Patient, family and carer experiences of nutritional screening: a systematic review.

BACKGROUND: Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers. METHODS: A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception - July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes. RESULTS: Nine studies, including five qualitative interview papers, were included. Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change. CONCLUSIONS: Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.

Assessing the function of homologous recombination DNA repair in malignant pleural effusion (MPE) samples.

BACKGROUND: Patients with malignant pleural effusions (MPEs) generally have advanced disease with poor survival and few therapeutic options. Cells within MPEs may be used to stratify patients for targeted therapy. Targeted therapy with poly(ADP ribose) polymerase inhibitors (PARPi) depends on identifying homologous recombination DNA repair (HRR)-defective cancer cells. We aimed to determine the feasibility of assaying HRR status in MPE cells. METHODS: A total of 15 MPE samples were collected from consenting patients with non-small-cell lung cancer (NSCLC), mesothelioma and ovarian and breast cancer. Primary cultures were confirmed as epithelial by pancytokeratin, and HRR status was determined by the detection of γH2AX and RAD51 foci following a 24-h exposure to rucaparib, by immunofluorescence microscopy. Massively parallel next-generation sequencing of DNA repair genes was performed on cultured MPE cells. RESULTS: From 15 MPE samples, 13 cultures were successfully established, with HRR function successfully determined in 12 cultures. Four samples - three NSCLC and one mesothelioma - were HRR defective and eight samples - one NSCLC, one mesothelioma, one sarcomatoid, one breast and four ovarian cancers - were HRR functional. No mutations in DNA repair genes were associated with HRR status, but there was probable loss of heterozygosity of FANCG, RPA1 and PARP1. CONCLUSIONS: HRR function can be successfully detected in MPE cells demonstrating the potential to stratify patients for targeted therapy with PARPi.

Short-term heat acclimation is effective and may be enhanced rather than impaired by dehydration.

UNLABELLED: Most heat acclimation data are from regimes longer than 1 week, and acclimation advice is to prevent dehydration. OBJECTIVES: We hypothesized that (i) short-term (5-day) heat acclimation would substantially improve physiological strain and exercise tolerance under heat stress, and (ii) dehydration would provide a thermally independent stimulus for adaptation. METHODS: Nine aerobically fit males heat acclimated using controlled-hyperthermia (rectal temperature 38.5°C) for 90 min on 5 days; once euhydrated (EUH) and once dehydrated (DEH) during acclimation bouts. Exercising heat stress tests (HSTs) were completed before and after acclimations (90-min cycling in Ta 35°C, 60% RH). RESULTS: During acclimation bouts, [aldosterone]plasma rose more across DEH than EUH (95%CI for difference between regimes: 40-411 pg ml(-1); P = 0.03; n = 5) and was positively related to plasma volume expansion (r = 0.65; P = 0.05), which tended to be larger in DEH (CI: -1 to 10%; P = 0.06; n = 9). In HSTs, resting forearm perfusion increased more in DEH (by 5.9 ml 100 tissue ml(-1) min(-1): -11.5 to -1.0; P = 0.04) and end-exercise cardiac frequency fell to a greater extent (by 11 b min(-1): -1 to 22; P = 0.05). Hydration-related effects on other endocrine, cardiovascular, and psychophysical responses to HSTs were unclear. Rectal temperature was unchanged at rest but was 0.3°C lower at end exercise (P < 0.01; interaction: P = 0.52). CONCLUSIONS: Short-term (5-day) heat acclimation induced effective adaptations, some of which were more pronounced after fluid-regulatory strain from permissive dehydration, and not attributable to dehydration effects on body temperature.

Osteogenic growth peptide normally stimulated by blood loss and marrow ablation has local and systemic effects on fracture healing in rats.

