Study Protocol for the Feasibility and Acceptability of Remote Food Photography Method (RFPM) to Document Dietary Intake Among Individuals With Spinal Cord Injury (SCI)

Objectives

There is a high prevalence of neurogenic obesity among individuals with spinal cord injury (SCI) with percentages reaching 97% when using body fat percentage cutoff of 22% for men and 35% for women. Accurately measuring energy intake in individuals with SCI is crucial to assess if they are exceeding caloric needs, which can further contribute to obesity. Currently, the pen/paper food record is commonly used to track dietary intake in both the able-bodied (AB) and persons with SCI; however this method is known to be burdensome and to under-report true dietary intake by up to 37% in AB persons. The remote food photography method (RFPM) is a reliable and validated method to accurately measure dietary intake by taking pictures of food and beverages before and after consumption. This method of tracking dietary intake has been validated in individuals without SCI, but not in persons with SCI. Persons with SCI may benefit from a convenient method to track dietary intake due to SCI-specific challenges, such as difficulty writing. The objective of this study protocol is to assess feasibility and acceptability of RFPM in individuals with chronic SCI.

Methods

20 participants with SCI (10 with paraplegia and 10 with tetraplegia) will be recruited. Participants must be at least 18 years of age and have chronic SCI (at least 1-year post-injury). Participants will track their dietary intake for a total of two weeks (2 weekdays and 1 weekend for each week) by using RFPM for one week and the traditional pen/paper method for another week. Participants will be randomly assigned to track their intake using either method (RFPM or pen/paper food record) the first week and then cross-over to using the remaining method the second week. Photos of dietary intake will be sent electronically (i.e., smartphone, tablet, etc.). A registered dietitian will review dietary entries for completeness per week with each participant. Feasibility of the RFPM of tracking dietary intake in individuals with SCI will be measured by the number of entries that are documented using RFPM compared to dietary intake as reported by the participant at the end of the week. Acceptability of the RFPM will be assessed by a short survey at the end of the study examining the acceptance of the RFPM for capturing and tracking dietary intake.

Results

N/A - Protocol Abstract

Conclusions

N/A - Protocol Abstract

Funding Sources

N/A.

Unmasking the Structure of Gross Anatomy Laboratory Sessions During Covid‐19

INTRODUCTION/OBJECTIVE

Covid‐19 created immediate challenges to anatomy education. The traditional format of gross laboratory sessions experienced a direct impact and few reports documented curricular delivery changes specific to laboratory format. The purpose of this study was to assess the adaptations incorporated in gross anatomy laboratories by anatomists, during May‐August 2020, in response to Covid‐19.

MATERIALS/METHODS

Data were collected through the IRB‐approved Virtual Anatomy During Covid‐19 survey that consisted of 20 questions, including open‐ended prompts asking participants to describe the structure of a “typical” laboratory session during Covid‐19. Responses were solicited from professional anatomy associations during June 2020. Open‐ended responses describing anatomy laboratory teaching methods used during Covid‐19 were coded. Descriptive codes were applied to the data according to published methods to summarize verbatim responses. Responses were tabulated and converted to frequencies and percentages. Chi square test assessed differences among the responses when applicable. Alpha<5%.

RESULTS

Descriptions of gross anatomy lab teaching during Covid‐19 were coded into four categories : (1) delivery format, (2) format of laboratory practice, (3) type of anatomy digital resources used, and (4) format of student teaching groups. In the first category, synchronous (46.7%), asynchronous (15.6%), and/or a combination of the two (18.8%) were the most frequent laboratory delivery formats (P<0.001). In the second category, student‐led dissection (17.2%), prosection (10.9%), and/or utilization of commercial and/or in‐house anatomical resources (26.2%) were the most frequent laboratory practices (P<0.001). Within this category, a subcategory was discovered in which physical distancing and personal protective equipment practices were reported (15.6%). Concerning the third category, anatomy digital resources (26.2%) were used for asynchronous laboratory preparation and laboratory sessions. In the final category, student small groups (29.7%) were used in remote sessions where “breakout rooms” permitted students to meet with peers and/or faculty. Large groups (9.4%) were used for faculty to review and present the assigned laboratory topic.

CONCLUSION

Anatomists largely taught through a remote, synchronous delivery format that relied on cadaveric specimens and digital anatomy resources, as well as small group learning.

