Aims: To compare between computer analysis of intrapartum cardiotocography (CTG) features by the Omniview-SisPorto® 3.5 and a consensus of clinicians. Methods: Agreement study using 50 consecutively ...acquired tracings (206 h of signals) with >60 min duration, <10% signal loss and recorded in labor at term by internal fetal heart rate (FHR) monitoring. Tracings were divided into 10-min segments and independently analyzed by three experienced clinicians, in order to estimate the FHR baseline and identify periodic events. A consensus was reached using a three round Delphi procedure. Results were compared with the analysis provided by the Omniview-SisPorto® 3.5 system. Results: For baseline estimation, agreement between the computer and the consensus was high intraclass correlation coefficient (ICC)=0.85; 95% confidence interval (CI) 0.46–0.93, with a mean difference of 3.7 bpm (limits of agreement –4.4–11.9 bpm), and 99% of differences under 15 bpm. A concordant identification was observed in 71% of accelerations (95% CI: 69%–73%), 68% of decelerations (95% CI: 66%–70%), and 87% of uterine contractions (95% CI: 85%–89%). Conclusions: A high agreement was observed between the Omniview-SisPorto® 3.5 and a consensus of clinicians in evaluation of intrapartum CTG baseline, accelerations, decelerations and uterine contractions.
Background:
Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task.
Aim:
To evaluate the ...influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center.
Design:
This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017.
Setting/Participants:
Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol.
Results:
In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (
p
= 0.010), feeling able to transmit bad news (
p
< 0.001), and to discuss the prognosis (
p
= 0.026), feeling capable of discussing ending the pregnancy (
p
= 0.003), and end-of-life issues (
p
= 0.007) and feeling confident about answering difficult questions (
p
= 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for “knowledge” (
p
< 0.001), “emotions,” (
p
= 0.004) and “strategy and summary” (
p
= 0.002).
Conclusion:
The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.
Purpose To compute the 3D vascular network of the human retina from high‐definition spectral‐domain optical coherence tomography (OCT).
Methods A method able to compute a fundus reference from SD‐OCT ...scans of the human macula to an extent similar to what can be achieved with color fundus photography was recently proposed by our research group. We resort to this new method and to an automatic supervised‐learning classification algorithm (both submitted for publication) to identify OCT A‐scans that cross the vascular network. A multi‐scale wavelet analysis is performed on each of these A‐scans to identify the transition between the hyper‐reflectivity due to the vessel and the shadow cast due to light absorption by hemoglobin. This transition is set as the vessel depth location, and the respective diameter estimated as the width from the computed fundus reference.
Results Eyes of healthy controls (N = 10) and eyes (ETDRS levels 10 to 35) from type 2 diabetic patients (N = 20) were imaged with the Cirrus HD‐OCT (Carl Zeiss Meditec, Dublin, CA, USA) and photographs were obtained with the Topcon TRC 50DX (Topcon Medical Systems, Inc., Oakland, NJ, USA) or the Zeiss FF 450. The vascular tree from the OCT reference presents an extension similar to that of the color fundus photography, 99.7(10.68)% (average(SD)). The 3D reconstruction of the vascular network allows to clearly distinguish between crossovers and bifurcations and the vascular network distribution is in agreement with the known anatomy of the human retina.
Conclusion The herewith presented method allows the visualization of the vascular network in 3D and compares favourably to the previous method both in terms of quality and extension of the vascular tree.
Formyl benzeno boronic acids rapidly and selectively react with
N
-terminal cysteines to yield a reversible boronated thiazolidine that may be used in the interactive orthogonal modification of ...peptides.