Osteogenic growth peptide, a histone H4-related, 14-amino-acid peptide, is an active mediator of local, as well as systemic, osteogenic activity in response to marrow ablation, trauma, and blood loss. In this study, the effect of exogenous osteogenic growth peptide on the healing of femoral fractures in rats was investigated. A fracture at the midshaft of the femur was created in 50 rats. Half of the rats were injected subcutaneously with 25 ng of osteogenic growth peptide per rat per day for the first 7 days after fracture. Radiographs were taken each week, and the diameter of the callus was measured. The femurs of four animals from each group were harvested 1, 2, 3, and 4 weeks after fracture. Two femurs from each group were sectioned for histologic examination, and two were sectioned for measurement of density and mineral content. Marrow was aspirated from the contralateral femurs to establish adhering cell cultures, which were examined for osteogenicity. At 2 weeks, a large increase in mitogenicity and osteogenicity was seen in the marrow-derived cultures from the rats treated with osteogenic growth peptide; this increase was sustained through 4 weeks. Extraction of RNA from the contralateral marrow (systemic expression) and callus (local expression) for amplification with reverse transcription-polymerase chain reaction revealed greater systemic expression of transforming growth factors beta1, beta2, and beta3, fibroblast growth factor-2, insulin-like growth factor-1, and aggrecan throughout the 4 weeks after fracture, whereas types IIA and IIB collagen, link protein, and fibroblast growth factor receptor-3 had a greater local expression. The specimens treated with osteogenic growth peptide had a stronger expression of transforming growth factor-beta1, both locally and systemically. The average diameter of the callus was greater for the treated rats at all time intervals, and peak diameters were 7.58 mm at 3 weeks for the treated rats and 6.64 mm at 2 weeks and 6.63 mm at 3 weeks for the controls. Histological study revealed an earlier organization and faster healing of the treated fractures, as evidenced by the larger, earlier appearance of cartilaginous soft callus and the more rapid organization of bridging trabecular bone. No statistical significance was obtained when these comparisons were made between the groups. These results suggest that osteogenic growth peptide can be used to promote earlier proliferation and differentiation of osteogenic cells in marrow and bone-repair callus, possibly through its effect on the transforming growth factor-beta family.

A non-linear effect of ambient temperature on apparent glucose tolerance.

Increased ambient temperature affects apparent oral glucose tolerance to an extent which may have clinical implications for the diagnosis of impaired glucose tolerance and gestational diabetes. As a first step in order to better define the nature of this effect, we have examined, in a climate chamber, the effects of ambient temperature at four levels (20, 25, 30, and 35 degrees C) on glucose and insulin responses to a standard 75 g oral glucose tolerance test in seven non-diabetic male subjects. Plasma glucose responses to ambient temperature were compared with the responses of core (auditory canal) and skin temperatures. The 2-h plasma glucose was affected in a nonlinear manner by ambient temperature (5.4 +/- 0.2, 5.3 +/- 0.4, 6.5 +/- 0.3, 6.4 +/- 0.4 mmol/l at 20, 25, 30, and 35 degrees C, P = 0.015) with the effect localised between 25 and 30 degrees C (P = 0.012). Core temperature responded in a similar manner (36.6 +/- 0.1, 36.6 +/- 0.1, 36.9 +/- 0.1, 37.0 +/- 0.1, (P = 0.0005) with the effect localised 25 and 30 degrees C (P = 0.011). However skin temperature increased significantly with each 5 degrees C increase in ambient temperature (30.2 +/- 0.5, 33.0 +/- 0.5, 34.2 +/- 0.2, 35.2 +/- 0.2, P < or = 0.0001). We conclude that the acute effect of ambient temperature on apparent glucose tolerance is most likely due to redistribution of blood flow between cutaneous and visceral beds driven by changes in core temperature. The absence of temperature effects between the two lowest, and between the two highest temperatures, provides workable guidelines for the standardisation of conditions during oral glucose tolerance tests in circumstances where temperature may have clinically significant effects.

Two-staged delayed open reduction and internal fixation of severe pilon fractures.

OBJECTIVE: To evaluate the use of a two-staged technique for the treatment of C3 pilon fractures. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-one consecutive patients with twenty-two C3 pilon fractures. Patients with C1 or C2 fractures and patients with open growth plates were excluded. INTERVENTION: All patients underwent immediate fibular fixation and placement of a medial spanning external fixator. After, on average, twenty-four days, patients underwent removal of the external fixator and formal open reduction and internal fixation of the pilon fractures. MAIN OUTCOME MEASUREMENTS: At average follow-up of twenty-two months, all patients were evaluated by using subjective, objective, and radiographic measurements as described by Burwell and Chamley (J Bone Joint Surg 1965;47B:634-659). Range of motion and postoperative complications were also recorded. RESULTS: Twenty-one of the twenty-two fractures healed within an average of 4.2 months. Average range of motion was 7 degrees of dorsiflexion, 33 degrees of plantar flexion, 17 degrees of eversion, and 11 degrees of inversion. Subjective and objective measurements showed 77 percent good results, 14 percent fair results, and 9 percent poor results. Radiographic reduction showed 73 percent anatomic and 27 percent fair reductions. There were no infections or soft tissue complications. The arthrodesis rate was 9 percent. CONCLUSIONS: A two-staged approach offers acceptable results for the treatment of severe pilon fractures. These results compare favorably with those of primary open reduction and of internal fixation and external fixation techniques. The major advantages include limited soft tissue complications and improved articular reconstruction.

