Reduced miR-26b Expression in Megakaryocytes and Platelets Contributes to Elevated Level of Platelet Activation Status in Sepsis.

In sepsis, platelets may become activated via toll-like receptors (TLRs), causing microvascular thrombosis. Megakaryocytes (MKs) also express these receptors; thus, severe infection may modulate thrombopoiesis. To explore the relevance of altered miRNAs in platelet activation upon sepsis, we first investigated sepsis-induced miRNA expression in platelets of septic patients. The effect of abnormal Dicer level on miRNA expression was also evaluated. miRNAs were profiled in septic vs. normal platelets using TaqMan Open Array. We validated platelet miR-26b with its target SELP (P-selectin) mRNA levels and correlated them with clinical outcomes. The impact of sepsis on MK transcriptome was analyzed in MEG-01 cells after lipopolysaccharide (LPS) treatment by RNA-seq. Sepsis-reduced miR-26b was further studied using Dicer1 siRNA and calpain inhibition in MEG-01 cells. Out of 390 platelet miRNAs detected, there were 121 significantly decreased, and 61 upregulated in sepsis vs. controls. Septic platelets showed attenuated miR-26b, which were associated with disease severity and mortality. SELP mRNA level was elevated in sepsis, especially in platelets with increased mean platelet volume, causing higher P-selectin expression. Downregulation of Dicer1 generated lower miR-26b with higher SELP mRNA, while calpeptin restored miR-26b in MEG-01 cells. In conclusion, decreased miR-26b in MKs and platelets contributes to an increased level of platelet activation status in sepsis.

TriHy: teaching an MA TESOL class face-to-face, synchronously online, and asynchronously online.

This study investigated whether the success of students in a Master of Arts in Teaching English to Speakers of Other Languages (MA TESOL) assessment course was comparable regardless of their chosen mode of attendance (face-to-face, synchronously online, asynchronously online) in this "Triple Hybrid" (or "TriHy") class. In an interactive, convergent, mixed-methods design, a pragmatic, participant-focused framework guided the study. Data collection extended to pre-, while-, and post-surveys of the participants; tracking of mode of communication with the instructor; as well as proxies for students' success in the course, including the rate of course completion, weekly class attendance, completion of weekly assignments, grades on low-stakes individual assignments, grades on a high-stakes individual assignment, and a final course grade. The findings of the quantitative and qualitative analyses revealed that overall there was no statistically significant difference in the learning outcomes among the modalities even though one of the groups' pre-test scores did differ from the others' significantly. Although the students' success in the course did not differ, their perception of the factors that contributed to their success did. The findings suggest that with considerable institutional support, substantial investment of time and commitment from the instructor, and meaningful choices from the students, the quality of instruction even in a language-teacher-preparation course focused on skill building does not need to be compromised. Supplementary Information: The online version contains supplementary material available at 10.1007/s43545-022-00434-4.

Number of painful procedures and pain management in a neonatal intensive care unit / A fájdalmas beavatkozások száma és a fájdalomcsillapítás módozatai egy hazai neonatalis intenzív centrumban.

