Endothelial NO synthase 786T/T polymorphism increases hemorrhagic transformation after endovascular thrombectomy.

BACKGROUND AND PURPOSE: This study examined whether the 786 NOS3 polymorphism is associated with the risk of hemorrhagic transformation (HT) in stroke patients with anterior large vessel occlusion (ALVO) treated using endovascular thrombectomy (EVT). METHODS: We performed an observational cohort study that included 118 patients with ALVO who underwent EVT. HT was assessed in follow-up CT and MRI. HT and non-HT patients were compared in terms of the 786 NOS3 polymorphism, flow mediated dilation (FMD) values within 3 days after the stroke, and collateral status based on three grading scales. Demographics, vascular risk factors, additional radiological data including ASPECT score, thrombus length and infarct size, and EVT procedure and outcome variables were also included. RESULTS: Radiological HT occurred in 55 (46.6%) patients and the 786T/T NOS3 polymorphism was associated with HT (unadjusted OR of 2.33, 95%CI: 1.05-5.20, adjusted OR of 3.14, 95%CI: 1.16-8.54). Collateral status and systemic endothelial function assessed by FMD were not mediators of this relationship as no differences were seen in the median FMD percentage values or collateral status between NOS3 genotypes. CONCLUSIONS: Our results suggest that genetic variations affecting the NO pathway, such as the 786 NOS3 polymorphism, may contribute to individual variability in the occurrence of HT and these results support involvement of this pathway in the pathogenesis of ischemia-reperfusion injury after EVT.

Adjuvant therapy improves survival in pT4aN0 oral cavity squamous cell carcinoma with bone invasion.

OBJECTIVE: The prognostic significance of bone invasion in oral cavity squamous cell carcinoma (OCSCC) after accounting for tumor size, nodal spread, and surgical margins is controversial. The aim of this study is to determine whether patients with pT4aN0 oral cavity squamous cell carcinoma with bone invasion have improved overall and disease-free survival with adjuvant treatment. METHODS: We conducted a retrospective review of medical records from 64 patients with stage pT4aN0 due to mandibular involvement who underwent surgery from 2000 to 2020. Kaplan-Meier analysis compared disease-free survival and overall survival between groups who underwent surgery only versus surgery and adjuvant therapy. The prognostic impact of adjuvant therapy was assessed using multivariate analysis and reported as hazard ratios. RESULTS: There were no statistically significant differences in clinicopathologic features or mean follow-up between patients who received surgery only and patients who received surgery with RT/CCRT (radiotherapy/concurrent chemoradiation therapy). 5-year disease-free (42.5% versus 65.9%, p = 0.02) and overall survival (43.6% versus 69.0%, p = 0.014) were improved in groups who received surgery and RT/CCRT. Regression analysis controlling for clinicopathologic characteristics, including tumor size, identified radiation as an independent predictor of improved disease-free survival (HR: 0.04, p < 0.001) and overall survival (HR: 0.10, p < 0.001). CONCLUSION: Adjuvant RT/CCRT in patients with pT4N0 OCSCC with mandibular bone involvement is associated with improved disease-free and overall survival. This association was significant regardless of tumor pathologic features such as size or margin status. These findings may help guide physicians in counseling patients regarding risks and benefits of adjuvant RT/CCRT and inform practice guidelines.

Validation of the fractional exhaled breath temperature measurement: reference values.

