Notes

Fortin associated with wheat meals and NOVA: the opportunity of modified nutritional consumption whilst avoiding ultra-processed food.
Episodic breathlessness is characterized by increased breathlessness intensity, and it is burdensome for patients. A vicious cycle of breathlessness-anxiety/panic-breathlessness leads to emergencies that can rarely be alleviated by drugs. Non-pharmacological interventions seem to be beneficial Can a brief cognitive and behavioral intervention help patients to better manage episodic breathlessness?

To evaluate the feasibility, safety, acceptability, and potential effects of a brief cognitive and behavioral intervention for the management of episodic breathlessness.

Between February 2019 and February 2020, 49 patients with life-limiting diseases suffering from episodic breathlessness were enrolled in the single-arm phase II study. The baseline assessment was followed by the 1- to 2-hour intervention. In weeks two, four, and six after the intervention, the outcomes (main outcome of potential effects mastery of breathlessness) were assessed, and in week six, a qualitative interview, and the final assessment cognitive and behavioral intervention shows a positive change in the management of episodic breathlessness in patients with life-limiting diseases by reducing panic and anxiety in breathlessness episodes and promoting a feeling of competence in managing the episodes. It is safe, feasible, and acceptable.
The brief cognitive and behavioral intervention shows a positive change in the management of episodic breathlessness in patients with life-limiting diseases by reducing panic and anxiety in breathlessness episodes and promoting a feeling of competence in managing the episodes. It is safe, feasible, and acceptable.
Health systems should aim to deliver on what matters most to patients. With respect to end of life (EOL) care, knowledge on patient preferences for care is currently lacking.

To quantify preference weights for key EOL care indicators.

We developed a discrete choice experiment survey with 13 key indicators related to patients' experience in the last six weeks of life. Fedratinib clinical trial We fielded the survey to a web-panel of caregiver proxies for recently deceased care recipients. We obtained 250 responses in each of five countries India, Singapore, Kenya, the UK and the US. Latent-class analysis was used to evaluate preference weights for each indicator within and across countries.

A 2-class latent-class model was the best fit. Class 1 (average class probability=64.7%) preference weights were logically ordered and highly significant, while Class 2 estimates were generally disordered, suggesting poor data quality. Class 1 results indicated health care providers' ability to control patients' pain to desired levels was most important (11.5%, 95% CI 10.3%-12.6%), followed by clean, safe, and comfortable facilities (10.0%, 95% CI 9.0%-11.0%); and kind and sympathetic health care providers (9.8%, 95% CI 8.8%-10.9%). Providers' support for nonmedical concerns had the lowest preference weight (4.4%, 95% CI 3.6%-5.3%). Differences in preference weights across countries were not statistically significant.

Results reveal that not all aspects of EOL care are equally valued. Not accounting for these differences would lead to inappropriate conclusions on how best to improve EOL care.
Results reveal that not all aspects of EOL care are equally valued. Not accounting for these differences would lead to inappropriate conclusions on how best to improve EOL care.
Patients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs.

Identify characteristics at time of intensive care unit (ICU) admission that identify patients at highest risk for high-intensity, costly care.

Retrospective cohort study using electronic health and financial records (2011-2017) for patients requiring ≥48 hours of mechanical ventilation with ≥1 underlying chronic condition at an academic healthcare system. Main outcome was total cost of index hospitalization. Exposures of interest included number and type of chronic conditions. We used finite mixture models to identify the highest-cost group.

4,892 patients met study criteria. Median cost for index hospitalization was $135,238 (range, $9,748 -$3,176,065). Finite mixture modelling identified three classes with mean costs of $89,980, $150,603, and $277,712. Patients more likely to be in the high-cost class were 1) < 72 years old (OR 2.03; 95% CI1.63, 2.52); 2) with dementia (OR 1.55; 95% CI1.17, 2.06) or chronic renal failure (OR 1.27; 95% CI1.08, 1.48); 3) weight loss ≥ 5% in year prior to hospital admission (OR 1.25; 95% CI1.05, 1.48); and 4) hospitalized during prior year (OR 1.92; 95% CI1.58, 2.35).

Among patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients' goals.
Among patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients' goals.
As no previous study has directly compared the linear wear rate in two types of second-generation annealed highly cross-linked polyethylene, we performed a retrospective study with a minimum of 5-year follow-up to assess primary arthroplasties in the (1) wear rates and (2) incidence of osteolysis of the two types of HXLPE.

There was no significant difference in the linear wear rate and the incidence of osteolysis between the two types of second-generation annealed highly cross-linked polyethylene.