Facial nerve biopsy for etiologic clarification of Bell's palsy.

Electron microscopic findings of biopsy specimens of the intratemporal facial nerve from four selected patients with Bell's palsy are described, and the results of clinical examinations and surgical findings are presented. In all specimens, wallerian degeneration of various degrees was demonstrated. In one specimen, extravascular erythrocytes, and in another, lymphatic infiltrations were noted. On the basis of the present investigation and reported temporal bone histopathologic evidence, the causes of Bell's palsy are concluded to be multiple and to be vascular, inflammatory, or degenerative.

Whole-body fluid distribution in humans during dehydration and recovery, before and after humid-heat acclimation induced using controlled hyperthermia.

AIM: This experiment was designed to test the hypothesis that the plasma volume is not selectively defended during exercise- and heat-induced dehydration following humid-heat acclimation. METHODS: Eight physically active males were heat acclimated (39.8 °C, relative humidity 59.2%) using 17 days of controlled hyperthermia (core temperature: 38.5 °C). Inter-compartmental fluid losses and movements were tracked (radioisotopes and Evans blue dye) during progressive dehydration (cycling) in these same conditions and also during a resting recovery without fluid replacement (28 °C), before (day 1), during (day 8) and after heat acclimation (day 22). RESULTS: On days 8 and 22, there were significant increases in total body water, interstitial fluid and plasma volume (P < 0.05), but the intracellular compartments did not change (P > 0.05). The baseline plasma volume remained expanded throughout: 43.4 [±2.6 (day 1)], 49.1 [±2.4 (day 8); P < 0.05] and 48.9 mL kg(-1) [±3.0 (day 22); P < 0.05]. During progressive dehydration, plasma reductions of 9.0% (±0.9: day 1), 12.4% (±1.6: day 8) and 13.6% (±1.2: day 22) were observed, with day 8 and 22 losses significantly exceeding day 1 (P < 0.05). During recovery, plasma volume restoration commenced, with the intracellular fluid contribution becoming more pronounced as acclimation progressed. CONCLUSION: It is concluded that the plasma volume was not defended more vigorously following humid-heat acclimation. Indeed, a greater fluid loss may well underlie the mechanisms for enhancing plasma volume recovery when heat acclimation is induced using the controlled-hyperthermia technique.

Effect of ribavirin on junin virus infection in guinea pigs.

Junin virus (JUNV) is the aetiological agent of Argentine haemorrhagic fever. The pathogenesis of the infection is not well understood, no licensed vaccines exist and no specific antiviral therapy is available. Previous studies have demonstrated the ability of ribavirin to delay and reduce JUNV disease and virus burden in guinea pigs without preventing death. Based on available data, we performed three different studies to determine the efficacy of ribavirin against JUNV in the guinea pig model with a focus on survival. Different doses and treatment schedules of ribavirin were tested in a lethal model of JUNV infection. Our results show that prolonged treatment with high doses of ribavirin significantly reduces the mortality in guinea pigs infected with JUNV. These results may be useful in future experimental studies or clinical testing.

Vestibular nerve pathology in cases of intractable vertigo: an electronmicroscopic study.

OBJECTIVE: This study aimed to determine the absence or presence and the nature of pathology of the vestibular nerve in case of intractable vertigo. STUDY DESIGN: This was a prospective study. SETTING: The study was performed at a private practice tertiary referral center. PATIENTS: There-were 42 patients with intractable vertigo in the study. INTERVENTIONS: All patients received thorough diagnostic examinations and surgical excision of the vestibular nerves. MAIN OUTCOME MEASURES: Segments of the superior and inferior vestibular nerves were surgically removed, preserved in glutaraldehyde, examined by electronmicroscopy, and the findings were correlated with the clinical diagnosis. RESULTS: A variety of different types of pathologic lesions were identified, including axon and supporting cell degeneration, herpes zoster virus, other viruses, results of bacterial infection, and regrowth of nerve after surgical resection. CONCLUSION: The vestibular nerves were found to be histologically normal in lesions primarily involving the end organ such as most early Meniere's disease cases, benign paroxysmal postural vertigo (BPPV), and mild labyrinthine concussion. Vestibular nerve degeneration was seen with advanced Meniere's disease, severe labyrinthine concussion, and with vascular loops in the internal auditory canal. Herpes zoster involves Scarpa ganglion in herpes zoster oticus. Viruses were found in the nuclei of vestibular nerve cells in a patient with delayed hydrops. Regrowth of the vestibular nerve after surgical resection was confirmed in three cases.

Epithelioid leiomyosarcoma originating in a hamartomatous polyp from a patient with Peutz-Jeghers syndrome.