SIGNIFICANCE/IMPLICATION: This study shows that anatomists were able to adapt the gross anatomy laboratory sessions to synchronous, virtual mediums; however, the impact of these changes to the learner during this unconventional time remains to be determined.

Changes in Gross Anatomy Laboratory Assessment During Covid‐19

INTRODUCTION & OBJECTIVE:

Traditional gross anatomy lab assessment involves in‐person examination using cadavers or models. Covid‐19 related restrictions introduced challenges to gross anatomy education due to the discipline's reliance on lab‐based learning and assessment. Therefore, the objective of this study was to assess changes made by anatomy educators to gross anatomy lab assessments during May‐August 2020.

MATERIALS & METHODS:

A 20‐item survey assessed gross anatomy pedagogy, teaching resources, and assessment before and during the pandemic. The survey was distributed online to anatomy educators through professional associations and listservs in June 2020. Data were obtained from two survey items that asked respondents for narrative descriptions of their lab‐based assessment before and during Covid‐19. Open coding was used to apply descriptive codes relating to 3 categories: (1) setting of the assessment, (2) format of the assessment, and (3) materials used for the questions. The last author coded the data, while the first author reviewed the coding. Both authors reconciled and re‐coded discrepancies. Code frequencies and percentages were calculated. Chi‐square or Fisher's exact test was used to assess differences in frequencies before and during Covid‐19. Alpha<5%.

RESULTS:

Of the 61 respondents who described lab assessment, the use of the physical lab setting decreased (before: 82%, during: 20%; P<0.001) while computer‐based platforms increased (before: 9%, during: 61%; P<0.001). The use of medical imaging and other anatomical images were maintained (before: 11%, during: 51%; P=0.37), but there were decreases in the use of cadavers (before: 63%, during: 14%; P<0.001) as well as bones, plastic models, and plastinates (before: 12%, during: 0%; P<0.001). There were no significant changes in assessment structure, with the majority of participants maintaining a practical examination (i.e. “bell ringer”) format during Covid‐19 (before: 66%, during: 62%; P=0.39).

CONCLUSION:

Anatomy educators continued the use of “bell ringer” style lab assessments during the early part of the Covid‐19 pandemic. The setting shifted towards computer‐based examinations due to Covid‐19 restrictions; thus, the use of digital images was maintained while cadaver use decreased.

SIGNIFICANCE/IMPLICATION:

The early adaptations made by anatomy educators to their lab assessments during Covid‐19 provide insight into how assessment may be offered in dire circumstances when the physical lab is unavailable, when accommodating students with extenuating circumstances preventing them from attending in‐person lab assessments, and for remediation assessments.

Shifts in Digital Resources Usage for Gross Anatomy Education During Covid‐19

INTRODUCTION/OBJECTIVE:

Covid‐19 has led to sudden changes to gross anatomy education when traditional dissection‐based laboratories had to shift towards virtual modalities due to physical distancing and remote learning requirements. The purpose of this study was to determine how the use of digital teaching resources in gross anatomy education changed from before to during Covid‐19.

MATERIAL/METHODS:

Data were obtained from an IRB‐approved survey distributed to professional associations and listservs targeting anatomy educators from June to November 2020. Respondents were asked to select the digital resources they used before and during Covid‐19. Data were analyzed during the early and latter parts of the pandemic as May‐August (T1) and August‐December (T2), as well as overall (T3). T2 data were classified into five categories: 2D illustrations, dissection media, interactive software, in‐house, and open access. Total usage for each timepoint, the proportions of digital resources, and the 5 categories before and during Covid‐19 were compared using McNemar's test with alpha<5%. Data are presented as percent increase (+value) or decrease (‐value).

RESULTS:

60 and 208 responses were received for T1 and T2, respectively. The total number of digital resources used for anatomy education increased from before to during COVID‐19 as seen in the data analysis from T1 (+47%), T2 (+41%), and T3 (+43%) (P≤0.003). In T1, the use of BlueLink (+122%) and Complete Anatomy (+140%) software increased (P<0.04), while Acland's Anatomy (+68%), Anatomy.TV (+1300%), Complete Anatomy (+89%), and BlueLink (+148%) increased in T2 (P≤0.03). During T3, the usage of Acland's Anatomy (+60%), Anatomy.TV (+750%), Complete Anatomy (+102%), BlueLink (+143%), and VisibleBody (+100%) increased (P≤0.03). All other digital resources did not change (P>0.05). When data for T2 were categorized, dissection media (+44%), interactive software (+87%), and open‐access (+100%) content increased (P≤0.008), while 2D illustrations (‐3%) and in‐house content (‐23%) decreased (P>0.05).