We show that formyl benzeno boronic acids (2FBBA) selectively react with
N
-terminal cysteines to yield a boronated thiazolidine featuring a B–N bond. The reaction exhibits a very rapid constant rate (2.38 ± 0.23 × 10
2
M
–1
s
–1
) under mild aqueous conditions (pH 7.4, 23 °C) and tolerates different amino acids at the position adjacent to the
N
-cysteine. DFT calculations highlighted the diastereoselective nature of this ligation reaction and support the involvement of the proximal boronic acid in the activation of the imine functionality and the stabilisation of the boronated thiazolidine through a chelate effect. The 2FBBA reagent allowed the effective functionalisation of model peptides (C-ovalbumin and a laminin fragment) and the boronated thiazolidine construct was shown to be stable over time, though the reaction was reversible in the presence of benzyl hydroxylamine. The reaction proved to be highly chemoselective, and 2FBBA was used to functionalize the
N
-terminal cysteine of calcitonin in the presence of a potentially competing in-chain thiol group. This exquisite selectivity profile enabled the dual functionalisation of calcitonin and the interactive orthogonal modification of this peptide when 2FBBA was combined with conventional maleimide chemistry. These results highlight the potential of this methodology to construct complex and well-defined bioconjugates.
The energetics of the C−F, C−Cl, C−Br, and C−I bonds in 2-haloethanols was investigated by using a combination of experimental and theoretical methods. The standard molar enthalpies of formation of ...2-chloro-, 2-bromo-, and 2-iodoethanol, at 298.15 K, were determined as Δf (ClCH2CH2OH, l) = −315.5 ± 0.7 kJ·mol-1, Δf (BrCH2CH2OH, l) = −275.8 ± 0.6 kJ·mol-1, Δf (ICH2CH2OH, l) = −207.3 ± 0.7 kJ·mol-1, by rotating-bomb combustion calorimetry. The corresponding standard molar enthalpies of vaporization, Δvap (ClCH2CH2OH) = 48.32 ± 0.37 kJ·mol-1, Δvap (BrCH2CH2OH) = 54.08 ± 0.40 kJ·mol-1, and Δvap (ICH2CH2OH) = 57.03 ± 0.20 kJ·mol-1 were also obtained by Calvet-drop microcalorimetry. The condensed phase and vaporization enthalpy data lead to Δf (ClCH2CH2OH, g) = −267.2 ± 0.8 kJ·mol-1, Δf (BrCH2CH2OH, g) = −221.7 ± 0.7 kJ·mol-1, and Δf (ICH2CH2OH, g) = −150.3 ± 0.7 kJ·mol-1. These values, together with the enthalpy of selected isodesmic and isogyric gas-phase reactions predicted by density functional theory (B3LYP/cc-pVTZ) and CBS-QB3 calculations were used to derive the enthalpies of formation of gaseous 2-fluoroethanol, Δf (FCH2CH2OH, g) = −423.6 ± 5.0 kJ·mol-1, and of the 2-hydroxyethyl radical, Δf (CH2CH2OH, g) = −28.7 ± 8.0 kJ·mol-1. The obtained thermochemical data led to the following carbon−halogen bond dissociation enthalpies: DH o(X−CH2CH2OH) = 474.4 ± 9.4 kJ·mol-1 (X = F), 359.9 ± 8.0 kJ·mol-1 (X = Cl), 305.0 ± 8.0 kJ·mol-1 (X = Br), 228.7 ± 8.1 kJ·mol-1 (X = I). These values were compared with the corresponding C−X bond dissociation enthalpies in XCH2COOH, XCH3, XC2H5, XCHCH2, and XC6H5. In view of this comparison the computational methods mentioned above were also used to obtain Δf (FCH2COOH, g) = −594.0 ± 5.0 kJ·mol-1 from which DH o(F−CH2COOH) = 435.4 ± 5.4 kJ·mol-1. The order DH o(C−F) > DH o(C−Cl) > DH o(C−Br) > DH o(C−I) is observed for the haloalcohols and all other RX compounds. It is finally concluded that the major qualitative trends exhibited by the C−X bond dissociation enthalpies for the series of compounds studied in this work can be predicted by Pauling's electrostatic-covalent model.
