[Frequency of burnout syndrome among health care workers during COVID-19 pandemic]. / Prevalencia del síndrome de burnouten profesionales de la salud durante la pandemia de COVID-19 en una clínica privada de Chile.

BACKGROUND: COVID-19 pandemic increased the prevalence of burnout syndrome. AIM: To describe the prevalence of burnout syndrome in health care workers of a private clinic in the Metropolitan Region of Chile. MATERIAL AND METHODS: Cross-sectional study, the study population were health care workers of a private clinic. An online version of Maslach Burnout Inventory-Human Service Survey was applied during June 2020. Variables such as age, sex, marital status, number of children, service, occupation, and night shift were studied. RESULTS: We collected 846 responses. A 36% (95% confidence intervals (CI) [32,8-39,2]) prevalence of high levels of burnout syndrome was found. Thirty one percent (95% CI [28,1-34,3]) of the respondents had high levels of emotional exhaustion (AE), 33% (95%CI [29,8-36,2]) had low personal fulfillment (RP) and 30% (95%CI [26,6-32,7]) had high levels of depersonalization (DP). CONCLUSIONS: Healthcare workers showed concerning levels of burnout syndrome. It is recommended to pay special attention to high levels of emotional exhaustion in nursing and night shift staff. Institutions should develop and apply prevention and emotional support strategies in health personnel.

SARS-CoV-2 infection in asymptomatic healthcare workers at a clinic in Chile.

Asymptomatic SARS-CoV-2 infection of healthcare workers (HCWs) has been reported as a key player in the nosocomial spreading of COVID-19. Early detection of infected HCWs can prevent spreading of the virus in hospitals among HCWs and patients. We conducted a cross-sectional study to determine the asymptomatic infection of HCWs in a private clinic in the city of Santiago, Chile. Our study was conducted during a period of 5 weeks at the peak of transmission of SARS-CoV-2 in Chile. Nasopharyngeal samples were obtained from 413 HCWs and tested for the presence of SARS-CoV-2 using RT-qPCR. We found that a 3.14% of HCWs were positive for the presence of SARS-CoV-2 (14/413). Out of these, 7/14 were completely asymptomatic and did not develop symptoms within 3 weeks of testing. Sequencing of viral genomes showed the predominance of the GR clade; however, sequence comparison demonstrated numerous genetic differences among them suggesting community infection as the main focus of transmission among HCWs. Our study demonstrates that the protocols applied to protect HCWs and patients have been effective as no infection clusters due to asymptomatic carriers were found in the clinic. Together, these data suggest that infection with SARS-CoV-2 among HCWs of this health center is not nosocomial.

Heterogeneity of Hepatic Stellate Cells in Fibrogenesis of the Liver: Insights from Single-Cell Transcriptomic Analysis in Liver Injury.

BACKGROUND & AIMS: Liver fibrosis is a pathological healing process resulting from hepatic stellate cell (HSC) activation and the generation of myofibroblasts from activated HSCs. The precise underlying mechanisms of liver fibrogenesis are still largely vague due to lack of understanding the functional heterogeneity of activated HSCs during liver injury. Approach and Results: In this study, to define the mechanism of HSC activation, we performed the transcriptomic analysis at single-cell resolution (scRNA-seq) on HSCs in mice treated with carbon tetrachloride (CCl4). By employing LRAT-Cre:Rosa26mT/mG mice, we were able to isolate an activated GFP-positive HSC lineage derived cell population by fluorescence-activated cell sorter (FACS). A total of 8 HSC subpopulations were identified based on an unsupervised analysis. Each HSC cluster displayed a unique transcriptomic profile, despite all clusters expressing common mouse HSC marker genes. We demonstrated that one of the HSC subpopulations expressed high levels of mitosis regulatory genes, velocity, and monocle analysis indicated that these HSCs are at transitioning and proliferating phases at the beginning of HSCs activation and will eventually give rise to several other HSC subtypes. We also demonstrated cell clusters representing HSC-derived mature myofibroblast populations that express myofibroblasts hallmark genes with unique contractile properties. Most importantly, we found a novel HSC cluster that is likely to be critical in liver regeneration, immune reaction, and vascular remodeling, in which the unique profiles of genes such as Rgs5, Angptl6, and Meg3 are highly expressed. Lastly, we demonstrated that the heterogeneity of HSCs in the injured mouse livers is closely similar to that of cirrhotic human livers. CONCLUSIONS: Collectively, our scRNA-seq data provided insight into the landscape of activated HSC populations and the dynamic transitional pathway from HSC to myofibroblasts in response to liver injury.