Exhaled breath temperature (EBT) is a known biomarker of inflammation and airways blood flow. As opposed to previous studies, we were able to measure temperature of separate fractions of exhaled breath (fEBT) (those from the peripheral and central airways). The aim was to validate the fEBT measurement method to determine the reference values and the influence of endogenous and exogenous factors on fEBT in healthy subjects. This cross-sectional study included 55 healthy adults in whom fEBT was repeatedly measured, two days in a row, using a FractAir®device. Also, basal metabolic rate, level of physical activity, distance from the main road, outdoor and ambient temperature, air pressure and humidity, haematology and inflammation markers, lung function, cumulative EBT and body temperature at characteristic points on the body were measured. The results showed that fEBT from central airways was lower compared to fEBT from the periphery and that fEBTs were not related to body temperature (p> 0.05 for all). We also showed repeatability of fEBT measurements for two consecutive days. All EBT fractions correlated significantly with ambient temperature (<0.01). No associations of fEBT with other personal and external factors were found using multivariate analysis. At room temperature of 22 °C, the physiological temperature values of the first fraction were 23.481 ± 3.150 °C, the second fraction 26.114 ± 4.024 °C and the third fraction 28.216 ± 3.321 °C. The proposed reference values represent the first part of validation of fEBT as the method for the use in clinical practice.

Adolescent and young adult allergic asthma treatment challenges.

The transition from paediatric care to adult care is often difficult, especially in children with chronic diseases like asthma. A significant number of children reach remission throughout puberty; consequently, they are not tracked down for subsequent follow-ups and are not included in transition programmes to adult care. This case report focuses on a young adult with asthma that began in childhood and went into remission during adolescence, only to experience a recurrence when the patient was a young adult. Due to failing to complete the transition process into adult care services, she had poor adherence to therapy and asthma control.Adherence and asthma control significantly improved after a multidisciplinary approach in an adult care setting. In conclusion, appropriate transition and a multidisciplinary approach are critical for the effective management of asthma in young adults.

Separation of vanadium and tungsten from synthetic and spent catalyst leach solutions using an ion-exchange resin.

Vanadium and tungsten ion adsorption and desorption characteristics and separation conditions were investigated using a simple porous anion-exchange resin. Initially, systematic experimental research was performed using synthetic aqueous vanadium and tungsten solutions. To evaluate the vanadium and tungsten (50-500 mg L-1) isotherm parameters, adsorption was performed at pH 7.0 using 0.5 g of ion-exchange resin at 303 K for 24 h. Well-known adsorption models such as Langmuir, Freundlich, and Temkin were used. Vanadium was desorbed from the resin using HCl and NaOH solutions. In contrast, tungsten was not desorbed by the HCl solution, which enabled the separation of the two ions. The desorption reaction reached equilibrium within 30 min of its start, yielding over 90% desorption. We investigated the adsorption mechanism and resin stability with the aid of spectroscopic and microscopic analysis, as well as adsorption results. The applicability and feasibility of the resin was tested via recovery of both metals from real spent catalysts. The applicability and reusability results indicated that the resin can be used for more than five cycles with an efficacy of over 90%.

Tracking Home Language Production and Environment in Children Who Are Deaf or Hard of Hearing.

OBJECTIVE: To use an automated speech-processing technology to identify patterns in sound environments and language output for deaf or hard-of-hearing infants and toddlers. STUDY DESIGN: Observational study based on a convenience sample. SETTING: Home observation conducted by tertiary children's hospital. METHODS: The system analyzed 115 naturalistic recordings of 28 children <3.5 years old. Hearing ability was stratified into groups by access to sound. Outcomes were compared across hearing groups, and multivariable linear regression was used to test associations. RESULTS: There was a significant difference in age-adjusted child vocalizations (P = .042), conversational turns (P = .022), and language development scores (P = .05) between hearing groups but no significant difference in adult words (P = .11). Conversational turns were positively associated with each language development measure, while adult words were not. For each hour of electronic media, there were significant reductions in child vocalizations (ß = -0.47; 95% CI, -0.71 to -0.19), conversational turns (ß = -0.45; 95% CI, -0.65 to -0.22), and language development (ß = -0.37; 95% CI, -0.61 to -0.15). CONCLUSIONS: Conversational turn scores differ among hearing groups and are positively associated with language development outcomes. Electronic media is associated with reduced discernible adult speech, child vocalizations, conversational turns, and language development scores. This effect was larger in children who are deaf or hard of hearing as compared with other reports in typically hearing populations. These findings underscore the need to optimize early language environments and limit electronic noise exposure in children who are deaf or hard of hearing.

