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The aim of this paper is to discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification, early recurrence identification and application of new imaging modalities, what is the PET-CT. Moreover, follow-up of patients with thyroid carcinoma should be carried out by specialized teams throughout life. Therefore, interdisciplinary case discussions in tumor conferences may improve the use of multimodal therapy especially in patients with poorly differentiated thyroid carcinomas. After baseline follow-up, if there is a suspicion of thyroid carcinoma, early PET-CT should be used for early detection and appropriate planning. Fortunately, due to the good localization possibility, the PET-CT enables a focused surgical procedure with avoidance of an unnecessary tumor search and thereby a reduction of the risk of injury of neighboring structures which is a concern with reoperative neck surgery.

Objective To outline the epidemiological profile and identify the hospital outcomes of patients submitted to neuromuscular scoliosis correction surgery. Methods This was a descriptive study that included 50 patients hospitalized following surgery for neuromuscular scoliosis in a tertiary-level hospital in São Paulo from January 2017 to July 2017. The variables were collected retrospectively from the patients’ medical records: age, sex, main diagnosis, length of hospital stay, duration of surgery, hospital complications, and mobility. Results Surgeries were performed in boys and girls in similar proportions, adolescents, many with cerebral palsy (42%), with mean hospital stay of 10.8 days. Fifty-two percent presented some complication, such as constipation. Infection of the surgical site was present in 12% of the sample. Forty-two percent had moderate to intense pain and only 2% did not achieve the proposed mobility goals. Conclusion We observed that the epidemiological profile presented data consistent with the scarce literature available, while the definitions of complications, incidence, and hospital outcomes available in the literature were varied quite a bit from the findings in this study. Level of evidence III; Retrospective study. RESUMO Objetivos Traçar o perfil epidemiológico e identificar os desfechos hospitalares de pacientes submetidos à correção cirúrgica de escoliose neuromuscular. Métodos Trata-se de um estudo descritivo, em que foram incluídos 50 pacientes internados em pós-operatório de escoliose neuromuscular, em um hospital de nível terciário em São Paulo, no período de janeiro de 2017 a julho de 2017. As variáveis foram coletadas de forma retrospectiva, a partir dos prontuários dos pacientes: idade, sexo, diagnóstico principal, tempo de internação, tempo de duração da cirurgia, complicações hospitalares e mobilidade. Resultados As cirurgias foram realizadas em meninos e meninas em proporção semelhante, adolescentes, em sua maioria com paralisia cerebral (42%), sendo que o tempo de internação médio foi de 10,8 dias e 52% apresentaram alguma complicação como a obstipação. A infecção de sítio cirúrgico esteve presente em 12% da amostra, 42% apresentaram dor moderada à intensa e só 2% não cumpriram as metas de mobilidade propostas. Conclusões Observamos que o perfil epidemiológico apresentou dados consistentes com a escassa literatura disponível, enquanto a definição de complicação, incidência e desfechos hospitalares disponíveis na literatura foram bastante variáveis com os achados neste estudo. Nível de Evidência III; Estudo Retrospectivo. RESUMEN Objetivos Trazar el perfil epidemiológico e identificar los resultados hospitalarios de pacientes sometidos a la corrección quirúrgica de escoliosis neuromuscular. Métodos Se trata de un estudio descriptivo, en el que fueron incluidos 50 pacientes internados en postoperatorio de escoliosis neuromuscular, en un hospital de nivel terciario en São Paulo, en el período de enero de 2017 a julio de 2017. Las variables fueron colectadas de forma retrospectiva, a partir de los prontuarios de los pacientes: edad, sexo, diagnóstico principal, tiempo de internación, tiempo de duración de la cirugía, complicaciones hospitalarias y movilidad. Resultados Las cirugías fueron realizadas en niños y niñas en proporción semejante, adolescentes, en su mayoría con parálisis cerebral (42%), siendo que el tiempo de internación promedio fue de 10,8 días y 52% presentaron alguna complicación como el estreñimiento. La infección de sitio quirúrgico estuvo presente en 12% de la muestra, 42% presentaron dolor moderado a intenso y sólo 2% no cumplieron las metas de movilidad propuestas. Conclusiones Observamos que el perfil epidemiológico presentó datos consistentes con la escasa literatura disponible, mientras que la definición de complicación, incidencia y resultados hospitalarios disponibles en la literatura fueron bastante variables con los hallazgos en este estudio. Nivel de Evidencia III; Estudio Retrospectivo.

