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Astragaloside VII (AST-VII), a major cycloartane saponin isolated from Turkish Astragalus species, turned out to be one of the most active metabolites demonstrating Th1/Th2 balanced immune response. As Quillaja saponins are extensively used in adjuvant systems, this study made an attempt to improve AST-VII based adjuvant systems by using different immunostimulatory/delivery agents (monophosphoryllipid A (MPL), Astragalus polysaccharide (APS) and squalene) and to induce cellular and humoral immune response against a viral vaccine. For this purpose, Newcastle Disease vaccine (NDV) was chosen as a model vaccine. Swiss albino mice were immunized subcutaneously with LaSota vaccines in the presence/absence of AST-VII or developed adjuvant systems. AST-VII administration both in live/inactivated LaSota vaccines induced neutralizing and NDV specific IgG, IgG1 and IgG2b antibodies response as well as IL-2 and IL-4 production. APS based delivery systems enhanced the production of neutralizing antibody and the minor augmentation of IFN-γ and IL-2 levels. Squalene emulsion (SE) alone or combined with AST-VII were effective in NDV restimulated splenocyte proliferation. As a conclusion, AST-VII and AST-VII containing adjuvant systems demonstrated Th1/Th2 balanced antibody and cellular immune responses in NDV vaccines. Thus, these systems could be developed as vaccine adjuvants in viral vaccines as alternative to saponin-based adjuvants.Gastropericardial fistula is a rare but lethal condition. Several etiologies have been reported, including previous gastric or esophageal surgery, malignancy, trauma, infection, and ulcer perforation. Typical symptoms included chest pain, epigastric pain, fever and dyspnea. Gastropericardial fistula can lead to serious complications, including cardiac tamponade, sepsis, hemodynamic compromise and death. Therefore, early diagnosis and timely management are important for physicians to prevent from catastrophic complications. Here, we present a case of a man who presented with acute purulent pericarditis secondary to a gastropericardial fistula to highlight the pathogenesis and suggest therapeutic strategies.

The clinical complexity of dementia, its physical burden, and the potential assaults associated with psychological and behavioral symptoms, could put healthcare workers working with dementia at high risk of burnout. Certain attitudes toward dementia and certain coping styles may be a protective factor against the stress experienced by these workers. On the other hand, it has been shown that a coping style based on psychological flexibility can prevent the development of burnout in the workplace. Neratinib order The present study analyzes the relationship between levels of burnout, psychological flexibility, attitudes towards dementia and life satisfaction in a sample of healthcare workers who work with people affected by dementia.

A sample of 105 healthcare workers from the Ricard Fortuny Social Hospital was recruited (day hospital, hospitalization unit, and nursing home), and psychological flexibility (AAQII), burnout levels (MBI), life satisfaction (SWL), anxiety (STAI-R), and attitudes towards dementia (EAD) were asseth people affected by dementia. Psychoeducational interventions promoting the psychological flexibility could help to reduce the risk of burnout in healthcare workers who work with dementia.

Those participants with greater psychological flexibility, in addition to feel more satisfaction with life, were found to be less likely to feel emotionally exhausted, to depersonalize patients with dementia, and felt more affection for them. On the other hand, no relationship was found between Burnout levels and the cognitive dimension of Attitudes towards dementia (the worker's knowledge of dementia). The results have significant implications regarding the type of training that is given to healthcare workers who work with people affected by dementia. Psychoeducational interventions promoting the psychological flexibility could help to reduce the risk of burnout in healthcare workers who work with dementia.

Acetazolamide is contraindicated in patients undergoing dialysis and should be used with caution in patients with chronic kidney disease (CKD). Here, we evaluate the effect of the concomitant use of aspirin by patient with CKD using acetazolamide.

A 63-year-old man with CKD and multimorbidity presented at our Emergency Department (ED) with general weakness and dyspnea for 4days. Work-up at the ED revealed severe metabolic acidosis and hyperammonemia, which were initially considered signs of sepsis due to an elevated C-reactive protein level and pyuria. However, subsequent blood work indicated hyperchloremic acidosis with low lactate levels. After reviewing his medical history, we suspected the concomitant use of acetazolamide and aspirin as the etiology. Weakness, acidosis, and hyperammonemia were resolved after the patient discontinued acetazolamide. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Severe acidosis can be life threatening. Acetazolamide is known for causing mild metabolic acidosis, excE OF THIS? Severe acidosis can be life threatening. Acetazolamide is known for causing mild metabolic acidosis, except in patients with severely impaired renal function. Here, we present a patient with mildly impaired renal function and concomitant aspirin use who developed severe metabolic acidosis and hyperammonemia after being prescribed acetazolamide. Regardless of the severity of the disease, patients with CKD should avoid taking acetazolamide concomitantly with aspirin.