Unexpected cause of dyspnoea in a patient with allergic rhinitis.

A defect in one part of the immune system may affect the whole system. As a result, there may be a myriad of immunological diseases, which are often masked with the one disease that has the most prominent symptoms. This case report presents a patient with long-lasting allergic rhinitis who recently developed dyspnoea in exertion with suspected asthma development. After extensive diagnostic processing, asthma was dismissed, and diagnosis of selective IgA deficiency and coeliac disease with consequential iron deficiency anaemia was established. The patient was treated with parenteral iron and a gluten-free diet, which corrected her anaemia and led to the disappearance of dyspnoea. This paper aims to show the interplay between different immunological disorders and the possible causal connection between them.

Hydrometallurgical process development to recycle valuable metals from spent SCR deNOX catalyst.

Spent catalyst, containing vanadium and tungsten oxide in a TiO2 glass fiber matrix, pose a risk of environmental contamination due to the high toxicity of its metal oxides if leached into the soil when disposed in landfills. Due to the increasing demand of metals and the continuous depletion of primary resources there is an growing necessity for recycling and reprocessing of spent catalysts and other secondary metal sources for environmental and economical reasons. Study of spent SCR catalyst soda roasting process with dissolved NaOH compared with the usual NaOH dry roasting and its influence in the subsequent water leaching. After optimization, the ideal parameters are roasting using a 0.4 ratio of NaOH/spent SCR catalyst in solution for 2 h at 973 K and de-ionized water leaching for 30 min, at 298 K with a pulp density of 30%. The research results show an important reduction of the roasting temperature and leaching time during the processing of spent SCR catalyst obtaining a 95.4% W and 80.2% V leaching efficiency liquor. Silicon compounds are one of the main impurities leached alongside the valuable metals and in this work, the silicon compounds leached are reduced significantly with the aim of avoiding the de-silication post-processing of the leach liquor. The main advantage of the proposed process is the increase of the leaching efficiency of vanadium and tungsten with a minimization of silicon impurities in a shorter time regardless of the leaching temperature.

Validation of a Hearing-Related Quality-of-Life Questionnaire for Parents and Deaf or Hard-of-Hearing Infants and Toddlers.

OBJECTIVE: To design and validate a hearing-related quality-of-life questionnaire targeted toward parents and deaf or hard-of-hearing infants and toddlers: the Hearing-Related Infant/Toddler and Parent Quality of Life (HIP-QL) questionnaire. STUDY DESIGN: Cross-sectional questionnaire and prospective instrument validation. SETTING: Academic pediatric otolaryngology clinic. METHODS: A 67-question questionnaire developed from constructs of a grounded theory analysis was administered to parents of 31 deaf or hard-of-hearing children and 14 typically hearing children. Questionnaire construct validity, reliability, and discriminant validity were tested. RESULTS: Based on exploratory factor analysis, a 32-item construct composed of developmentally appropriate questions was reduced to a 17-item construct with 4 domains addressing quality of life for both child (auditory/communication behavior, temperament) and parent (management, parent-directed factors). Internal consistency measures were appropriate (Cronbach's alpha = 0.65), and test-retest reliability was high (intraclass correlation coefficient = 0.73). Total HIP-QL scores correlated significantly with related total PedsQL scores (r = 0.57, P < .001). As predicted, parents of children who are deaf or hard of hearing reported significantly lower mean HIP-QL scores but not mean PedsQL scores. HIP-QL was more sensitive than PedsQL for predicting case versus control membership (86.7% vs 76.9%). Multivariable regression confirmed a negative relationship between severity of hearing loss and HIP-QL score after controlling for age, sex, income, and maternal education. CONCLUSIONS: This context-specific questionnaire is the first validated quality-of-life instrument for parents and deaf or hard-of-hearing infants and toddlers. Previously, parental stress and functional disability questionnaires were used as proxies; therefore, this questionnaire has the potential to serve as an important tool for patient- and caregiver-centered outcomes research.