Összefoglaló. Bevezetés: A neonatalis intenzív centrumokban kezelt betegek naponta számos fájdalmas beavatkozáson eshetnek át. A kezeletlen fájdalom következményeinek ismerete ellenére, fájdalmuk csillapítása még messze nem ideális. Célkituzés: Obszervációs tanulmányunk célja az osztályunkon kezelt koraszülötteket és beteg újszülötteket ért fájdalmas beavatkozások gyakoriságának és természetének meghatározása volt. Vizsgáltuk a procedurális fájdalom esetén alkalmazott gyógyszeres és nonfarmakológiai fájdalomcsillapítók használatát, valamint a beavatkozások számát és a fájdalomcsillapítás alkalmazását befolyásoló tényezoket. Módszerek: A vizsgálatba az osztályunkon 2019. 09. 01. és 2019. 12. 31. között kezelt betegeket vontuk be. Prospektív adatgyujtést végeztünk a hospitalizáció elso 14 napján, egy erre a célra kialakított kérdoíven, amelyet az egészségügyi személyzet valós idoben töltött ki. Eredmények: Kutatásunkba 143 gyermeket tudtunk bevonni. A vizsgálati idoszak alatt 43-féle fájdalmas beavatkozás történt, összesen 13 314 alkalommal, amibol 12 953 elso, 361 többszöri kísérlet volt. Gyermekenként átlagosan 93,1 beavatkozást végeztünk a hospitalizáció elso 2 hetében, ami átlagosan 8,2 fájdalmas procedúrát jelentett naponta és gyermekenként. Fájdalomcsillapítás összesen 4190 alkalommal, a beavatkozások 31,5%-ában történt. Ennek 55,5%-a folyamatos gyógyszeres, 40,7%-a nem gyógyszeres, 2,5%-a alkalmi gyógyszeres, 1,3%-a kombinált terápia volt. A legkisebb születési súlyú, legrövidebb gestatiós idore született és a lélegeztetett koraszülöttek szenvedték el a legtöbb fájdalmas beavatkozást. Következtetés: Betegeink nagyszámú fájdalmas beavatkozáson esnek át, és ezek nagyobb részénél nem történik fájdalomcsillapítás. A beavatkozások tervezésével, összehangolásával, a gyógyszeres és nem gyógyszeres fájdalomcsillapítás kiterjedtebb alkalmazásával jobb fájdalommenedzsment lenne elérheto. Orv Hetil. 2021; 162(48): 1931-1939. INTRODUCTION: Preterm infants and sick neonates treated in neonatal intensive care units may undergo numerous painful interventions. Despite rapidly growing knowledge about consequences of untreated pain, pain management of neonates is far from ideal. OBJECTIVE: To determine the frequency and nature of painful procedures and corresponding analgesic therapies in neonates treated in a neonatal intensive care unit of a university teaching hospital in Hungary. METHODS: A prospective observational study was performed between September and December 2019. We collected data of all painful procedures, pharmacological and non-pharmacological analgesic therapy performed on neonates during the first 14 days of hospitalization. For data collection, we used a questionnaire designed for this purpose, which was completed in real time by the medical staff. RESULTS: 143 children were enrolled. 43 types of painful interventions were performed, a total of 13,314 times, of which 12,953 were the first, 361 multiple attempts. Each neonate was subjected to a mean of 93.1 interventions in the first 2 weeks of hospitalization, representing an average of 8.2 painful procedures per day per child. Pain relief was performed a total of 4190 times, in 31.5% of the interventions. Of this, 55.5% were continuous pharmacological, 40.7% non-pharmacological, 2.5% occasional drug, and 1.3% combination therapy. Ventilated neonates and preterm infants with shorter gestational age and lower birth weight had the most painful procedures. CONCLUSION: Patients treated in our unit undergo a large number of painful interventions, most of which are not accompanied by analgesia. Increased efforts are needed to promote our better pain management. Orv Hetil. 2021; 162(48): 1931-1939.

[Successful renal transplantation following lung transplantation: a survey of the first Hungarian case]. / Sikeres vesetranszplantáció tüdoátültetés után: az elso magyarországi eset ismertetése.

The authors review the case of their young patient, who underwent a lung transplantation in Vienna because of an end stage idiopathic pulmonary fibrosis. During the prolonged postoperative phase renal failure full of complications developed, which necessitated haemodialysis. As the pulmonological rehabilitation was complete, but the regular dialyses considerably raised the risk of opportunistic infections, and also significantly reduced the quality of life of the patient, renal transplantation was performed in Debrecen four years after the lung transplantation. This is the first lung transplanted patient in Hungary who also underwent renal transplantation. Now, more than two years after the renal transplantation the patient lives a compensated, rehabilitated life, the respiratory function values have improved and the renal function values are also acceptable. The number of transplanted patients has significantly increased in recent years worldwide, and also in Hungary. However, due to immunosuppressive medications, calcineurin inhibitors mainly, numerous complications must be reckoned with. An outstanding one among them is the secondary renal failure which may occur both in acute and chronic form and may even necessitate renal transplantation. Renal transplantation is an excellent treatment option for end stage renal failure patients, who had received another organ transplant earlier. Kidney transplantation improves quality of life and increases expected survival, too.

A potential role of aminoglycoside resistance in endemic occurrence of Pseudomonas aeruginosa strains in lower airways of mechanically ventilated patients.

Altogether, 98 Pseudomonas aeruginosa isolates from a 5-bed intensive care unit were fingerprinted with pulsed-field gel electrophoresis and tested for aminoglycoside resistance genes aac(6')-Ib, aac(3″)-IIa, ant(2″)-Ia, armA, rmtA, and rmtB and integrons and virulence genes/operons phzI, phzII, phzM, phzS, apr, lasB, plcH, plcN, pilA, algD, toxA, exoS, exoT, exoY, and exoU. Two major clusters were identified (49 and 19 isolates), harbouring aac(6')-Ib, blaPSE-1, and ant(3″)-Ia genes or ant(2″)-Ia gene, respectively, on a class I integron. Most virulence genes except for exoU and pilA were found. Only 1 isolate of the minor cluster (8 isolates) and 1 of the 22 sporadic isolates carried integrons (without gene cassettes); virulence profile was highly variable. Comparing the resistance and virulence patterns of endemic and sporadic isolates suggests that integron-borne aminoglycoside resistance is more closely associated with the frequency than virulence. Consequently, aminoglycoside usage may have played a role in maintenance of the endemic clones.