferential statistics using SPSS. Results Listening to the mother's heartbeat sound did not influence on mean arterial pressure in the intervention group. However, it had significant medium to large effects on oxygen saturation and respiratory rate immediately after and 10 min after the intervention. Also, it had a large effect on heart rate immediately after the intervention (P Conclusion The mother's heartbeat sound can be used by nurses as a non-pharmacologic and safe intervention along with routine care in order to reduce suffering and pain in neonates undergoing invasive and painful procedures in the intensive care unit.

To evaluate (1) the effects of 3 mild stressors on urinary cortisol––a stress marker––in cats and to evaluate; (2) the effects on this parameter of a new prescription diet (diet US) with L-tryptophan, lemon balm, oligofructose, and fish peptides compared with a control prescription diet (Diet U) with L-tryptophan alone. Ten colony cats were included in the study. Baseline measurements were first obtained with cats fed a baseline diet without nutraceutical to validate the effects of 3 mild stressors (open field test, overnight fast, and blood sampling) on urinary cortisol. Twenty-four-hour free catch urine specimens were obtained under routine management conditions and following application of the three mild stressors. Cats were then randomized in 2 groups to test diet U or US for 5 weeks in a crossover design, following the same procedure as for baseline measurements. Twenty-four-hour urinary cortisol/creatinine ratio, serum cortisol and serum serotonin were measured. At baseline, open field test and blood sampling induced greater 24-hour urinary cortisol/creatinine ratio compared to the value obtained under routine management while overnight fasting did not. In the crossover design, compared to diet U, diet US resulted in a lower average 24-hour urinary cortisol/creatinine ratio. Open field test and blood sampling can be considered as mild stressors in cats. Compared to a diet with L-tryptophan alone, a diet supplemented with lemon balm, fish peptides, oligofructose, and L-tryptophan resulted in a lower average 24-hour urinary cortisol/creatinine ratio, a marker of stress, in cats.

Umbilical catheterization is commonly used as a route to provide medications and fluids to the neonates as well as for blood sampling and continuous monitoring. Although the rupture of umbilical catheters is considered as a rare, preventable complication, it has been reported several times in the literature. Healthcare providers need to be cautious with catheter placement, maintenance, and removal to prevent such a complication. Hereby, we review the literature about this complication after presenting two incidents of umbilical venous catheter rupture in two separate patients in our neonatal ICU. One was removed easily through the umbilical stump, whereas the other required surgical exploration.

Objective To investigate the pharmacokinetics and pharmacodynamics of an e-aminocaproic acid (EACA) regimen designed for the context of cardiac surgery with cardiopulmonary bypass (CPB). Design Prospective observational study requiring blood sampling to measure EACA concentrations and fibrinolysis markers (fibrinogen, D-dimer, α2-antiplasmin (A2AP), and tissue plasminogen activator-plasminogen activator inhibitor [tPA-PAI-1] complex). Setting Single-center, tertiary medical center Participants Patients who underwent cardiac surgery with CPB between 2018 and 2019 for aortic or mitral valve replacement/repair (AVR or MVR) or coronary artery bypass grafting (CABG). Previous sternotomy patients were included. Intervention None Measurements and Main Results The pharmacokinetic of EACA, during CPB, was described by a 3-compartment disposition model. EACA concentrations were above 130 mg/L in all patients post-CPB and in most patients during CPB. D-dimer level trended up and reached a peak median level of 1.35 mg/L Fibrinogen Equivalence Units (FEU) at 15 min post-protamine administration. The median change in D-dimer (ΔD-dimer) from baseline to 15 min post-protamine was 0.34 (-0.48-3.81) mg/L FEU. ΔD-dimer did not correlate with EACA concentration intraoperatively, urine output, body weight, glomerular filtration rate, cell salvage volume, and ultrafiltration volume. The median 24-hour chest tube output was 445 (180-1011) mL. Conclusion This regimen provided maximum EACA concentrations near the time of protamine administration with a total perioperative dose of 15 grams. Most patients had EACA concentrations above target during CPB. ΔD-dimer did not correlate with EACA concentration. The median 24-hr chest tube output compares well to similar studies that employed higher doses of EACA.