The increasing ubiquity of smartphone data, with greater spatial and temporal coverage than achieved by traditional study designs, have the potential to provide insight into habitual physical activity patterns. This study implements and evaluates the utility of both K-means clustering and agglomerative hierarchical clustering methods in identifying weekly and yearlong physical activity behaviour trends. Characterising the demographics and choice of activity type within the identified clusters of behaviour. Across all seven clusters of seasonal activity behaviour identified, daylight saving was shown to play a key role in influencing behaviour, with increased activity in summer months. Investigation into weekly behaviours identified six clusters with varied roles, of weekday versus weekend, on the likelihood of meeting physical activity guidelines. Preferred type of physical activity likewise varied between clusters, with gender and age strongly associated with cluster membership. Key relationships are identified between weekly clusters and seasonal activity behaviour clusters, demonstrating how short-term behaviours contribute to longer-term activity patterns. Utilising unsupervised machine learning, this study demonstrates how the volume and richness of secondary app data can allow us to move away from aggregate measures of physical activity to better understand temporal variations in habitual physical activity behaviour.

Background Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide and characterised by joint pain and inflammation. It is a complex disease involving inflammatory factors and affecting the whole joint, including the synovial membrane. Since drug combination is widely used to treat chronic inflammatory diseases, a similar strategy of designing plant-derived natural products to reduce inflammation in OA joints may be of interest. In this study, we characterised the response of OA synovial cells to lipopolysaccharide (LPS) and investigated the biological action of the combination of curcumin, bromelain and harpagophytum in this original in vitro model of osteoarthritis. Methods Firstly, human synovial cells from OA patients were stimulated with LPS and proteomic analysis was performed. Bioinformatics analyses were performed using Cytoscape App and SkeletalVis databases. Additionally, cells were treated with curcumin, bromelain and harpagophytum alone or with the three vegetal compounds together. The gene expression involved in inflammation, pain or catabolism was determined by RT-PCR. The release of the encoded proteins by these genes and of prostaglandin E2 (PGE2) were also assayed by ELISA. Results Proteomic analysis demonstrated that LPS induces the expression of numerous proteins involved in the OA process in human OA synovial cells. In particular, it stimulates inflammation through the production of pro-inflammatory cytokines (Interleukin-6, IL-6), catabolism through an increase of metalloproteases (MMP-1, MMP-3, MMP-13), and the production of pain-mediating neurotrophins (Nerve Growth Factor, NGF). These increases were observed in terms of mRNA levels and protein release. LPS also increases the amount of PGE2, another inflammation and pain mediator. At the doses tested, vegetal extracts had little effect: only curcumin slightly counteracted the effects of LPS on NGF and MMP-13 mRNA, and PGE2, IL-6 and MMP-13 release. In contrast, the combination of curcumin with bromelain and harpagophytum reversed lots of effects of LPS in human OA synovial cells. It significantly reduced the gene expression and/or the release of proteins involved in catabolism (MMP-3 and -13), inflammation (IL-6) and pain (PGE2 and NGF). Conclusion We have shown that the stimulation of human OA synovial cells with LPS can induce protein changes similar to inflamed OA synovial tissues. In addition, using this model, we demonstrated that the combination of three vegetal compounds, namely curcumin, bromelain and harpagophytum, have anti-inflammatory and anti-catabolic effects in synovial cells and may thus reduce OA progression and related pain.

Supplemental Digital Content is available in the text., OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN: Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING: The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS: We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS: We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS: Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Bovine colostrum (BC) has been used for nutraceutical purposes for animals and humans. Bovine colostrum is a complex heterogeneous product and its antimicrobial activity, antioxidant potential, and growth factors can vary depending on age and species of the cow as well as their environment. Bovine colostrum preparation in skimmed or whey fractions can also alter properties of BC. Our goal was to compare cumulative anti-inflammatory, antioxidant, and adipogenic properties of natural (whole) versus whey BC. We compared properties of whole and whey BC in 3T3-L1 preadipocytes permanently transfected with reporters responding to changes in inflammatory (NfκbRE/green fluorescent protein), anti-inflammatory (Nrf2/YFP), and adipogenic (Fabp4/cyan fluorescent protein) status in cells. Interleukin-6 secretion in these cells was measured by ELISA. Whole and whey BC induce IL-6 secretion from 3T3-L1 fibroblasts; however, whey preparation stimulated less IL-6 secretion. Cumulative inflammatory nuclear factor (NF)κB activation in the presence of lipopolysaccharide was reduced by both whole (-27%) and whey BC (-22%) compared with lipopolysaccharide-treated cells (100%). Treatment with whole BC was more effective in the reduction of NFκB activation compared with whey BC and occurred in a dose-dependent manner. In consonance with decreased NFκB activation, the Nrf2 promoter activity was also reduced in response to whole (-27%) and whey (-13%) treatments compared with nontreated cells (100%). Whole and whey BC suppressed adipogenesis, measured as induction of Fabp4, by -27 and -13%, respectively, compared with nontreated 3T3-L1 fibroblasts (100%). Our results showed distinct differences in properties of whey and whole BC that could be used to attain reduced adipogenic or cumulative inflammatory responses.