Risk factors for nontuberculous mycobacterial pulmonary disease (NTM-PD) in Croatia.

BACKGROUND: The incidence, geographical distribution and clinical relevance of different nontuberculous mycobacteria (NTM) in Croatia are well described. There are few data on the risk factors for developing NTM pulmonary disease (NTM-PD) in this setting. METHODS: We conducted a retrospective cohort study on all Croatian residents with NTM isolated from respiratory samples in the period from 2006 to 2015 with follow-up to 2018. The American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines were used to establish NTM-PD diagnosis. Clinical, radiological and treatment data were collected from hospital records. RESULTS: Risk analysis calculations were made on the 439 isolation episodes that were classified as definitive NTM-PD (n = 137) or no disease (n = 302). Female gender, presence of bronchiectasis, low BMI and long-term systemic corticosteroid treatment were independent risk factors associated with NTM-PD. Hemoptysis and malaise were presenting symptoms independently associated with NTM-PD. Chronic obstructive pulmonary disease (COPD) and low/moderate dose inhaled corticosteroid (ICS) treatment were not associated with NTM-PD. High dose ICS treatment was a significant risk factor for developing NTM-PD (aOR = 4.73, CI 1.69-13.23 p = 0.003). CONCLUSION: The NTM-PD patients in Croatia are similar to those in other published cohorts in terms of their characteristics and risk factors. The significant dose-dependent association between ICS use and NTM-PD adds to the body of evidence suggesting that high dose ICS use is associated with NTM-PD.

Environmentally friendly approach to recover vanadium and tungsten from spent SCR catalyst leach liquors using Aliquat 336.

This research paper deals with an environmentally friendly approach for the treatment of spent selective catalytic reduction (SCR) catalyst. To recover vanadium (V) and tungsten (W) from spent SCR catalyst, leach liquors from hydrometallurgical processing were utilized to develop a proper methodology for extraction and possible separation of vanadium and tungsten from each other. This study investigated the solvent extraction (also called liquid-liquid extraction) of vanadium and tungsten utilizing the alkaline roasted leached solution containing approximately ∼7 g L-1 of tungsten and ∼0.7 g L-1 of vanadium. The commercial extractant, N-methyl-N,N,N-tri-octyl-ammonium chloride [R3NCH3]+Cl- (commercial name Aliquat 336), was dissolved in Exxsol™ D80 (diluent) system and adopted in this research. Solvent extraction studies were performed to determine the following experimental parameters: equilibrium pH, extractant concentration, diluent influence, chloride ion concentration, temperature, and stripping reagent concentration, which were systematically scanned to ascertain the optimum conditions for quantitative extraction of both title metals. An anion exchange mechanism was proposed using the quaternary ammonium chloride solvent reagent after slope analysis. Excess supplement of chloride proved to have adverse effects, further supporting the extraction mechanism. Thermodynamics results show positive values for enthalpy (ΔH) for vanadium and tungsten, favoring the endothermic nature of the extraction reaction towards the uptake of either metal. McCabe-Thiele plots for extraction were constructed, suggesting 2 and 3 stages for vanadium and tungsten extraction, respectively, at the aqueous (A) to organic (O) phase ratio of 7 : 1, ensuring more than 99.9% and 7-fold enrichment of both title metals. The stripping trend follows the order: (NaOH + NaCl) > (NaOH + NaNO3) > NaOH > NaNO3 > NaCl. Stripping isotherm followed by stripping counter-current (CCS) study was carried out for quantitative stripping of the metals.

[Use and maintenance of a peripheral venous catheter for more than three days]. / Mantenimiento del catéter venoso periférico (CVP) durante más de tres días.