In oncology, liquid biopsy denotes the use of any biological fluid to detect cancer. Several approaches exist to perform such biopsy. These approaches target circulating tumor cells, circulating free DNA, exosomes, and more. The aim is to enable physicians to search for early signs of cancer with minimal patient burden. The effort to go after the minute amounts of cellular material through these technologies is remarkable, involving considerable financial investments and hundreds of research groups. Here, we highlight possible use of T cell repertoire sequencing for the same task. Repertoire sequencing has demonstrated a related capacity for early detection of cancer biomarkers via blood sampling, by focusing on the genomic sequences of T cell receptors found in the blood of potential patients. This mini-review aims to examine and assess the current methods of liquid biopsy and repertoire sequencing for their ability to uncover early signs of cancer, focusing on analytical validity as well as clinical utility.

Purpose The aim of the study was to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in a university student population. Methods This was a cross-sectional survey study based on the World Health Organization population-based seroepidemiological investigational protocol for SARS-CoV-2 conducted between April 29, 2020, and May 8, 2020, examining SARS-CoV-2 antibody prevalence among 790 university students in Los Angeles, CA. Participants completed a questionnaire on potential risk factors before blood sampling. Samples were analyzed using the EUROIMMUN Anti-SARS-CoV-2 ELISA (IgG) for the qualitative detection of IgG class antibodies to SARS-CoV-2 in human serum or plasma. Results The estimated prevalence of SARS-CoV-2 antibody was 4.0% (3.0%, 5.1%). Factors associated with having a positive test included history of anosmia and/or loss of taste (95% CI: 1.4–9.6). A history of respiratory symptoms, with or without fever, was not associated with a positive antibody test. Conclusions Prevalence of SARS-CoV-2 antibodies in the undergraduate and graduate student university population was similar to community prevalence.

Background Premature infants hospitalized in the neonatal intensive care unit are routinely exposed to many painful procedures. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates, hence pain in infants should be reduced. Kangaroo care and oral sucrose are some of the methods that can help reduce pain. Aim This study aimed to compare the effects of kangaroo care and oral sucrose on pain relief in preterm infants during heel lancing. Methods Our study involved 64 infants. The infants were randomly divided into two groups using a randomized block design of drawing out slips from a thick, non-transparent envelope. There were 64 slips in this envelope (32 for kangaroo care and 32 for oral sucrose). Kangaroo care was given to the preterm infants in the first group and oral sucrose to those in the second group. In both groups, heart rate and oxygen saturation were measured and pain score was evaluated by two observers using the Premature Infant Pain Profile (PIPP) before, during, and 2 minutes after blood sampling by heel lancing. Results There was a statistically significant difference between the groups in favor of the kangaroo group in terms of change in the PIPP values after heel lancing. Kangaroo care is more effective than oral sucrose in pain relief during heel lancing in preterm infants. Conclusions In addition to many benefits it offers to infants, kangaroo care can be used to reduce pain during painful procedures in premature infants.

Distraction is a method that is easy to use in emergency departments and effective in relieving procedural pain and anxiety. This study aimed to determine the effect of 2 new distraction methods-1 active distraction (rotatable wooden toy) and 1 passive distraction (toy wristband)-on procedural pain, fear, and anxiety in children during venous blood sampling.This study was a randomized controlled experimental study. The sample consisted of 216 children aged 6 years to 12 years. They were divided into 3 groups using the block randomization procedure: active distraction group (n = 72); passive distraction group (n = 72); and control group (n = 72). The levels of pain and anxiety in the children were measured before and during the blood sampling by the children themselves, their parents, and the researcher using the Visual Analog Scale, the Wong-Baker FACES Pain Rating Scale, and the Children's Fear Scale.The children and their parents included in the control and experimental groups had similar sociodemographic characteristics. The active distraction group had lower levels of procedural pain, fear, and anxiety than the other groups (children's visual analog scale score, F = 134.22; P0.05; Wong-Baker FACES Pain Rating Scale score, F = 137.54; P0.001; and Children's Fear Scale score, F = 92.44; P0.001).Both the toy wristband and rotatable wooden toy interventions can be used to reduce procedural pain, fear, and anxiety in children during blood sampling in emergency departments.