Graphical abstract, Highlights • Risk of RLN palsy during thyroidectomy for Graves’ disease is high. • I-IONM and C-IONM are feasible and useful during thyroidectomy for Graves’ disease. • Proportion of complete thyroidectomy was significantly higher using IONM technology., We evaluate the role of intraoperative neuromonitoring (IONM) in thyroidectomy performed for Graves’ disease (GD) with an emphasis on recurrent laryngeal nerve (RLN) management and completeness of resection. The study is a retrospective series comprising 55 thyroidectomy (control group) versus 82 procedures with intermittent IONM (I-IONM) and 72 by means of continuous IONM (C-IONM). In the control group the laryngeal nerves have been identified by visualization solely. In the I-IONM group both vagal nerve (VN) and RLN have been localized and monitored during thyroid resection. C-IONM was achieved with a vagal stimulation probe. I-IONM group had shorter operating times (P = 0.032). RLN morbidity, meaning palsy rate, was 2.7% in the C-IONM group, 3.6% in I-IONM and 5.4% in the control group (P = 0.058). The proportion of complete procedures (total or near total resections) were significantly higher using monitoring technology (P = 0.049). Persistent positive serum TBII values were found in 25 (45%), 25 (30%) and 20 (27%) patients at 12 months in the control, I-IONM and C-IONM groups respectively (P = 0,04). IONM is an effective technology in GD patients.

Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

In this study, a novel robotic bioreactor is presented with capabilities of closed-loop control of force and displacement applied to a tissue scaffold and tissue scaffold stiffness calculation. These characteristics bring the potential of a robotic bioreactor that can optimize the mechanical properties of tissue constructs in order for them to match those of native tissues. Custom position and force control signals are designed to maintain a steady tensioning of the tissue scaffold while the latter one’s mechanical properties evolve in time. We propose a simple model to support the hypothesis that the stiffness of a cell-seeded scaffold increases over time, and thus force control signals need to be adjusted accordingly. The robotic bioreactor is able to measure the stiffness of a scaffold sample relatively accurately, with an average standard deviation of 0.2N/mm. The combination of accurate stiffness measurements and a closed-loop control system equips the robotic bioreactor with the fundamental requirements to achieve stiffness based force control in future in vitro experiments, and thus to a tissue-scaffold responsive technology for advanced tissue engineering.

Aims: Social prescribing continues to grow and change across healthcare services in Wales; however, research of the day-to-day performance of social prescribers is limited. This study aimed to explore which roles are perceived to be the most important and frequently used by social prescribers in Wales and compare these results to reports in studies of services in other countries in order to support future role development and potential standardisation. Methods: This study used the Group Concept Mapping via the Concept Systems Global Max™ software to collect and analyse all data from both participants and literature. Results: There was a total of 101 statements generated (119 participants, 84 literature) ranging from generic interpersonal skills to specialised training (cognitive behavioural therapy). These statements were then sorted by conceptual similarity into seven clusters (Providing a Specialist Service, Working in a person-centred way, Skills, Connecting Clients with Community, Collaborative Working, Evaluating and postprogramme duties, and Networking/Community). Statements were rated based on their perceived importance and frequency, with the ‘Skills’ cluster having the highest overall average and ‘Providing a Specialist Service’ having the lowest. Conclusions: Reports indicate that in general there is variation in the roles performed by individual participants in Wales; however, greater variation was observed between participants and literature suggesting geographical divergence in practice. In the top 12 highest rated statements for both frequency and importance, individualistic traits such as empathy and ‘being a listener’ are favoured over specialised methods such as cognitive behavioural therapy and behaviour change taxonomy. Results suggest that local need plays a part in the choices and performance of social prescribers and as such should be considered in future standardisation.