A case of Peutz-Jeghers syndrome with long history and multiple resections is presented. Despite the large number of intestinal polyps in these patients, malignant transformations are rare. In this case, an epithelioid leiomyosarcoma developed within a single polyp. At the time of resection this tumor had already metastasized to the liver. The histology and ultrastructure of this tumor is presented. Reviews of the clinical syndrome and leiomyosarcoma are given, with discussion of the possible interaction of these two processes as presented in this patient.

Peroneus longus tendon rupture as a cause of chronic lateral ankle pain.

Rupture of the peroneus longus tendon with an associated fracture of the os peroneum is an uncommon injury, which may present as chronic lateral ankle instability. There have been only seven cases documented in the literature since 1966. A case of chronic peroneus longus tendon rupture with os peroneum fracture is presented. The authors review their clinical, radiographic, and operative treatment of this patient and review the literature of this unusual injury.

Ventricular remodeling after acute myocardial infarction: effect of low-intensity laser irradiation.

BACKGROUND AND OBJECTIVE: Low-intensity laser irradiation is claimed to enhance wound healing. Healing after myocardial infarction results in ventricular enlargement and wall thinning. If laser treatment accelerated cardiac healing, we speculated that ventricular remodeling would be attenuated. STUDY DESIGN/MATERIALS AND METHODS: In vitro, fibroblasts were irradiated for 1 minute twice a day for 4 days (5 mW; wavelength, 780 nm). One day after infarction, rats were randomly assigned to 5 or 10 mW transdermal irradiation twice a day for 4 days or to sham. One week after infarction, we measured the remodeling parameters; cavity volume, infarct thickness, and vascular structure, and the healing parameters; collagen content and inflammation. RESULTS: Laser-treated fibroblasts occupied more area than controls. Hearts receiving the 10 mW treatment had smaller volumes than sham hearts. Laser treatment reduced infarct thinning and preserved arterial lumen area; however, collagen was not increased and inflammation was inhibited. CONCLUSIONS: Low-intensity irradiation attenuated infarct-associated remodeling. In contrast to expectations from in vitro study, these effects were not a result of enhanced healing.

Attenuation of the cutaneous blood flow response during combined exercise and heat stress.

Skin blood flow (SkBF) was measured in six male subjects using laser-Doppler velocimetry, with zero-gradient auditory canal temperature (Tac) used as an index of body core temperature (Tc). Subjects performed incremental, upright cycling commencing at 40% peak power (Wpeak: 10 min), increasing every 4 min by 5% Wpeak thereafter. Trials were conducted in hot (ambient temperature (Ta) 36.7 +/- 0.2 degree C, relative humidity (rh) 46.1 +/- 3.2%; mean +/- S.D.), and neutral environments (Ta 19.6 +/- 0.3 degree C, rh 50.2 +/- 1.4%). SkBF increased with Tac in all subjects. Attenuation of SkBF occurred at the same Tac, relative SkBF and cardiac frequency (fc) between environments, but at a lower exercise intensity (40.8 +/- 0.8% versus 55.8 +/- 3.0% Wpeak) in the hot environment (p < 0.05). Data indicate that Tc thresholds for SkBF attenuation may exist. However, it is suggested that attenuation thresholds coincided with a reduced central blood volume, which may occur at a critical level of cutaneous blood pooling.

Thermal tolerance following artificially induced polycythaemia.

Polycythaemia has been shown to improve physical performance, possibly due to increased arterial oxygen transport. Enhanced thermoregulatory function may also accompany this manipulation, since a greater proportion of the cardiac output becomes available for heat dissipation. We further examined this possibility in five trained men, who participated in three-phase heat stress trials (20 min rest, 20 min cycling at 30% peak power (Wpeak) and 20 min at 45% Wpeak at 38.3 (SEM 0.7) degrees C [relative humidity 41.4 (SEM 2.9)%]. Trials were performed during normocythaemia (control) and polycythaemia, obtained by reinfusion of autologous red blood cells and resulting in significant elevation of arterial oxygen transport. During the polycythaemic trials, the subjects demonstrated diminished thermal strain, as evidenced by a significant reduction in cardiac frequency (fc: 12 beats.min-1 lower throughout the test; P < 0.05), and reduced auditory canal temperatures (Tac) during the latter 20-min phase (P < 0.05). Forearm sweat onset was more rapid (363.0 compared to 1083.0 s; P < 0.05), and forearm sweat rate (msw) sensitivity was elevated from 1.80 to 2.91.mg.cm-2.min-1.degrees C-1 (P < 0.05). Forehead msw was depressed during the final 20 min, while forearm msw was greater during all test phases, averaging 0.94 and 1.20 mg.cm-2.min-1, respectively, over the 60 min. Skin blood flows for the upper back, upper arm and forearm were reduced (P < 0.05). Polycythaemia enhanced thermoregulation, through an elevation in forearm sweat sensitivity and msw, but not via increased cutaneous blood flow. These modifications occurred simultaneously with decreases in fc and Tac, resulting in greater thermal tolerance.