Exertional dyspnea is a common complaint for patients seen in pulmonary, cardiac, and general medicine clinics, and elucidating the cause is often challenging, particularly when physical examination, echocardiography, radiography, and pulmonary function test results are inconclusive. Invasive cardiopulmonary exercise testing has emerged as the gold standard test to define causes of dyspnea and exertional limitation in this population. In this review, we describe the methods for performing and interpreting invasive cardiopulmonary exercise testing, with particular attention to the hemodynamic and blood sampling data as they apply to patients being evaluated for heart failure and pulmonary hypertension.

Background and purpose Low levels of von Willebrand factor (VWF) were associated with intracerebral hemorrhage (ICH) in a previous study. Persons with blood group O have lower VWF levels than other ABO blood groups. This study aimed to investigate the association between VWF and the risk of ICH in adults, as well as the association between ABO blood group and risk of ICH. Methods This population-based, nested case-control study was conducted using data and blood samples from health examinations between 1985 and 2007. All participants were followed, and cases with first-ever ICH were identified and validated. One or two controls were matched to each case. Results During a median follow-up time from blood sampling to ICH of 5.6 years, 176 cases with ICH were identified. The mean age at health examination was 57 years; 50% of participants were women. There was an association between hypertension and risk of ICH, but there was no association between VWF level and risk of ICH. There was no association between blood group O and risk of ICH. Conclusions To our knowledge this is the largest prospective study investigating the association between VWF, ABO blood group and ICH. We found no association between VWF or blood group O and risk of future ICH.

Objectives The primary objective was to determine the lowest trimegestone (TMG) dose, administered via a vaginal ring, that effectively inhibited ovulation. Study design Single-centre, open-label, single-dose, parallel-group clinical trial with adaptive design. Eighty healthy female volunteers with proven ovulatory cycles were allocated to treatment with a vaginal ring during 28 days, with an average daily release rate of either 46 µg, 94 µg, 147 µg, or 184 µg TMG (20 women/group). Ultrasound measurements of follicular growth and endometrial thickness, and blood sampling for follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone determinations were performed every 3rd (±1) day from treatment day 4 (±1) until day 28 (±1), and in a follow-up phase after ring removal, until study day 39 (±1). Trimegestone concentrations were measured at each visit in the treatment phase. Results Mean age and body mass index were 28.8 years and 23.15 kg/m2. One subject in the lowest dose group (46 µg/day) ovulated, no ovulations were seen in the higher dose groups. The degree of ovarian suppression increased with the dose. Median estradiol levels were 119, 36.5, 33.2 and 27.2 pg/mL in the 46, 94, 147 and 184 µg/day groups, respectively. Ovarian activity was resumed in the follow-up phase. Plasma TMG levels gradually declined over the treatment period and showed dose proportionality. The study treatment was safe and well tolerated. Conclusion The release rate of 94 µg TMG per day was the lowest effective dose for ovulation inhibition. The study results justify further development of the TMG-ring as progestogen-only contraceptive. Implications The vaginal ring releasing TMG seems to be an effective new progestogen-only contraceptive preparation, having the advantage of once-a-month vaginal insertion.

Background Lipoprotein insulin resistance (LPIR) score is a composite biomarker representative of atherogenic dyslipidemia characteristic of early insulin resistance. It is elevated in obesity and may provide information not captured in glycosylated hemoglobin and homeostatic model assessment for insulin resistance. While bariatric surgery reduces diabetes incidence and resolves metabolic syndrome, the effect of bariatric surgery on LPIR is untested. Objectives We sought to assess the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on LPIR in nondiabetic women with obesity. Setting Nonsmoking, nondiabetic, premenopausal Hispanic women, age ≥18 years, undergoing Roux-en-Y gastric bypass or sleeve gastrectomy at Bellevue Hospital were recruited for a prospective observational study. Methods Anthropometric measures and blood sampling were performed preoperatively and at 6 and 12 months postoperatively. LPIR was measured by nuclear magnetic resonance spectroscopy. Results Among 53 women (Roux-en-Y gastric bypass, n = 22; sleeve gastrectomy, n = 31), mean age was 32 ± 7 years and body mass index 44.1 ± 6.4 kg/m2. LPIR was reduced by 35 ± 4% and 46 ± 4% at 6 and 12 months after surgery, respectively, with no difference by procedure. Twenty-seven of 53 patients met International Diabetes Federation criteria for metabolic syndrome preoperatively and had concomitant higher homeostatic model assessment for insulin resistance, glycosylated hemoglobin, nonhigh-density lipoprotein-cholesterol and LPIR. Twenty-five of 27 patients experienced resolution of metabolic syndrome postoperatively. Concordantly, the preoperative differences in homeostatic model assessment for insulin resistance, glycosylated hemoglobin, and nonhigh-density lipoprotein-cholesterol between those with and without metabolic syndrome resolved at 6 and 12 months. In contrast, patients with metabolic syndrome preoperatively exhibited greater LPIR scores at 6 and 12 months postoperatively. Conclusion This is the first study to demonstrate improvement in insulin resistance, as measured by LPIR, after bariatric surgery with no difference by procedure. This measure, but not traditional markers, was persistently higher in patients with a preoperative metabolic syndrome diagnosis, despite resolution of the condition.