Integrated sensing and delivery of oxygen for next-generation smart wound dressings.

Chronic wounds affect over 6.5 million Americans and are notoriously difficult to treat. Suboptimal oxygenation of the wound bed is one of the most critical and treatable wound management factors, but existing oxygenation systems do not enable concurrent measurement and delivery of oxygen in a convenient wearable platform. Thus, we developed a low-cost alternative for continuous O2 delivery and sensing comprising of an inexpensive, paper-based, biocompatible, flexible platform for locally generating and measuring oxygen in a wound region. The platform takes advantage of recent developments in the fabrication of flexible microsystems including the incorporation of paper as a substrate and the use of a scalable manufacturing technology, inkjet printing. Here, we demonstrate the functionality of the oxygenation patch, capable of increasing oxygen concentration in a gel substrate by 13% (5 ppm) in 1 h. The platform is able to sense oxygen in a range of 5-26 ppm. In vivo studies demonstrate the biocompatibility of the patch and its ability to double or triple the oxygen level in the wound bed to clinically relevant levels.

Continuously-infused human C-reactive protein is neither proatherosclerotic nor proinflammatory in apolipoprotein E-deficient mice.

Studies of human native C-reactive protein (nCRP) in mice have shown effects ranging from proatherogenic, to antiatherogenic, to no effect. It is likely that these disparities are related to (a) the use, in some studies, of contaminated nCRP, or to (b) variation in CRP levels associated with either its episodic administration or the use of CRP-transgenic mice. In our study, 12-week-old male apolipoprotein E-deficient (apoE (-/-)) mice, maintained on a Western diet, received azide- and endotoxin-free nCRP (n = 23) or placebo (n = 23) continuously via osmotic pumps (20.4 microg/day) for 4 weeks. CRP-treated and control mice developed similar atherosclerotic lesions in whole aortas (nCRP: 10.4 +/- 4.7% vs. controls: 11.7 +/- 4.4%, P = 0.76) and aortic roots (nCRP: 65.0 +/- 7.8% vs. controls: 64.7 +/- 9.7%, P = 0.94). No differences were observed in macrophage or T-lymphocyte infiltrates and there was no meaningful change in VCAM-1 or IL-6 expression, in the levels of soluble VCAM-1, or in circulating proinflammatory (IL-1 beta, IL-6, IL-12p40, IL-12p70, TNF-alpha, and INF-gamma), or anti-inflammatory (IL-4 and IL-10) cytokines. We conclude that continuous infusion of uncontaminated nCRP in apoE (-/-) mice is not associated with increased atherosclerosis, does not alter systemic or local inflammation, and does not affect endothelial activation. These observations suggest that alternative approaches to study CRP (perhaps using different pentraxins in the mouse model or using a rabbit model instead of a mouse model) are needed to evaluate the effects of pentraxins on atherosclerosis.