Background: Osteoarthritis is the most common cause of arthritis affecting millions of people worldwide, characterized by joint pain and inflammation. It is a complex disease involving inflammatory factors and affecting the whole joint including synovium. Since drug combination is widely used to treat chronic inflammatory diseases, a similar strategy may be worth of interest to design plant-derived natural products to reduce inflammation in OA joint. Here, we characterized the response of OA synovial cells to lipopolysaccharide (LPS) and investigated the biological action of the combination of curcumin, harpagophytum and bromelain in this original in vitro model of osteoarthritis.Methods: Primary, human synovial cells from OA patients were stimulated with LPS and proteomic analysis was performed. Bioinformatics analysis were performed using Cytoscape App and SkeletalVis databases. Additionally, cells were treated with curcumin, harpagophytum and bromelain alone or the three vegetal compounds together. The expression of genes involved in inflammation, pain or catabolism were determined by RT-PCR. The release of the encoded proteins by these genes and of prostaglandin E2 (PGE2) were also assayed by ELISA. Results: Proteomic analysis demonstrated that LPS induces the expression of numerous proteins involved in OA process in human OA synovial cells. In particular, it stimulates inflammation through the production of pro-inflammatory cytokines (Interleukin-6, IL-6), the catabolism through an increase of metalloproteases (MMP-1, MMP-3, MMP-13), and the production of pain-mediating neurotrophin (Nerve Growth Factor, NGF). These increases were observed at level of mRNA levels and of protein release. LPS also increases the amount of PGE2, another inflammation and pain mediator. At doses tested, vegetal extracts had little effects: only curcumin slightly counteracted the effects of LPS on NGF and MMP13 mRNA, and PGE2, IL-6 and MMP13 release. In contrast the association of curcumin with harpagophytum and bromelain reversed lots of effects of LPS in human OA synovial cells. It significantly reduced the gene expression and/or the release of proteins involved in catabolism (MMP3 and 13), inflammation (IL-6) and pain (PGE2 and NGF).Conclusion: We show that the stimulation of human OA synovial cells with LPS permit to induce protein changes similar to an inflamed OA synovial tissues. In addition, using this model, we demonstrate that the combination of three vegetal compounds, namely curcumin, harpagophytum and bromelain have anti-inflammatory and anti-catabolic action in synovial cells and may thus reduce OA progression and related-pain.

BACKGROUND AND OBJECTIVES: It is possible that patients submitted to lumbar spine surgery present chronic pain and need a multidimensional assessment of postoperative pain due to the variables that influence pain. The objective of this study was to evaluate the correlation between uni and multidimensional scales for postoperative pain assessment. METHODS: Longitudinal and observational study carried out in the inpatient units of an orthopedic reference hospital in São Paulo. 53 patients were selected in the preoperative period of lumbar spine arthrodesis, 28 were excluded and 25 were evaluated with the numerical verbal scale and Brief Pain Inventory on the preoperative day and on postoperative day 2. RESULTS: In the sample, all patients had chronic pain with a mean previous pain time of 9.24 years. There was variation between the pre and postoperative periods on the Brief Pain Inventory in almost all items, but only the item regarding the amount of pain ‘’right now’’ (in the moment) was equivalent to the numerical verbal scale (Kappa=almost complete correlation). CONCLUSION: The numerical verbal scale and Brief Pain Inventory were not comparable since the Numerical Verbal Scale showed a worsening of postoperative pain, while the Brief Pain Inventory reflected improvement in the perception of postoperative pain. The Brief Pain Inventory seemed to be a better tool for pain assessment in this study RESUMO JUSTIFICATIVA E OBJETIVOS: É possível que pacientes submetidos a cirurgia de coluna lombar apresentem dor crônica e necessitem de avaliação multidimensional da dor pós-operatória devido às variáveis que influenciam a dor. O objetivo deste estudo foi avaliar a correlação entre as escalas uni e multidimensional para avaliação de dor pós-operatória. MÉTODOS: Estudo longitudinal e observacional desenvolvido nas unidades de internação de um hospital ortopédico de referência em São Paulo. Foram selecionados 53 pacientes no pré-operatório de artrodese da coluna lombar, 28 foram excluídos e 25 avaliados com a escala verbal numérica e o Inventário Breve de Dor no dia do pré-operatório e no 2° dia de pós-operatório. RESULTADOS: Na amostra todos os pacientes apresentavam dor crônica com tempo médio de dor prévia de 9,24 anos. Observou-se variação entre o pré e pós-operatório no Inventário Breve de Dor em quase todos os itens, mas apenas o item sobre a dor ‘’neste momento” se equiparou à escala verbal numérica (Kappa=correlação quase completa). CONCLUSÃO: A escala verbal numérica e o Inventário Breve de Dor não foram equiparáveis uma vez que a Escala Verbal Numérica evidenciou piora da dor pós-operatória, enquanto o Inventário Breve de Dor refletiu melhora na percepção da dor pós-operatória. O Inventário Breve de Dor pareceu ser melhor instrumento para avaliação de dor neste estudo.