Background Pulmonary gas exchange efficiency, determined by the alveolar-to-arterial P o 2 difference (A-aD o 2), progressively worsens during exercise at sea-level; this response is further elevated during exercise in hypoxia. Traditionally, pulmonary gas exchange efficiency is assessed through measurements of ventilation and end-tidal gases paired with direct arterial blood gas (ABG) sampling. Because these measures have a number of caveats, particularly invasive blood sampling, the development of new approaches for the noninvasive assessment of pulmonary gas exchange is needed. Research Question Is a noninvasive method of assessing pulmonary gas exchange valid during rest and exercise in acute hypoxia? Study Design and Methods Twenty-five healthy participants (10 female) completed a staged maximal exercise test on a cycle ergometer in a hypoxic chamber (F io 2 = 0.11). Simultaneous ABGs via a radial arterial catheter and noninvasive gas-exchange measurements (AGM100) were obtained in 2-minute intervals. Noninvasive gas exchange, termed the O2 deficit, was calculated from the difference between the end-tidal and the calculated Pa o 2 (via pulse oximetry and corrected for the Bohr effect by using the end-tidal P co 2). Noninvasive O2 deficit was compared with the traditional alveolar to arterial oxygen difference (A-aD o 2), using the traditional Riley analysis. Results Under conditions of rest at room air, hypoxic rest, and hypoxic exercise, strong correlations between the calculated gPa o 2 and directly measured Pa o 2 (R2 = 0.97; P o 2 (R2 = 0.68; P o 2 (R2 = 0.70; P Interpretations Our findings support the use of a noninvasive measure of gas exchange during acute hypoxic exercise in heathy humans. Further studies are required to determine whether this approach can be used clinically as a tool during normoxic exercise in patients with preexisting impairments in gas exchange efficiency.

1, 25-dihydroxycholecalciferol is recognized as a potent immune-modulator which can fight against the pathogens via the activation of vitamin D3 receptors (VDRs), as well as stimulating various cytokines in infectious diseases. In the present study, because of the vitamin D3 has an appropriate immunomodulatory, the effects of this vitamin on the levels of pre-inflammatory and anti-inflammatory cytokines have been investigated in calves with experimental pasteurellosis. This study was experimentally carried out on 10 Holstein crossbred male calves (2–4 months) that were divided into two groups. Prepared Pasteurella multocida (3 × 109 CFU/mL) was inoculated in the trachea with a lavage catheter and then the treatment group was injected with 1, 25-dihydroxycholecalciferol after confirming pneumonia. Blood sampling, clinical symptoms scoring and radiological evaluation were recorded for both groups at different time intervals. The prescription of, vitamin D3 to the treatment group caused a decline in clinical symptoms score and changed interstitial and alveolo-interstitial lung pattern to such a degree that it could recover in comparison with the control group. The concentrations of pro-inflammatory cytokines (i.e., IL-1β, IL-6, and TNF-α) and the chemokine (IL-8) showed a significant decrease in the treatment group while the concentration of IL-10 increased in the treatment groups following the vitamin D3 injection (P = .001). The evidence from the current study suggests that vitamin D3 exert the immunomodulatory effects in infectious diseases through the regulation of cytokines and activation of VDR pathways to produce antimicrobial peptides.