Prevalencia del síndrome de burnouten profesionales de la salud durante la pandemia de COVID-19 en una clínica privada de Chile / Frequency of burnout syndrome among health care workers during COVID-19 pandemic

BACKGROUND: COVID-19 pandemic increased the prevalence of burnout syndrome. AIM: To describe the prevalence of burnout syndrome in health care workers of a private clinic in the Metropolitan Region of Chile. MATERIAL AND METHODS: Cross-sectional study, the study population were health care workers of a private clinic. An online version of Maslach Burnout Inventory-Human Service Survey was applied during June 2020. Variables such as age, sex, marital status, number of children, service, occupation, and night shift were studied. RESULTS: We collected 846 responses. A 36% (95% confidence intervals (CI) [32,8-39,2]) prevalence of high levels of burnout syndrome was found. Thirty one percent (95% CI [28,1-34,3]) of the respondents had high levels of emotional exhaustion (AE), 33% (95%CI [29,8-36,2]) had low personal fulfillment (RP) and 30% (95%CI [26,6-32,7]) had high levels of depersonalization (DP). CONCLUSIONS: Healthcare workers showed concerning levels of burnout syndrome. It is recommended to pay special attention to high levels of emotional exhaustion in nursing and night shift staff. Institutions should develop and apply prevention and emotional support strategies in health personnel.

Skin Regeneration Using Dermal Substrates that Contain Autologous Cells and Silver Nanoparticles to Promote Antibacterial Activity: In Vitro Studies.

We hypothesized that the addition of silver nanoparticles (AgNP) to a dermal substrate would impart antibacterial properties without inhibiting the proliferation of contained cells. Our in vitro model was based on the commercial substrate, Integra. The substrate was prepared by simple immersion into 0 to 1% suspension of AgNP (75 or 200 nm diameter) followed by rinsing for 20 minutes and sterilization under an ultraviolet C lamp. A total of 107 human adipose stem cells per cubic centimeter were injected and after 1 hour, 6 × 105 keratinocytes/cm2 were seeded and cultured for up to 14 days. Constructs were evaluated using a metabolic assay (WST-1), and hematoxylin and eosin and immunoperoxidase staining. Bactericidal activity was measured using a log reduction assay against bacteria that are prevalent in burns. The presence of AgNP did not significantly change the metabolic activity of constructs after 14 days of culture, and the distribution of cells within the substrate was unchanged from the controls that did not have AgNP. Antibacterial activity of Integra containing AgNP (75 nm diameter) was concentration dependent. In conclusion, the addition of AgNP to the dermal substrate suppressed bacterial growth but did not significantly affect cell proliferation, and may represent an important property to incorporate into a future clinical skin regeneration system.

Value of the first post-transplant biopsy for predicting long-term cardiac allograft vasculopathy (CAV) and graft failure in heart transplant patients.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the principal cause of long-term graft failure following heart transplantation. Early identification of patients at risk of CAV is essential to target invasive follow-up procedures more effectively and to establish appropriate therapies. We evaluated the prognostic value of the first heart biopsy (median: 9 days post-transplant) versus all biopsies obtained within the first three months for the prediction of CAV and graft failure due to CAV. METHODS AND FINDINGS: In a prospective cohort study, we developed multivariate regression models evaluating markers of atherothrombosis (fibrin, antithrombin and tissue plasminogen activator [tPA]) and endothelial activation (intercellular adhesion molecule-1) in serial biopsies obtained during the first three months post-transplantation from 172 patients (median follow-up = 6.3 years; min = 0.37 years, max = 16.3 years). Presence of fibrin was the dominant predictor in first-biopsy models (Odds Ratio [OR] for one- and 10-year graft failure due to CAV = 38.70, p = 0.002, 95% CI = 4.00-374.77; and 3.99, p = 0.005, 95% CI = 1.53-10.40) and loss of tPA was predominant in three-month models (OR for one- and 10-year graft failure due to CAV = 1.81, p = 0.025, 95% CI = 1.08-3.03; and 1.31, p = 0.001, 95% CI = 1.12-1.55). First-biopsy and three-month models had similar predictive and discriminative accuracy and were comparable in their capacities to correctly classify patient outcomes, with the exception of 10-year graft failure due to CAV in which the three-month model was more predictive. Both models had particularly high negative predictive values (e.g., First-biopsy vs. three-month models: 99% vs. 100% at 1-year and 96% vs. 95% at 10-years). CONCLUSIONS: Patients with absence of fibrin in the first biopsy and persistence of normal tPA in subsequent biopsies rarely develop CAV or graft failure during the next 10 years and potentially could be monitored less invasively. Presence of early risk markers in the transplanted heart may be secondary to ischemia/reperfusion injury, a potentially modifiable factor.