BACKGROUND AND OBJECTIVES: Pain education is a tool that helps health professionals in the biopsychosocial approach and in pain management in patients with musculoskeletal pain. The objectives of the study were to verify the effects of a pain education program in patients with chronic musculoskeletal pain. The evaluated outcomes were pain, kinesiophobia, catastrophizing, quality of life, central sensitization and perception of the disease. METHODS: Observational, retrospective study. Data from 24 participants with chronic pain, mean age 57 years, were analyzed, 83% of whom were female. Patients participated in a pain education program, which addressed topics such as acceptance, pain alarm, sleep, relaxation, negative thoughts, return to activities, relationships, and exercises. RESULTS: Participants showed significant changes in the cognitive representation of the disease measured by the Illness Perception Questionnaire (Brief-IPQ) (p

This research full paper presents an investigation on pedagogical practices and educational methods used by professionals who work in the teaching of the elderly. The study of the ageing process is one of the most significant research trends of the 21st century and represents new social, educational and computational challenges. Increased life expectancy and the number of elderly elevate the heterogeneity in the segment, beyond the age. This research focuses on education and mobile learning (m-learning) application. Considering the elderly audience, it is necessary to develop m-learning apps based on accessibility and pedagogical proposals, since the elderly may have their physical and cognitive abilities compromised due to age. Currently, there are consolidated accessibility guidelines for software development. However, these guidelines do not regard cognitive, language and learning disabilities. These points are necessary for the process of developing m-learning applications, especially those specific to the elderly user. Thus, this paper aims to present the results of a survey applied with 33 professionals (teachers, pedagogues, gerontologists and others) involved in the education of the elderly. Issues involving teaching practices for the elderly, content preparation, interactivity, and motivation are addressed. This study is part of a larger project aimed to contribute to the development of accessibility and pedagogical guidelines that aim to assist in the process of developing m-learning applications focused on the elderly.

Case A 36-year-old male professional soccer player sustained an acute left hip injury during a tournament game while defending the goal. Magnetic resonance imaging demonstrated a complete avulsion of the iliopsoas tendon from the left trochanter. The patient was treated nonoperatively, and after 10 weeks, he was able to return to full activity. After 1 year of follow-up, the patient was completely asymptomatic, and was still playing professional soccer without flexion strength deficit. Conclusion In this professional soccer athlete, nonoperative treatment of complete psoas avulsion resulted in a good functional outcome and successful return to play.

As a consequence of developing antimicrobial resistance to disinfectants, copper, which exhibits antimicrobial activity, has been studied as a possible alternative to the use of stainless steel surfaces. The aim was to evaluate the antimicrobial activity of copper surfaces in preventing biofilm formation by Salmonella Enteritidis and to determine their corrosive capacity. Strains of S. Enteritidis were incubated at 4 °C, 12 °C, and 25 °C with 1 cm2 coupons of electrolytic copper (99.9% Cu), brass (70% Cu), copper coated with tin, and stainless steel (control). A planktonic cell-suspension assay was used, followed by serial dilutions and bacterial counts. The corrosion test was performed with two disinfectants: benzalkonium chloride and sodium hypochlorite (100, 200, and 400 ppm). There was a significant reduction in biofilm production (log10 CFU cm−2) on the copper (2.64 at 4 °C, 4.20 at 12 °C, 4.56 at 25 °C) and brass (2.79 at 4 °C, 3.49 at 12 °C, 4.55 at 25 °C) surfaces compared to the control (5.68 at 4 °C, 5.89 at 12 °C, 6.01 at 25 °C). The antimicrobial surfaces showed uniform corrosion similar to that of surfaces generally used. These results demonstrated the effectiveness of copper surfaces in reducing S. Enteritidis and suggest they can be used as a complementary antimicrobial to control for this pathogen.