Plasma NT-proBNP (N-terminal prohormone of brain natriuretic peptide) is an established clinical biomarker for children with congenital heart disease. In adult studies the relation between plasma and urinary NT-proBNP has been investigated with a good correlation. Considering the age dependence of NT-proBNP in healthy children and the age dependence of kidney function, an investigation of the correlation between NT-proBNP plasma and urinary values in children of different ages is necessary. We analyzed plasma and urine samples of 33 children (mean age 7 months) with congenital heart disease before surgery. Plasma and urinary creatinine were also measured to evaluate the influence of kidney function. A Pearson correlation between Lg10-plasma and Lg10-urine values of NT-proBNP corrected for urine creatinie showed a correlation coefficient of r = 0,902 (P 0,000) without discriminating for age. This study demonstrates that urinary NT-proBNP values correlate well with plasma NT-proBNP values in infants and toddlers and that single random urine sample corrected to urine-creatinine can be used as an alternative to plasma samples. The use of urinary biomarkers could help reduce the need of stressful blood sampling in infants and children.

The present study was undertaken to evaluate the comparative effect of in vivo heat stress on native and crossbred cattle based on specific hormone responses and antioxidant enzyme activities. Eighteen healthy cattle aged between 4 and 5 years were selected and divided into three equal groups (n = 6) with consideration of breed as Sahiwal, Tharparkar, and crossbred (Hariana × Holstein Friesian/Brown Swiss/Jersey). The temperature-humidity index was calculated using temperature and relative humidity daily throughout the experimental period. Blood sampling was performed during summer and winter and the serum was used for the estimation of hormones such as triiodothyronine, thyroxine, and cortisol. The enzymatic antioxidant activity of catalase, superoxide dismutase, glutathione peroxidase, and total antioxidant capacity was also recorded. Temperature-humidity index values indicated that the animals were under thermal stress in summer but thermoneutral in winter. During heat stress, significant higher levels of triiodothyronine and thyroxine were observed in native cattle compared with the crossbred cattle. A significantly higher (P

Objective Among combined oral contraception (COC) users, to determine the effect on ovarian activity and ovulation of waiting five days before restarting COC, versus restarting immediately, having taken ulipristal acetate 30 mg (UPA, the dose used for emergency contraception) after missing three consecutive COC pills. Study design Women already using COC were enrolled for two cycles of COC use (21/7 regimen). In cycle 2, all women omitted COC pills for three consecutive days (days 5,6,7), and on day 8 took UPA 30 mg. They were randomized either to restart their COC pills that same day (immediate restart) or to wait five days (delayed restart). Transvaginal ultrasound, and blood sampling for estradiol and progesterone were undertaken on days 4,8,11,13,15,18,22 and 26. A modified Hoogland score was used to quantify ovarian activity/ovulation and to assess whether luteal phase progesterone concentrations were sufficiently ‘adequate’ to have conferred a theoretical risk of pregnancy. Results No one ovulated with risk of pregnancy during the five days following UPA. Among 26 women with immediate restart, none ovulated with a theoretical risk of pregnancy at any time in the cycle. Four of 23 women (17.4% CI [5.0; 38.8]) with delayed restart ovulated with theoretical risk of pregnancy before the end of the cycle. This difference was statistically significant (p = 0.042). Conclusion Women who delay restarting COC for five days after taking UPA 30 mg are at much greater risk of ovulation, and therefore theoretically of pregnancy, than if they restart their COC on the same day as taking UPA. Current recommendations should be revisited. Implications Women who take UPA-EC after having missed combined oral contraceptive pills are advised to wait five days before restarting the COC. This delay puts them at risk of ovulation and, if intercourse occurs, theoretically therefore of pregnancy. Women who restart their COC pills immediately are much less likely to ovulate. The label for UPA-EC and clinical guidelines on using EC after missed pills should be revisited.

Background With increasing age, non-alcoholic fatty liver disease is very common among women with low levels of physical activity. Nonlinear resistance training is one of the new methods to help patients who have low levels of physical activity. Curcumin is an herbal supplement that has anti-inflammatory effects. The present study aimed to examine the effects of nonlinear resistance training and curcumin supplementation on the liver structure and biochemical markers in obese older women with non-alcoholic fatty liver disease. Methods Forty-five obese women with non-alcoholic fatty liver disease were randomly assigned into resistance training (RT), curcumin supplement (C), resistance training with curcumin supplement (RTC), and placebo (P) groups. The RT and RTC groups received 12-weeks of nonlinear resistance training while the C and P groups had a normal sedentary lifestyle. Daily, the C and RTC groups received a curcumin capsule while the P and RT groups were given a placebo capsule. Blood sampling and ultrasonography were taken before and after the protocol. Results Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels significantly decreased in the RT and RTC groups (P ≤ 0.05) but not in the C and P groups (P > 0.05). Alkaline phosphatase (ALP), total bilirubin (TB) levels, platelet counts (PLT), and liver structure did not significantly change in all groups (P > 0.05). Resistance training alone and with curcumin supplementation could significantly improve liver function while taking curcumin alone did not have any significant effect on it. Conclusion 12-week non-linear resistance training has beneficial effects on non-alcoholic fatty liver disease in older obese women.