The topography of eccrine sweating in humans during exercise.

The purpose of this study was to investigate the distribution of steady-state sweating rates (msw), during stressful exercise and heat exposures. Six men completed 42-min trials: 2-min rest and 40-min cycling at 40% peak power in 36.6 degrees C (relative humidity 46.0%). The msw was monitored using ventilated capsules at the forehead, and at three additional sites. Repeat trials allowed monitoring from eleven skin surfaces. Auditory canal temperature (Tac) and 11 skin temperatures were measured. After normalising msw to the forehead response within subjects, differences in Tac and onset time thresholds, and transient and steady-state msw were examined. The pooled, lower torso msw onset [mean 45.5 (SEM 42.0) s] preceded that of the head [mean 126.5 (SEM 34.8) s, P < 0.05], but was not significantly different from the legs [mean 66.6 (SEM 25.7) s], upper torso [mean 80.2 (SEM 36.8) s] or arms [mean 108.6 (SEM 31.2) s]. Transient msw did not differ among regions (P = 0.16). Mean, steady-state forehead msw [3.20 (SEM 0.51) mg.cm-2.min-1] was not significantly greater than the scapula, forearm, hand, stomach and lower back msw (in descending order), but was greater than the chest [1.6 (SEM 0.2)], upperarm [1.6 (SEM 0.2)], calf [1.5 (SEM 0.3)] and thigh msw [1.0 (SEM 0.2), P < 0.05 for all comparisons]. The results did not support the caudal-to-rostral sweat onset evident during supine, resting heat stress. Equivalent Tac sweat thresholds existed between sites, while steady-state state msw topography varied among subjects and was not dominated by central regions.

Women and abortion: a phenomenological analysis.

PIP: This article gives a brief history of abortion law in the US and reports some findings from a study of individual abortion and birth decisions among 92 pregnant mothers. It is argued that a "wide gap exists between the language of public debate and private decision making." Private decision making involves a moral standard that is absent from the public debate. Social adjustment to a birth or abortion outcome was better among women who made their own decisions and retained their right to choose during the decision-making process. Women in the study reported that they experienced some conflict during the decision-making process. The feeling of lack of choice or that partners or health officials were making the decision for them exacerbated women's conflicting emotional responses. Women who chose abortion desired a return to their original emotional state. Women who experienced more conflict during decision making experienced greater difficulty during the abortion procedure or had a negative reaction to the abortion procedure. Poor or neglectful abortion treatment was related to both physical and emotional negative reactions during the procedure. Good treatment led to positive experiences. Long-term negative reactions tended to occur among women who had poor treatment during illegal abortions, conflict over the meaning of abortion, bonding with the fetus prior to abortion, and ambivalence about the degree to which the pregnancy was desired. Postabortion social support was less important in reducing postabortion trauma than women's sense of their right to choose. Unfortunately, the legal debate focuses only two positions, pro-life or pro-choice.^ieng

Sweat distribution before and after repeated heat exposure.

We investigated the impact of short-term, moderate humidity heat acclimation upon sweat distribution. Eight males completed six daily heat exposures [cycling: ambient temperature 39.5 (0.2) degrees C, relative humidity 59.2 (0.8)%], during which auditory canal temperature (T(ac)) was maintained 1.4 degrees C above pre-exposure levels for 70 min by manipulating the work rate. On days 1 and 6, T(ac) and local sweat rates (m(sw): eight sites) were monitored. The pre-exposure, resting T(ac) and the T(ac) sweat threshold decreased from day 1 to day 6 [36.83 (0.05) degrees C vs 36.62 (0.05) degrees C, and 36.90 (0.05) degrees C vs 36.75 (0.05) degrees C, respectively; both P < 0.05]. However, the sweat-onset time, sweat sensitivity (delta m(sw)/deltaT(ac)) and established m(sw) were unaltered (P > 0.05). There was also no evidence of a post-acclimation redistribution in established m(sw) between the eight skin regions, though both the sweat sensitivity and established m(sw) for the forehead and hand were significantly greater than at the remaining sites (P < 0.05). It is concluded that the 5-day heat acclimation regimen provided only a minimal stimulus for sudomotor adaptation.