The African bonytongue (Heterotis niloticus) is an excellent candidate for fish farming because it has outstanding biological characteristics and zootechnical performances. However, the absence of sexual dimorphism does not favor its reproduction in captivity or the understanding of its reproductive behavior. Moreover, no molecular data related to its reproduction is yet available. This study therefore focuses on the structural identification of the different molecular actors of vitellogenesis expressed in the pituitary gland, the liver and the ovary of H. niloticus. A transcriptomic approach based on de novo RNA sequencing of the pituitary gland, ovary and liver of females in vitellogenesis led to the creation of three transcriptomes. In silico analysis of these transcriptomes identified the sequences of pituitary hormones such as prolactin (PRL), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and their ovarian receptors (PRLR, FSHR, LHR). In the liver and ovary, estrogen receptors (ER) beta and gamma, liver vitellogenins (VtgB and VtgC) and their ovarian receptors (VLDLR) were identified. Finally, the partial transcript of an ovarian Vtg weakly expressed compared to hepatic Vtg was identified based on structural criteria. Moreover, a proteomic approach carried out from mucus revealed the presence of one Vtg exclusively in females in vitellogenesis. In this teleost fish that does not exhibit sexual dimorphism, mucus Vtg could be used as a sexing biomarker based on a non-invasive technique compatible with the implementation of experimental protocols in vivo.

Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) may represent the next phase of minimally invasive endocrine surgery, and early clinical experience shows that TOETVA i...

In endoscopic neck endocrine surgery, the subplatysmal plane is an anatomic key structure that must be identified and preserved, to progress with the dissection. We define the prevalence of platysma, in the intermediate plane of the anterior cervical region, and evaluate potential statistical correlations with clinical and pathologic variables.The study included patients who had thyroid surgery. Morphologies, asymmetry, and patterns of the platysma were described. The analysis of the different considered variables was quantitative and qualitative, using multiple data reports.A total of 23 men and 90 women, aged 19 to 70 (median 41±19) years constituted the study cohort. Their neck circumference and height were 388.5±45 mm (334 to 479 mm) and 200±30 mm (160 to 270 mm), respectively. The hemi-platysmal muscle was bilaterally identified in 109 (96.4%). The mean platysmal thickness was 2.7±1.7 mm (range: 0.7 to 8.2 mm). The intermediate plane between the platysmal muscles was classified into 4 types, depending on the muscle features in the midline: Type A: the left and right platysmal fibers were interlaced with each other in the midline (7%); type B: the platysmal fibers were disconnected by1 cm (27%); type C: between 1 and 3 cm (52%); and type D separated3 cm (14%).We provide descriptive characteristics of the cervical platysma. A better understanding of the anatomic variability in cervical platysma may be useful in performing a more accurate dissection in endoscopic endocrine neck surgery.

Background: Health professional education has been criticized for not integrating patient expertise into professional curricula to develop professional skills in patient empowerment. Objective: To develop and translate a new expert patientcentered model for teaching empowerment into professional education about routine chronic care management. Methods: Eight Finnish patients (known as expert patients), 31 students, and 11 lecturers from 4 European countries participated in a new pilot intensive educational module. Thirteen focus groups, artefacts, and an online student evaluation were analyzed using a thematic analysis and triangulated using a meta-matrix. Results: A patient-centered pedagogical model is presented, which describes 3 phases of empowerment: (1) preliminary work, (2) the elements of empowerment, and (3) the expected outcomes. These 3 phases were bound by 2 cross-cutting themes “time” and “enabling resources.” Conclusion: Patient expertise was embedded into the new module curriculum. Using an example of care planning, and Pentland and Feldman’s theory of routine organization, the results are translated into a patient-centered educational model for teaching empowerment to health profession students.