The use of vascular access in a frequent procedure in the field of hospital practice. Nonetheless, vascular access is not bereft of complications, phlebitis being the most common. Following the Center for Disease Control and Prevention (CDC) recommendations, in our internal medicine service, changing a peripheral venous catheter is systematically carried out every 48-72 hours. The objective of this present study is to evaluate the need to change the vein accessed systematically every 48-72 hours, following the Center for Disease Control and Prevention (CDC) recommendations, in those patients who have a catheter inserted in a peripheral vein blocked by the administration of medication as part of the treatment of their pathology; or to evaluate the need to establish a new operational protocol since, according to other studies, its utility has not been demonstrated in a convincing manner. As a final conclusion, and while awaiting the results obtained in this study the authors believe it is possible to amplify the established periods for changing peripheral venous catheters while guaranteeing the security and comfort of patients having peripheral venous catheters inserted.

Investigational multitargeted kinase inhibitors in development for head and neck neoplasms.

INTRODUCTION: Despite advances in treatment, head and neck squamous cell carcinoma (HNSCC) survival rates remain stagnant. Current treatment is associated with significant toxicities and includes chemotherapy, radiation, surgery, and few targeted treatments. Targeted treatments, epidermal growth factor receptor (EGFR)-targeted agent, cetuximab, and immune checkpoint inhibitors, pembrolizumab and nivolumab, show improved toxicity profiles and modestly improved survival in select patients. An urgent need remains to identify novel targeted treatments for single-agent or combined therapy use. AREAS COVERED: Multitargeted kinase inhibitors are small molecule inhibitors with limited toxicity. This review will focus on early-stage investigations of multitargeted tyrosine kinase inhibitors (m-TKIs) (those that target at least two tyrosine kinases) for HNSCC. Preclinical and early trials investigating m-TKIs for various disease settings of HNSCC will be evaluated for efficacy, identification of significant biomarkers and potential for combination therapy. EXPERT OPINION: Few single agent m-TKIs have demonstrated efficacy in unselected HNSCC populations. The most promising clinical results have been obtained when m-TKIs are tested in combination with other therapies, including immunotherapy, or in mutation-defined subgroups of patients. The future success of m-TKIs will rely on identification, in preclinical models and clinical trials, of predictive biomarkers of response and mechanisms of innate and acquired resistance.

Sexual behaviour and contraception in people under the age of 20 in Alicante, Spain.

OBJECTIVE: To describe and to analyse the relationship between patterns of sexually-risky behaviour and emergency contraception among young females attending a Family Planning Centre (FPC). METHODS: Data was obtained from a systematic analysis of 384 health records. RESULTS: Mean age of the sample subjects was 18.24 years (SD 1.47, range 13-20). Of these, 92% were single, 60% students and 83% were with the same partner. Age at first intercourse was 16.5 years (SD 1.52, range 11-20). Those who used condoms systematically totalled 72%. Mean number of sexual partners was 1.85 (SD 2.91, range 1-50). A total of 9% had become pregnant and 2% had had an abortion. Emergency contraception was resorted to by 26% of the young women on at least one occasion. Emergency contraception was related to younger age at first sexual intercourse (p < 0.001) and to a great number of partners (p = 0.011). Of the total number of subjects, 48.4% demonstrated sexually-risky behaviour. This behaviour was related to alcohol consumption (p < 0.0001) and to the existence of dysfunction (p < 0.001). CONCLUSIONS: Spanish youngsters have enough knowledge regarding contraception. Condoms are mostly used on the occasion of a first sexual intercourse. However, the frequency of sexually-risky behaviour is still high due to the limited use of condoms in successive sexual relations with the same partner. Sexually-risky behaviour is also related to a high number of partners and to alcohol consumption on weekends.