In this single-center study, we reviewed 257 cases of primary cementless total hip arthroplasties between 2011 and 2015, which were performed with 32mm delta ceramic on second-generation annealed highly cross-linked polyethylene (X3 and E1 were used in 105 and 103 cases, respectively.). The mean wear rate was evaluated using a computer-assisted method, and the incidence of osteolysis was evaluated based on the appearance of a localized area with loss of trabecular bone or cortical erosion adjacent to the implaerence between the two materials in terms of the long-term wear rate should be further validated.

III; retrospective case control study.
III; retrospective case control study.
Three-dimensional (3D) right ventricular (RV) strain analysis is not routinely performed perioperatively. Although 3D RV strain adds incrementally to outcome prediction in various cardiac diseases, its role in the perioperative setting is not sufficiently understood. The aim of this study was to investigate the association between 3D RV strain measured on RV meshes created from 3D transesophageal echocardiographic data and short-term outcomes among patients undergoing cardiac surgery.

A total of 496 patients undergoing cardiac surgery who underwent intraoperative 3D transesophageal echocardiography (under general anesthesia, before sternotomy) were retrospectively selected, and RV meshes were generated using commercially available speckle-tracking software. Custom-made software automatically quantified longitudinal and circumferential RV strains on the mesh surfaces. Echocardiographic and clinical parameters were entered into logistic regression models to determine their associations with the primary (in-nsion (P=.04), tricuspid regurgitation (P<.01), emergency procedures (P=.02), LV-GLS (P=.02), and RV-GLS (P<.001) were associated with the secondary end point.

RV-GLS measured on RV meshes derived from 3D transesophageal echocardiography was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.
RV-GLS measured on RV meshes derived from 3D transesophageal echocardiography was independently associated with short-term outcomes in patients undergoing cardiac surgery and might be helpful for identifying patients at risk for adverse postoperative events.The treatment of unhealable and chronic cutaneous wounds is a significant challenge for the healthcare system. Hence, there has been heightened interest in the development of innovative therapeutic approaches for the acceleration of wound healing. Regenerative medicine based on mesenchymal stem cells (MSCs) has shown appropriate potential in skin repair. The regenerative properties of stem cells are mainly attributed to paracrine effects of secreted products, including exosomes. There are advantages to using exosomes as a cell-free approach instead of direct application of stem cells. Exosomes have the nanoscale dimension and are immune-tolerant. They can easily endocytose, and transfer the cargo content to recipient cells. They contribute to the regulation of the wound healing process by activating specific signaling pathways. To preserve exosome bioactivity and controlled release of effective concentration during prolonged wound care, the design of an optimized delivery system is necessary. Accordingly, hydrogels with their unique properties are promising candidates as exosome delivery and wound management products. This article investigates the characteristics of exosomes, their molecular mechanism in wound healing, and the advantages of the hydrogel delivery system. Also, published reports on the potential of exosome-loaded hydrogels in skin regeneration have been reviewed.Huntington's disease (HD) is a neurodegenerative disorder caused by a mutation in the huntingtin (HTT) gene, leading to a toxic version of the HTT protein. There are currently no disease-modifying therapies available. In this scenario, gene-based treatments for HD aimed at lowering HTT levels have become one of the most promising emerging therapeutic options. To date, however, promising results have only been achieved following direct intrathecal or intracranial injections designed to circumvent the blood-brain barrier (BBB). Consequently, efforts to develop less invasive delivery platforms are highly desirable. Here, we described a novel delivery system based on modified cyclodextrin nanoparticles (CDs) loaded with small interfering RNAs (siRNAs) targeting HTT andcomplexed with the rabies virus glycoprotein(RVG), a BBB-shuttle peptide. Results using an in vitro BBB model, indicate the formulation successfully crosses the brain endothelial cells, releases the encapsulated siRNAs into the cytoplasm of neuronal cells, and mediates downregulation of HTT. In conclusion, the CD platform is a promising option for delivery of siRNA-based therapeutics for HD with wider potential to treat other diseases with a genetically validated target in the central nervous system.Neuroinflammation is increasingly recognized as playing a critical role in depression. Early-life stress exposure and constitutive differences in glucocorticoid responsiveness to stressors are two key risk factors for depression, but their impacts on the inflammatory status of the brain is still uncertain. Moreover, there is a need to identify specific molecules involved in these processes with the potential to be used as alternative therapeutic targets in inflammation-related depression. Here, we studied how peripubertal stress (PPS) combined with differential corticosterone (CORT)-stress responsiveness (CSR) influences depressive-like behaviors and brain inflammatory markers in male rats in adulthood, and how these alterations relate to microglia activation and miR-342 expression. We found that high-CORT stress-responsive (H-CSR) male rats that underwent PPS exhibited increased anhedonia and passive coping responses in adulthood. Also, animals exposed to PPS showed increased hippocampal TNF-α expression, which positively correlated with passive coping responses.
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