We performed a serological study with sera from 92 patients with confirmed sporotrichosis registered between 1999 and 2004 in two hospitals in Rio de Janeiro State, Brazil. The clinical presentation ...of sporotrichosis was distributed as follows: lymphocutaneous, 67%; fixed cutaneous, 23%; disseminated cutaneous, 8%; and extracutaneous, 2%. Sera were assayed by ELISA against a cell wall antigen of Sporothrix schenckii, SsCBF, that we have previously described. The cross-reactivity was determined with 77 heterologous sera. The serological test showed a sensitivity of 90% and a global efficiency of 86%. A group of 55 patients with several clinical presentations of sporotrichosis was clinically and serologically followed-up for at least 6 months. We observed by ELISA data a decrease in the antibody serum titers which correlated with the progress in healing. An HIV-positive patient with meningeal sporotrichosis was serologically followed-up for over 2 years. Serum and cerebrospinal fluid specimens were examined and significant antibodies levels against the antigen SsCBF were detected. Our results strongly suggest that this serological test is valuable for the differential diagnosis and follow-up of all clinical forms of sporotrichosis.
Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease with a broad clinical spectrum. PsA can affect the axial skeleton, peripheral joints, entheses, synovial sheaths of tendons, ...skin, nails and extra-articular organs. Tumour necrosis factor alpha blockers (TNF blockers) were a breakthrough development in the treatment of PsA. Identifying predictors of response to biological therapies in patients with PsA is of utmost importance, especially in view of the costs and potential side effects of these agents. The aims of the present study were to determine baseline predictive factors of response to biological therapies, at 3 and 6 months, in PsA patients with polyarticular involvement (with or without axial involvement). Data were collected from the Rheumatic Diseases Portuguese Register (Reuma.pt). Eligible patients had to be anti-TNF-naive at baseline and to have at least 3 months of follow-up after the beginning of TNF blocker therapy. Only patients with information on at least one of the response measures (at 3 or 6 months of follow-up) were included in the analysis. Univariable logistic regression analysis of potential baseline predictors of European League Against Rheumatism (EULAR) good clinical response, EULAR good/moderate response, 28-joint Disease Activity Score with three variables including the erythrocyte sedimentation rate (DAS28-3V-ESR) remission and Health Assessment Questionnaire (HAQ) response were performed. Multivariable logistic regression using a forward selection procedure was used until the best-fit model was obtained, taking confounding effects into account. A total of 180 patients were eligible for the study (mean age 52 years, 54% women). In multivariable analysis at 3 months, females were less likely to attain a good EULAR response OR=0.082 (95% CI=0.024, 0.278), a DAS28-3V-ESR remission OR=0.083 (95% CI=0.017, 0.416), a moderate or good EULAR response OR=0.091 (95% CI=0.011, 0.091) and a HAQ response OR=0.074 (95% CI=0.009, 0.608). At 6 months, female gender was also less likely to achieve a good EULAR response OR=0.060 (95% CI=0.011, 0.325), DAS28-3V-ESR remission OR=0.060 (95% CI=0.012, 0.297), and a HAQ response OR=0.138 (95% CI= 0.029, 0.654). In this study we found that gender was the most consistent predictor of response to TNF blocker therapy in patients with polyarticular PsA, with females having a lower probability of response compared to males. These findings suggest that gender-related biochemical, hormonal and psychological factors could play an important role in the response to TNF blocker therapy in PsA.
Micro- and nano-scale systems have emerged as important tools for developing clinically useful drug delivery systems. In this tutorial review, we discuss the exploitation of biomacromolecules for ...this purpose, focusing on proteins, polypeptides, nucleic acids and polysaccharides and mixtures thereof as potential building blocks for novel drug delivery systems. We focus on the mechanisms of formation of micro- and nano-scale protein-based capsules and shells, as well as on the functionalization of such structures for use in targeted delivery of bioactive materials. We summarise existing methods for protein-based capsule synthesis and functionalization and highlight future challenges and opportunities for delivery strategies based on biomacromolecules.
We highlight methods for the construction of functionalised protein-based capsules and their use in delivery strategies.
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