Notes

Incorrect diagnosis involving persistent symptoms of asthma of the individual being affected by intense bronchopulmonary aspergillosis (ABPA).
This paper sets out to explore the use of a systemic reflexive exercise called "Collective Cut-Outs", detailing its methodology and usefulness with "frontline" mental health practitioners within supervision and teaching contexts. We draw on the use of storytelling, image, creativity and the usefulness of the left hand (right brain) in clinical mental health contexts and focus on its value in reflexive supervisory groups. We also aim to give voice to the experiences of "frontline" Black Asian Minority Ethnic (BAME) clinicians in an inner-city mental health team during the COVID-19 pandemic. The Collective Cut-Out exercise and its methodology provide a framework to help facilitate reflexive spaces that promote mindful group exercise and the subsequent expression of personal and professional resonance. Corn Oil purchase The subjects of clinical challenge and collective resilience are also brought forth. We offer a case study in the second part of the paper, outlining the use of the exercise in a reflexive group supervisory context. The team in focus have kindly given us, the authors, permission to use their experiences and "cut-outs". We have either adapted or removed identifiable information from the writing to protect and respect the identity of the team and individuals involved.Firefighters are exposed to potentially traumatic events throughout their careers, placing them at heightened risk for the development of posttraumatic stress disorder (PTSD). Individuals experiencing PTSD symptoms often experience interpersonal problems and relationship stress, and this may be due to emotion regulation difficulties. The current study examined the association between PTSD symptoms, couple relationship satisfaction, and emotion regulation difficulties among firefighters. Participants were comprised of 188 firefighters (M age = 41.32, SD = 9.25, 97.3% male) who completed an online questionnaire. Results indicated that PTSD symptom severity was negatively associated with relationship satisfaction and positively associated with emotion regulation difficulties. Additionally, there was a significant negative indirect effect of PTSD symptom severity on relationship satisfaction through heightened emotion regulation difficulties. Negative alterations in cognition and mood were especially relevant to emotion regulation difficulties and relationship satisfaction. Findings highlight the importance of understanding associations between PTSD and interpersonal functioning among firefighters. Emotion regulation difficulties may offer a clinically relevant transdiagnostic factor for targeting PTSD symptoms and relationship functioning among firefighters.
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel drug administration method with promising efficacy for the treatment of peritoneal metastases (PM). This study aimed to evaluate the prognostic value of an immunonutritional assessment on the feasibility, safety, and survival in this setting.

Data of PM patients undergoing PIPAC between September 2018 and May 2020 were prospectively recorded. A CT scan-derived body composition assessment was performed for each patient.

Fifty-one patients were enrolled, of which 30 (58%) underwent multiple PIPAC cycles, with a pathological response rate of 55%. Prognostic nutritional index (PNI) and neutrophil-to-lymphocytes predicted completion of more than one PIPAC cycle, with a cut off of 36.5 and 4.8 respectively. Muscle attenuation and body fat tissues were associated with pathological response. At multivariate Cox regression analysis, only the presence of a low PNI (HR 2.41, 95% CI 1.08-5.46) was significantly associated with a worse OS.

A pretreatment immunonutritional assessment may provide valuable information for PIPAC patients' selection and survival, while body composition parameters are able to predict pathological response. Further larger studies are needed to validate the role of these biomarkers in tailoring the treatment and monitoring PM patients undergoing PIPAC.
A pretreatment immunonutritional assessment may provide valuable information for PIPAC patients' selection and survival, while body composition parameters are able to predict pathological response. Further larger studies are needed to validate the role of these biomarkers in tailoring the treatment and monitoring PM patients undergoing PIPAC.
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has been established in the management of peritoneal carcinomatosis. Although it is still necessary to take adequate measures against major postoperative complications including acute kidney injury (AKI), consensus is lacking on how to assess and stratify risk for patients with postoperative AKI after CRS-HIPEC. The aim of this retrospective cohort study was to investigate the association of intraoperative gross hematuria as a surrogate marker of ureter injury with postoperative AKI incidence.

This retrospective cohort study investigated patients without impaired preoperative kidney function who underwent CRS-HIPEC at a single referral center, and evaluated the relationship between intraoperative gross hematuria and incidence of postoperative AKI as defined by the Kidney Disease Improving Global Outcomes practice guidelines. Logistic regression analysis was performed to calculate the odds ratio of intraoperative gross hematuria for AKI, adjusting for confounding factors and other risk factors for AKI.

We enrolled 185 patients (males, 37%). Twenty-five patients developed intraoperative gross hematuria. Postoperative AKI occurred in 10 (40%) of 25 patients withhematuria and 28 (17.5%) of 160 patients without hematuria. The crude odds ratio for exposure to hematuria was 3.14 (95% confidence interval, 1.30-7.60; p=0.020) for postoperative AKI. Adjusted odds ratio as estimated by multivariate logistic regression was 4.57 (95% confidence interval, 1.55-13.45; p=0.006).

