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Background Contained in-bag spleen morcellation is a conventional extraction technique for safe spleen removal during laparoscopic splenectomy. Existing data for the use of in-bag enzymatic splenic digestion as an alternative to morcellation are lacking. This proof-of-concept study sought to evaluate the effectiveness of single and combinatorial enzyme digestion of murine spleens. Materials and methods Murine spleens were digested with collagenase alone or with combinations of commercially available enzymes (collagenase, elastase, hyaluronidase, neutral protease) to determine their degradation effect. The primary end point was the percentage of mass reduction at 15 and 30 min. Results For collagenase alone ( n = 15), the mean reduction in mass was 14 ± 10% (range: 2%-31%) at 15 min and 30 ± 25% (range: 7%-100%) at 30 min. Using combinatorial dissolution with collagenase, hyaluronidase, and elastase ( n = 8), the mean reduction in mass was 27 ± 16% (range: 6%-42%) at 15 min and 48 ± 27% (range: 3%-100%) at 30 min. Injecting the enzyme solution into whole spleens ( n = 9) yielded a mean reduction in mass of 22 ± 13% (range: 9%-42%) at 15 min and 55 ± 31% (range: 9%-100%) at 30 min; mean reduction was 9 ± 13% (range: 0%-39%) at 15 min and 23 ± 13% (range: 3%-53%) with no injection ( n = 12). Conclusions We provide the first demonstration of successful enzymatic murine spleen digestion as an alternative method for in-bag spleen removal during laparoscopic splenectomy. However, the significant cost and quantities of commercial enzyme required for clinical application dampens the enthusiasm for this novel approach. [ABSTRACT FROM AUTHOR]

Adherence to antiretroviral therapy (ART) enables people living with HIV (PLWH) to reach and maintain viral suppression. As viral suppression significantly reduces risk for secondary transmission, this study aimed to examine sociodemographic factors associated with viral suppression among PLWH in South Carolina (SC). We analyzed cross-sectional data collected from 342 PLWH receiving HIV care from a large clinic in SC and provided complete information on most recent viral load, ART adherence, and sociodemographic factors. Bivariate analysis examined associations between key variables, and logistic regression was used to calculate the odds of viral suppression among select sociodemographic groups and adherence levels. Results indicated that approximately 82% of participants reported achieving viral suppression. PLWH who were older, male, and employed full-time had higher odds of being virally suppressed compared to those who were younger, female, and unemployed. PLWH with medium (adjusted Odds Ratio [aOR]: 3.79; 95% CI: 1.15-12.48) and high (aOR: 3.51; 95% CI: 1.21-10.24) levels of adherence were more likely to report viral suppression than those with low adherence. Targeted interventions are warranted for groups at-risk of low ART adherence, and healthcare providers should also be aware of contextual factors that serve as barriers to adherence for PLWH.

Purpose: The purpose of this study was to identify ways parents comfort their children to help them cope and adapt to the stresses of the deployment of a mother or father in military service, as well as the reintegration process of the parent returning home., Design and Methods: This qualitative study used a hermeneutic phenomenological approach to better understand the lived experiences of these families and strategies used to combat stressors of deployment and post-deployment. Using purposive and snowball sampling for recruitment, participants completed an online anonymous survey that consisted of demographic and open-ended questions. A study sample of 15 participants (n = 15) was selected based on inclusion and exclusion criteria. Using an interpretive framework for data analysis, six themes emerged from the survey., Results: Six themes emerged from the data including the value of family communication, the importance of maintaining a routine, the occurrence of behavioral issues and emotional distress in children, the use of creative coping strategies, the need for parental self-care, and the resilience of the military families., Conclusion: There are unique challenges for military families during and after deployment that can be mitigated with identified strategies., Implications for Practice: Incorporation of the study's findings into nursing practice will enhance patient education and anticipatory guidance for military families with children experiencing or planning for a parental deployment., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Individual clinical trials suggested that when treated with probiotic foods or supplements with Lactobacillus and Bifidobacterium, specific symptoms of metabolic syndrome (MetS) could be alleviated, but the results have been inconclusive., Aims: The objective of the present meta-analysis was to use anthropometric and biochemical as indicators to evaluate the efficacy of using these probiotic foods or supplements among individuals with MetS., Methods: PubMed, Cochrane Library, and CINAHL Plus were used to collect randomized controlled trials (RCTs) studies published from January 2000 to January 2018. Studies were included if they had at least one of the following outcome measurements: body mass index (BMI), waist circumference, hip circumference, waist-to-hip ratio, body fat mass (BFM), body fat percentage (BFP), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, fasting insulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and/or hemoglobin A1c (HbA1c)., Results: The 356 records were identified during the literature search, of which only 18 met the selection criteria. The 18 RCTs with a total of 1,544 participants were included in this analysis. This meta-analysis indicated that there were no significant differences of BMI, BFM, waist circumference, hip circumference, waist-to-hip ratio, SBP, DBP, fasting glucose, fasting insulin, TC, HDL-C, HbA1c, or triglycerides between the intervention and control groups. Significant standardized mean net differences were found in the BFP and LDL-C between the intervention and control groups., Conclusions: The results indicated that probiotic food and supplement with Lactobacillus and Bifidobacterium could be used as interventions to improve specific anthropometric and biochemical outcomes among individuals with MetS. However, probiotic treatment alone could not reduce overall health risks. In addition, there were methodological drawbacks among reviewed studies, and further research is needed., (© 2019 S. Karger AG, Basel.)