Posterior tibial tendon (PTT) dysfunction is three times more common in females, and some patients may have a predisposition without a clinically evident cause, suggesting that individual characteristics play an important role in tendinopathy. The present study investigated the association of rs4986938 (+ 1730G > A; AluI RFLP) and rs1256049 (− 1082G > A; RsaI RFLP) single nucleotide polymorphisms (SNPs) of estrogen receptor-beta (ER-β) gene with PTT dysfunction. A total of 400 participants were recruited. The PTT dysfunction group: these patients underwent surgery, with PTT tendinopathy confirmed by histopathology and magnetic resonance image (MRI). The control group was composed of participants with no clinical or MRI evidence of PTT dysfunction. Each group was composed of 100 postmenopausal women, 50 premenopausal women, and 50 men. Genomic DNA was extracted from saliva samples, and genotypes were obtained by polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP). Concerning the ER-β SNP rs4986938, there were significant differences in the frequencies of alleles between test and control groups of all the cases, only postmenopausal women and only men (p

UK public health nurse assessment of family resilience is a necessary component of monitoring family health and children’s development and identifying areas for change. This research was part of an exploration of Welsh public health nurses’ understanding of ‘family resilience’ as a concept underpinning their practice. From it, the Family Resilience Assessment Instrument Tool (FRAITTM www.frait.wales/) was developed for public health nurses use. We report on a virtual commissioning process using focus groups and an immersive simulation suite to test a FRAIT prototype in a safe environment before field testing. Virtual commissioning design: Hydra-Minerva Immersive Simulation Suite – individual public health nurses presented with a multi-media scenario as they used the prototype FRAIT. Follow-up focus groups for usability insights before field testing. Virtual commissioning raised real-world issues which public health nurses discussed in focus groups. Issues were scoring, absence of information, focusing on family resilience, identifying adults caring for children, potential for use, identifying need and monitoring change, potential impact of using FRAIT and fitting it to everyday practice. Prototype testing like this allowed us to fine tune the FRAIT for field testing.

Veterinary students experience high levels of psychological distress including anxiety, stress, perceived stress and depression. The inability to cope with the demands of veterinary training has personal and professional consequences. Existing evidence shows that mindfulness-based interventions (MBI) can reduce stress in students, but more research on how MBIs are introduced into the veterinary curriculum is required. The first aim of the pilot study was to design and deliver a bespoke MBI to third-year veterinary students at the University of Liverpool Institute of Veterinary Science. The second aim was to gain feedback from those taking part, thus using their experiences to explore the challenges of introducing an MBI into a veterinary curriculum. By doing this, we aim to reflect and learn for future interventions. Qualitative feedback provided by participants of the MBI focus group was analyzed using thematic analysis and organized into two main themes: (1) “Taking Part in the MBI and Beyond—What it Was Like and What Has the MBI Done for Me?” and (2) “Mindfulness for Veterinary Students—Reflections, Challenges, and Making it Happen.” Experiences and outcomes of the MBI were positive. However, implementation into the veterinary curriculum was found to be challenging. This pilot study provides clear recommendations to support the future integration and delivery of MBIs into a veterinary curriculum.

WOS: 000475757700011, PubMed ID: 31360931, The transoral thyroidectomy (TT) is a feasible novel surgical procedure that does not need visible incisions, a truly cutaneous scar-free surgery. Inclusion criteria are (a) patients who have a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm, (b) US estimated gland volume

Decreases in the use of antibiotics and anticoccidials in the poultry industry have risen the appearance of necrotic enteritis (NE). The purpose of this study was to evaluate the effect of a Bacillus direct-fed microbial (DFM) on growth performance, intestinal integrity, NE lesions and ileal microbiota using a previously established NE-challenged model. At day-of-hatch, chicks were randomly assigned to three different groups: Negative control (NC), Positive control (PC) challenged with Salmonella Typhimurium (day 1), Eimeria maxima (EM, day 13) and Clostridium perfringens (CP, day 18–19), and Bacillus-DFM group (DFM) challenged as the PC. Body weight (BW) and body weight gain (BWG) were measured weekly. Total feed intake (FI) and feed conversion ratio (FCR) were evaluated at day 21. Liver samples were collected to assess bacterial translocation and blood samples were used to measure superoxide dismutase (SOD) and fluorescein isothiocyanate-dextran (FITC-d). Intestinal contents were obtained for determination of total IgA and microbiota analysis. NE lesion scores (LS) were performed at day 21. Chickens consuming the DFM significantly improved BW and had a numerically more efficient FCR compared to PC at day 21. Additionally, there were no significant differences in FCR between the DFM group and NC. Furthermore, the DFM group showed significant reductions in LS, IgA and FITC-d levels compared to the PC. However, there were no significant differences in SOD between the groups. The microbiota analysis indicated that the phylum Proteobacteria was significantly reduced in the DFM group in comparison to PC. At the genus level, Clostridium, Turicibacter, Enterococcus, and Streptococcus were reduced, whereas, Lactobacillus and Bacillus were increased in the DFM group as compared to PC (p < 0.05). Likewise, the DFM significantly reduced CP as compared to PC. In contrary, no significant differences were observed in bacterial composition between NC vs. DFM. In addition, beta diversity showed significant differences in the microbial community structure between NC vs. PC, and PC vs. DFM. These results suggest that the dietary inclusion of a selected DFM could mitigate the complex negative impacts caused by NE possibly through mechanism(s) that might involve modulation of the gut microbiota.