Introduction: Peripheral arterial catheters (PAC) are used for haemodynamic monitoring and blood sampling in paediatric critical care. Limited data are available regarding PAC insertion and management practices, and how they relate to device function and failure. This information is necessary to inform future interventional research. Objectives: The primary objective of this study was to describe PAC insertion and management practices, and associated complications. Secondary objectives were to determine patient and clinical characteristics associated with risk of PAC successful insertion and failure. Methods: A prospective, observational study was conducted in the anaesthetic department and paediatric intensive care unit of a tertiary paediatric facility. Data were collected on PAC insertion, PAC management and PAC removal. Standard incidence and prevalence were calculated per 1,000 device days. Risk factors for multiple insertions and PAC failure were identified using Cox regression. Results: A total of 100 catheters in 89 children were examined capturing 472 device days. PACs were primarily inserted for blood sampling (78%) in the radial artery (78%) using ultrasound guidance (67%), with 31% inserted on first attempt. Heparin saline solution was used in 82% of devices. Median catheter dwell was 50.6 hours (IQR 24.0 – 158.0), with PAC failure occurring in 19 devices (20%), at a rate of 40.2 per 1000 catheter days (95% CI 25.7 - 63.1). Arm board immobilisation (HR 2.9; 95% CI 1.02-8.02; p = 0.05), higher PIM3 score (HR 1.06; 95% CI 1.03-1.09; p < 0.01) was associated with an increased the risk of PAC failure, and non-2% chlorhexidine antisepsis was associated with a decrease in PAC failure (HR 0.32; 95% CI 0.11-0.96; p = 0.04), in univariate analysis. Conclusions: PAC insertion is challenging, and failure is common. Prospective clinical trial data is needed to identify high risk patient groups and to develop interventions which optimise practices, thereby reducing failure.

Rationale & Objectives Conventional monitoring of hemodialysis dose is implemented using urea kinetic modeling based on single-pool Kt/V, which requires both pre- and postdialysis serum urea nitrogen (SUN) measurements. We compared this conventional approach to one in which Kt/V is calculated using conductivity clearance, thereby reducing the need for regular postdialysis SUN measurements. Study Design Comparative study of 2 diagnostic tests. Setting & Participants Prevalent patients receiving maintenance hemodialysis for at least 2 years for whom both urea reduction ratio (URR) and average conductivity clearance (Kecn) were measured. Tests Compared During the initial 8 months (baseline interval), average Kecn and URR were used to calculate a median patient-specific, modeled, calibration solute distribution volume (Vcal). During months 9 to 16 (period 1) and 17 to 24 (period 2), Kt/V was conventionally computed using URR and also by a new method using Vcal and Kecn without postdialysis SUN values. We examined the percentage error between these 2 methods of calculating Kt/V. Outcomes Concordance between the 2 methods of calculating Kt/V. Results Among 1,093 patients, mean individual-level median single-pool Kt/V values derived using the conventional method during the baseline interval, period 1, and period 2 were 1.62±0.24 (SD), 1.66±0.24, and 1.67±0.24, respectively. During periods 1 and 2, patient-level median Kt/V values derived using Kecn were 1.64±0.24 and 1.65±0.24, respectively. Percent differences between patient-level median values of Kt/V (conductivity minus conventional URR methods) were−0.63%±7.7% and−0.75%±8.4% for periods 1 and 2. Normalized protein nitrogen appearance were comparable between the 2 methods. Limitations Data were collected over 2 years. Study was limited to in-center hemodialysis patients dialyzed 3 times per week. Dialysis session length was not adjusted for treatment interruptions. Conclusions A new method of calculating Kt/V based on Kecn that requires fewer postdialysis SUN measurements provided diagnostic data comparable to those from conventional use of URR and has the potential to avoid errors related to postdialysis blood sampling and measurement.