Educação em saúde para a prevenção do câncer cérvico-uterino / Health education for cervical cancer prevention

Este estudo se trata do relato de uma experiência vivenciada por graduandos de Medicina e Enfermagem participantes do PET-Saúde da Universidade de Brasília, cujo objetivo foi realizar atividades de educação em saúde dentro do tema prevenção de câncer cérvico-uterino nos municípios de Ceres e Santa Isabel, Goiás. Para tanto, foram feitas diferentes ações comunicativas, tais como: confecção e distribuição de cartazes/panfletos; produção de um programa de rádio; e promoção de rodas de conversa na sala de espera das unidades básicas de saúde. Essa atividade se mostrou como uma oportunidade de compartilhar experiências e sentimentos, bem como discutir ideias e conceitos visando a construir um novo conhecimento, com contribuições do saber teórico dos acadêmicos e do saber prático das usuárias. As dúvidas e questionamentos das usuárias estavam de acordo com os apontados trazidos pela literatura, e as atividades mostraram-se uma boa forma de esclarecer as dúvidas das usuárias e aproximar sistema de saúde e população, bem como de promover a educação em saúde, especialmente no âmbito da autovalorização, da prevenção e da promoção da saúde.

This case report describes the experience of undergraduate medical and nursing students participating in the Educational Program for Health Work (PET-Saúde) at the University of Brasília, the objective of which was to conduct health education activities in cervical cancer prevention in Ceres and Santa Isabel, Goiás State. The following communications activities were used: preparation and distribution of posters and leaflets; production of a radio program; and conversation groups held in the waiting rooms of primary healthcare units. This activity provided an opportunity to share experiences and feelings, as well as discussing ideas and concepts aimed at building new knowledge, with contributions from the students' academic training and the users' practical knowhow. The users' doubts and questions were consistent with those found in the literature, and the activities proved to be a good way for clearing up users' doubts and drawing the health system and the population closer, as well as promoting health education, especially in the areas of self-esteem, prevention, and health promotion.

Capacitação do agente comunitário de saúde na prevenção do câncer de colo uterino / Training community health agents in cervical cancer prevention

Atualmente, intensificam-se as discussões a respeito da educação em saúde, principalmente em relação aos agentes comunitários de saúde (ACS), para os quais a capacitação deve ser constante. Este estudo tem como objetivo relatar a experiência de capacitação de ACSs a respeito do tema câncer cérvico-uterino. A escolha do tema abordado baseou-se em sua relevância e na necessidade concreta dos ACSs observados, que não se sentiam empoderados com relação ao assunto. Diante disso, nove acadêmicos de Medicina e Enfermagem, monitores do PET-Saúde da Universidade de Brasília (UnB), realizaram encontros com ACSs dos municípios de Ceres e Santa Isabel (GO), com o intuito de fornecer a esses profissionais mais informações e técnicas para que a abordagem das usuárias em relação ao exame colpocitologico fosse bem-sucedida. A metodologia utilizada foi a integração entre educação bancária e educação dialógica, a fim de que elas se complementassem para alcançar melhores resultados. Foi evidenciado êxito, uma vez que os ACSs demonstraram ter assimilado o conteúdo e ter organizado os conceitos e puderam aplicá-los de forma criativa, envolvendo-se com o aprendizado e acrescentando a ele as suas vivências próprias em relação ao conhecimento aprendido.

Recent years have witnessed increasing discussion on health education, especially for community health workers (CHWs), who should receive continuing training. The aim of this study was to report on an experience with CHWs trained in cervical cancer prevention. The choice of the theme was based on its relevance and the observed need among CHWs, who did not feel empowered to deal with it. Thus, nine undergraduate medical and nursing students, who were monitors in the PET-Saúde project at the University of Brasília (UnB), held meetings with CHWs in the municipalities (counties) of Ceres and Santa Isabel, Goiás State, Brazil, to provide them with information and techniques in order to improve the success of Pap smears for patients. The methodology used a combination of traditional and critical dialogical learning in order to achieve the best results. The training proved successful, since the CHWs assimilated the concepts and were able to apply them creatively, interacting with the learning process and enriching it with their own personal experiences.