Intraoperative gross hematuria is significantly associated with postoperative AKI incidence after CRS-HIPEC.
Intraoperative gross hematuria is significantly associated with postoperative AKI incidence after CRS-HIPEC.
Oxaliplatin immune-induced syndrome (OIIS) was recently recognized as an uncommon complication of oxaliplatin therapy.

We report an exceptionally OIIS after pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Our patient developed a severe OIIS probably related to the intraperitoneal administration of oxaliplatin. Specific tests were performed and detected high-titer antibodies to oxaliplatin.

The OIIS is a rare. Physicians had to be aware of that clinical situation because it could be reversible, even in case of peritoneal advanced disease, and ICU treatment is justified.
The OIIS is a rare. Physicians had to be aware of that clinical situation because it could be reversible, even in case of peritoneal advanced disease, and ICU treatment is justified.
Exposure to silica nanoparticles has been associated with pleural effusions (PEs) in animal models and case series. We hypothesized that some PEs labelled as "idiopathic" could, in fact, be secondary to inhalation of silica.

A retrospective case control study was designed utilizing a prospectively maintained pleural database. Cases, represented by idiopathic PEs, were matched by age and gender to control patients who had been diagnosed with malignant, cardiac, or infectious PEs. A survey consisting of questions about occupational life and possibility of silica inhalation was conducted. In a subgroup of patients, pleural fluid concentrations of silica were quantified by plasma atomic emission spectrometry analysis. Also, the pleural biopsy of a silica-exposed case was subjected to an energy dispersive X-ray spectroscopy (EDX) to identify the mineral, the size of which was determined by electron microscopy.

A total of 118 patients (59 cases and 59 controls) completed the survey. There were 25 (42%, 95% CI 31-55%) and 13 (22%, 95% CI 13-34%) silica-exposed workers in case and control groups, respectively. The exposure attributable fraction was 0.62 (95% CI 0.14-0.83). Four of eight exposed cases showed detectable levels of silica in the pleural fluid (mean 2.37mg/L), as compared to none of 16 tested controls. Silica nanoparticles of 6-7nm were identified in the pleural biopsy of an exposed case patient.

It is plausible that some idiopathic PEs could actually be caused by occupational silica inhalation.
It is plausible that some idiopathic PEs could actually be caused by occupational silica inhalation.
Safe implementation and thorough evaluation of new treatments require prospective data monitoring and standardization of treatments. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising alternative for the treatment of patients with peritoneal disease with an increasing number of suggested drug regimens. The aim was to reach expert consensus on current PIPAC treatment protocols and to define the most important research topics.

The expert panel included the most active PIPAC centers, organizers of PIPAC courses and principal investigators of prospective studies on PIPAC. A comprehensive literature review served as base for a two-day hybrid consensus meeting which was accompanied by a modified three-round Delphi process. Consensus bar was set at 70% for combined (strong and weak) positive or negative votes according to GRADE. Research questions were prioritized from 0 to 10 (highest importance).

Twenty-two out of 26 invited experts completed the entire consensus process. Consensus was reached for 10/10 final questions. The combination of doxorubicin (2.1mg/m
) and cisplatin (10.5mg/m
) was endorsed by 20/22 experts (90.9%). 16/22 (72.7%) supported oxaliplatin at 120 with potential reduction to 90mg/m
(frail patients), and 77.2% suggested PIPAC-Ox in combination with 5-FU. Mitomycin-C and Nab-paclitaxel were favoured as alternative regimens. The most important research questions concerned PIPAC conditions (n=3), standard (n=4) and alternative regimens (n=5) and efficacy of PIPAC treatment (n=2); 8/14 were given a priority of≥8/10.

The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research.
The current consensus should help to limit heterogeneity of treatment protocols but underlines the utmost importance of further research.Angiotensin-converting enzyme 2 (ACE2) is not only an enzyme but also a functional receptor on cell membrane for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, the activity of ACE2 in single living cell is firstly determined using a nanokit coupled electrospray ionization mass spectrometry (nanokit-ESI-MS). Upon the insertion of a micro-capillary into the living hACE2-CHO cell and the electrochemical sorting of the cytosol, the target ACE2 enzyme hydrolyses angiotensin II inside the capillary to generate angiotensin 1-7. After the electrospray of the mixture at the tip of the capillary, the product is differentiated from the substrate in molecular weight to achieve the detection of ACE2 activity in single cells. The further measurement illustrates that the inflammatory state of cells does not lead to the significant change of ACE2 catalytic activity, which elucidates the relationship between intracellular ACE2 activity and inflammation at single cell level. The established strategy will provide a specific analytical method for further studying the role of ACE2 in the process of virus infection, and extend the application of nanokit based single cell analysis.
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