Hospital-acquired anemia (HAA) is a prevalent condition that is independently associated with worse clinical outcomes including prolongation of hospital stay and increased morbidity and mortality. While multifactorial in general, iatrogenic blood loss has been long recognized as one of the key contributing factors to development and worsening of HAA during hospital stay. Patients can be losing over 50 mL of blood per day to diagnostic blood draws. Strategies such as elimination of unnecessary laboratory tests that are not likely to alter the course of management, use of pediatric-size or small-volume tubes for blood collection to reduce phlebotomy volumes and avoid blood wastage, use of closed blood sampling devices, and substituting invasive tests with point-of-care testing alone or bundled together have generally been shown to be effective in reducing the volume of iatrogenic blood loss, hemoglobin decline, and blood transfusions, with no negative impact on the availability of test results for the clinical team. These strategies are important components of Patient Blood Management programs and their adoption can lead to improved clinical outcomes for patients.

Background and aim Systemic lupus erythematosus (SLE) is associated with accelerated atherogenesis. Traditional risk factors do not seem to fully explain this process in patients with SLE and no other imaging/serum biomarkers have so far improved risk stratification. Here, we focused on the role of adiponectin in women with SLE. Methods and results This is a sub-analysis of a validated cohort enrolling eighty females (age 18–65 years) affected by SLE. Patient underwent a single blood sampling and carotid echography. Serum adipocytokines (i.e. leptin, resistin and adiponectin) were assessed by enzyme-linked immunosorbent assay (ELISA). Patients with a carotid plaque (n = 23) were older, with longer duration of the disease, chronic use of corticosteroids, and immunosuppressive therapies. As expected, patients with a carotid plaque had increased vascular risk and high serum levels of inflammatory biomarkers, total and LDL cholesterol and adiponectin. Significant positive correlation between serum adiponectin and presence of a carotid plaque was found independently of patient age, SCORE Risk Charts, duration of disease, and SLE treatments. Conclusions These results indicate that high serum adiponectin is associated with accelerated carotid atherosclerosis in SLE young women and it might be useful to improve vascular risk stratification in this patient setting.

Objectives Muscle damage symptoms induced by unaccustomed eccentric contraction exercise can be reduced by repeating the experience several times. This phenomenon is termed the repeated bout effect. Although traditional biochemical markers require invasive blood sampling, biochemical measurements have recently been developed that can be non-invasively performed using urinary titin N-terminal fragment (UTF). However, it is unclear whether UTF can reflect the repeated bout effect. Therefore, the aim of the present study was to clarify whether UTF decreased with the repeated bout effect. Design This study compared changes in muscle damage markers between bouts of exercise performed for the first and second time. Methods Eight young men performed 30 eccentric exercises of the elbow flexor on the first day of the first week (Bout 1). A second bout of eccentric exercises, same as the first, was performed 2 weeks later, (Bout 2). The dependent variables were muscle soreness (SOR), maximal voluntary isometric contraction (MVIC), range of motion (ROM), creatine kinase (CK), and UTF. All dependent variables were analyzed using two-way analysis of variance. Results No significant difference was observed in workload or peak torque between the first and second exercise bouts. SOR as well as CK and UTF were significantly lower and ROM and MVIC were significantly higher in Bout 2 in comparison to Bout 1. Conclusions These results suggest that UTF sensitively reflects the repeated bout effect and exercise-induced muscle damage can be non-invasively measured.

Objective To explore whether auricular concha eletroacupuncture (ACEA) is effective in regulating lipid-lipoprotein metabolism in rats submitted to cold stress. Methods Thirty-six adult male Sprague–Dawley rats were placed in four groups(9 rats in each group), the rats in three groups of which were submitted to cold stress for fourteen days, the last one of which was a control group. After the cold stress process, in those three groups, the rats of one group were with no treatment (stress only), two were treated with either ACEA or auricular margin eletroacupuncture (AMEA) repeated for fourteen days. On the 14th day, all the rats were sacrificed after all experimental procedure for blood sampling. Blood glucose, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were tested by using the collected serum. Plasma lecithin-cholesterol acyltransferase (LCAT) was measured with ELISA kit. Results ACEA down-regulated the TG level (P Conclusion ACEA played an important role in regulating lipid-lipoprotein metabolism in rats submitted to cold stress.