Microvascular thrombosis and cardiac allograft vasculopathy in rat heart transplantation.

BACKGROUND: The role of a hypercoagulable microvasculature in the development of cardiac allograft vasculopathy (CAV) after heart transplantation in humans is not well understood. The aim of this study was to identify an animal model by which to further evaluate the role of coagulation in the pathogenesis of CAV. METHODS: Adult male PVG (RT-1(c)) rats were transplanted into ACI (RT-1(av1)) recipients (n = 29). ACI donors into ACI recipients (n = 31) and rats with a sham operation (n = 33) served as controls. All rats received cyclosporine (10 mg/kg/day) on Days 0 to 9 after surgery. Grafts and native hearts were harvested at 10 days to 3 months after surgery. Hearts were processed for immunohistochemistry and light microscopy. A hypercoagulable microvasculature was defined as presence of microvascular fibrin and capillary antithrombin. CAV was defined as the presence of concentric intimal proliferation and chronic inflammatory infiltrate in the arterial intima, and assessed by computer-assisted image analysis. RESULTS: Donor and recipient hearts from PVG-ACI rats showed high levels of fibrin (donors 7.5% to 21.9%, recipients 5.1% to 20.2%) and antithrombin (donors 5.2% to 27.9%, recipients 3.3% to 20.8%) at 10 days to 3 months post-transplant. ACI-ACI donor and recipient hearts had lower deposition of fibrin (donors 0.9% to 9.9%, recipients 0% to 4.0%) and antithrombin (donors 1.4% to 15.2%, recipients 0.8% to 4.5%). Hearts from sham-operated rats had negligible amounts of fibrin (0% to 1.5%) and antithrombin (0% to 2.8%). There was a strong association (p < 0.001) between presence of fibrin and capillary antithrombin and development of CAV. CONCLUSIONS: A hypercoagulable microvasculature in a rat model of heart transplantation was associated with development of CAV, as found in humans.

Syncytiotrophoblast intercellular adhesion molecule-1 expression in placental villitis of unknown cause.

OBJECTIVE: The purpose of this study was to determine syncytiotrophoblast intercellular adhesion molecule-1 expression in villitis and in normal chorionic villi from term (37-42 weeks of gestation) placentas with or without villitis. STUDY DESIGN: A cross-sectional study was conducted to determine syncytiotrophoblast intercellular adhesion molecule-1 expression in villitis (n = 16) and in normal villi from placentas with or without villitis (n = 16). Villitis was diagnosed with antibodies to human leukocyte antigen-DR and CD3 and hematoxylin and eosin staining of serial sections; intercellular adhesion molecule-1 reactivity in syncytiotrophoblast was confirmed with antibodies to intercellular adhesion molecule-1 and cytokeratin. RESULTS: Villitis lesions had higher syncytiotrophoblast intercellular adhesion molecule-1 expression than normal chorionic villi from placentas with (19.9% vs 3.5% villi; P < .001) or without (19.9% vs 0.31% villi; P < .001) villitis. Normal villi from placentas with villitis had higher syncytiotrophoblast intercellular adhesion molecule-1 than villi from placentas without villitis (3.5% vs 0.31% villi; P < .001). CONCLUSION: Placentas with villitis have significantly more syncytiotrophoblast intercellular adhesion molecule-1 expression than placentas without villitis. The finding that normal villi from placentas with villitis have more syncytiotrophoblast intercellular adhesion molecule-1 than normal villi from placentas without villitis suggests that syncytiotrophoblast intercellular adhesion molecule-1 could be the first step in villitis development.