Background Patients admitted to hospital with Covid-19 are at risk of deterioration. The National Early Warning Score (NEWS2) is widely recommended, however it's validity in Covid-19 is not established and indices more specific for respiratory failure may be more appropriate. We aim to describe the physiological antecedents to deterioration, test the predictive validity of NEWS2 and compare this to the ROX index ([SpO2/FiO2]/respiratory rate). Method A single centre retrospective cohort study of adult patients who were admitted to a medical ward, between 1/3/20 and 30/5/20, with positive results for SARS-CoV-2 RNA. Physiological observations and the NEWS2 were extracted and analysed. The primary outcome was a composite of cardiac arrest, unplanned critical care admission or death within 24 hours. A generalized linear model was used to assess the association of physiological values, NEWS2 and ROX with the outcome. Findings The primary outcome occurred in 186 patients (26%). In the preceding 24 hours, deterioration was most marked in respiratory parameters, specifically in escalating oxygen requirement; tachypnoea was a late sign, whilst cardiovascular observations remained stable. The area under the receiver operating curve was 0.815 (95% CI 0.804–0.826) for NEWS2 and 0.848 (95% CI 0.837–0.858) for ROX. Applying the optimal level of ROX, the majority of patients triggered four hours earlier than with NEWS2 of 5. Interpretation NEWS2 may under-perform in Covid-19 due to intrinsic limitations of the design and the unique pathophysiology of the disease. A simple index utilising respiratory parameters can outperform NEWS2 in predicting the occurrence of adverse events.

Objective: The aim is to identify the role and scope of Accredited Exercise Physiologist (AEP) services in the mental health sector and to provide insight as to how AEPs can contribute to the multidisciplinary mental health team. Methods: A modified Delphi approach was utilised. Thirteen AEPs with experience in mental health contributed to the iterative development of a national consensus statement. Six mental health professionals with expertise in psychiatry, mental health nursing, general practice and mental health research participated in the review process. Reviewers were provided with a template to systematically provide feedback on the language, content, structure and relevance to their professional group. Results: This consensus statement outlines how AEPs can contribute to the multidisciplinary mental health team, the aims and scope of AEP-led interventions in mental health services and examples of such interventions, the range of physical and mental health outcomes possible through AEP-led interventions and common referral pathways to community AEP services. Outcome: AEPs can play a key role in the treatment of individuals experiencing mental illness. The diversity of AEP interventions allows for a holistic approach to care, enhancing both physical and mental health outcomes.

Background. There is increasing debate about the advantages and disadvantages of family-witnessed resuscitation. Research about the views of healthcare providers depends upon reliable tools to measure their perceptions. Two tools have been developed for use with nurses (26-item cost-benefit tool, 17-item self-confidence tool). Objectives. Firstly, to validate these tools for use with student nurses in the UK. Secondly, to report on the perceived risks and benefits reported by student nurses, and their self-confidence in dealing with this situation. Methods. A sample of 79 student nurses were invited to complete the tools. Item-total correlations and Cronbach’s α were used to determine internal consistency. Factor analysis was computed to assess construct validity. The correlation between the two scales was explored. Results. 69 students completed a questionnaire. Very few had experience of family-witnessed resuscitation. Mean total scores were 3.16 (standard deviation 0.37; range 2.04–4.12) on the risk-benefit scale and 3.14 (standard deviation 0.66; range 1.94–4.82) on the self-confidence scale. Four of the original items were removed from the risk-benefit scale (Cronbach's α 0.86; 95% confidence interval ≥0.82). None were removed from the self-confidence scale (Cronbach's α 0.93; 95% confidence interval ≥0.91). There was a significant correlation between the two scales ( r = 0.37, p = 0.002). Conclusions. There is growing evidence that these tools are valid and reliable for measuring student nurses’ perceptions about family-witnessed resuscitation.