The use of total neoadjuvant therapy (TNT) for locally advanced rectal cancer has been increasing in recent years, but the long-term overall survival characteristics of this approach is currently unknown.

We performed a retrospective study of patients with clinical stage II/III rectal cancer within the National Cancer Database. Patients who received TNT (defined as chemotherapy, followed by CRT, followed by surgery) were propensity score matched to patients who received adjuvant therapy (defined as CRT, followed by surgery, followed by chemotherapy). We compared overall survival (OS) and rates of pathologic complete response (pCR) between the 2 arms.

Of the 4300 patients in our cohort, 3502 (81%) received adjuvant therapy and 798 (19%) received TNT. At baseline, patients who received TNT were more likely to have higher clinical T and N stages (P< .001). The 5-year OS was 77% for both TNT and adjuvant therapy patients (hazard ratio [HR] 1.06, 95% confidence interval [CI], 0.88-1.28, P=.57). After propensity score matching and adjusting for potential confounders, there were no significant differences in OS (HR

1.00, 95% CI, 0.71-1.40, P=.99). After propensity score matching, there were higher pCR rates among TNT patients (16.1%) compared to adjuvant therapy patients (12.0%) (P=.037).

In this observational study, we found TNT was not associated with a lower OS compared to standard adjuvant chemotherapy. This finding potentially reassures clinicians choosing TNT as an alternative to adjuvant chemotherapy. However, future prospective data are needed to confirm these findings.

In this observational study, we found TNT was not associated with a lower OS compared to standard adjuvant chemotherapy. This finding potentially reassures clinicians choosing TNT as an alternative to adjuvant chemotherapy. However, future prospective data are needed to confirm these findings.

To investigate whether a specific (SP) or non-specific (NSP) clinical presentation, predicts prognosis and in-hospital resource utilization in emergency medical admissions.

We studied admissions over 5 years (2015-2019) and classified the symptom presentation as SP or NSP. The predictive capacity of the NSP category was related to 30-day in-hospital mortality with a multivariable logistic regression model. Utilization of procedures/services was related to hospital length of stay (LOS) with zero truncated Poisson regression.

There were 39,776 admissions in 23,995 patients. A NSP occurred in 18.2% of our top 20 clinical presentations; the top five being shortness of breath (12.8%), 'unwell' (7.1%), collapse (4.1%), abdominal pain (3.6%) and headache (2.7%). Baseline demographic characteristics were similar and unrelated to type of presentation; the model adjusted mortality by SP 4.0% (95% CI 3.8%, 4.2%) or NSP 3.9% (95% CI 3.5%, 4.4%) was identical. LOS was a dependant quantitative function of procedures/services undertaken; for the top two presentations of shortness of breath (SP) or unwell (NSP) there was no relationship between a SP or NSP presentation and hospital utilization of procedures/services or LOS.

Our data suggest no utility for a categorisation of presentations as specific or non-specific in terms of provision of prognostic information nor as an indicator of the pattern of hospital investigation or LOS.

Our data suggest no utility for a categorisation of presentations as specific or non-specific in terms of provision of prognostic information nor as an indicator of the pattern of hospital investigation or LOS.

Survey-based studies are often the basis of policy changes; however, the methodologic quality of such research can be questionable. Methodologic reviews of survey-based studies have been conducted in other medical fields, but the surgical literature has not been assessed.

All citations published in 9 major surgical journals from 2002 to 2019 were screened for studies administering surveys to health care professionals. Descriptive and methodologic data were collected by 2 reviewers who also assessed the transparency and quality of the methodology. Agreement between reviewers was assessed using a weighted κ-statistic. Survey quality metrics were measured, descriptive statistics were calculated, and regression analysis was used to assess the association between subjective overall study quality and objective quality metrics.

We included 271 articles in our analysis; the weighted-κ for reviewer quality assessment was 0.69 and for transparency assessment was 0.71. Deficiencies were identified in questionnaires identified by this study and other investigations.

There is growing interest in identifying trainees with surgical aptitude predictive of eventual technical proficiency. Musical tasks involve complex, cerebral activity, and ambidextrousity, which may have a positive impact on the acquisition of surgical skill sets. The purpose of this study was to investigate the influence of prior musical experience on the performance of basic surgical skills.

This was a prospective cross-sectional study involving 51 novice undergraduate and medical school trainees with no prior surgical exposure. Musicality was assessed with a detailed survey and objectively with the Mini-Profile of Music Perception Skills test. Dexterity was assessed using the Purdue Pegboard test. Surgical skills were then evaluated by performing 2 timed suturing trials after observing tutorial video, followed by a timed laparoscopic peg transfer test. Outcomes included both speed and quality of performance.

Participants with prior musical experience performed better than nonmusicians on the Mini-Prugh this does not imply superior ultimate surgical ability, musicality may be a marker for basic surgical skill development useful in identifying suitable candidates for surgical training.