CONCLUSIONS:

This study demonstrates sustained increases in digital resource usage for gross anatomy education during Covid‐19. This was particularly pronounced for interactive software, open access resources and dissection media that allowed educators to mimic features of a dissection lab.

SIGNIFICANCE:

These rapid shifts in both commercial and free digital resources are likely to drive innovation in anatomy education for years to come. It remains unknown if the current findings are transient Covid‐19‐related changes or if they will persist long‐term.

Changes in Anatomy Lecture and Laboratory Instruction During Covid‐19

Introduction/Objective

Covid‐19 created challenges to anatomy education, particularly gross anatomy given the traditional in‐person format of lectures and lab. The objective of this study was to assess the changes in lecture methods and lab materials used in anatomy courses that ran between May‐August (T1) and August‐December (T2) 2020 responding to Covid‐19 restrictions.

Materials/Methods

A survey was distributed to anatomy educators through professional associations from June‐November 2020. Respondents indicated (1) their institution; (2) programs taught (professional health (PH), medicine (MED), or undergraduate (UG)); (3) course type (integrated or stand‐alone); (4) percentage of lab time before and during Covid‐19 that utilized cadaveric, plastic, and/or other teaching materials; and (5) lecture format. Institutions were classified as public or private via institution websites. Mann‐Whitney U and Wilcoxon signed‐rank tests with Bonferroni correction compared responses before and during Covid‐19 across programs, course type, and institution. Data are presented as percent increase (+value) or decrease (‐value). Alpha<5%.

Results

T1 and T2 received 67 and 191 responses, respectively. During T1 and T2, cadaver use decreased in PH (‐58% & ‐28%), MED (‐55% & ‐34%), and UG (‐57% & ‐55%) programs (P≤0.045); stand‐alone (‐58% & ‐33%,P<0.001) and integrated (‐48% & ‐28%, P≤0.004) courses; and private (‐49% & ‐25%, P<0.001) and public (‐65% & ‐34%, P<0.001) institutions. During T1 and T2, plastic use did not change for programs, institutions, or courses (P>0.05), except UG decreased plastic usage during T2 (‐20%; P=0.033). During T1 and T2, use of other teaching materials increased in PH (+1180% & +278%), MED (+385% & +1000%), and UG (+285% & +246%) (P≤0.015); stand‐alone (+920% & +540%, P<0.001) and integrated (+330% & +500%, P≤0.002) courses; and private (+1233% & +667%, P<0.001) and public (+415% & +400%, P<0.001) institutions. For T1 and T2, in‐person lecture decreased (‐89% & ‐72%, P≤0.001), while remote lecture increased (+509% & +533%, P≤0.001) during Covid‐19.

Conclusion

Reduction in cadaver use and in‐person lecture were most pronounced in T1, but remained diminished through both time points, suggesting a shift from the initial pandemic response to teaching to more complex hybrid programs as regulations permitted.

Significance/Implication

This study provides evidence to better understand how anatomy educators adapted their gross anatomy teaching due to Covid‐19 across programs. In addition, this study provides first of its kind insight into how anatomy was taught across programs prior to Covid‐19. Future studies need to determine whether the findings characterized here were pandemic‐based or if they represent long‐term changes for anatomy education.

Stereoselective coordination: a six-membered P,N-chelate tailored for asymmetric allylic alkylation

Six-membered chelate complexes [Pd(1a–b)Cl₂], (2a–b) and [Pd(1a–b)(η³-PhCHCHCHPh)]BF₄, (3a–b) of P,N-type ligands 1a, ((2S,4S)-2-diphenyl-phosphino-4-isopropylamino-pentane) and 1b, ((2S,4S)-2-diphenyl-phosphino-4-methylamino-pentane) have been prepared.

Polymorph screening of an active material

Polymorph screening is currently one of the most important tasks for innovators and for generic companies from both pharmaceutical and intellectual property rights aspects. The different polymorphs have different physicochemical properties, such as the crystal polymorph-dependent solubility which influences the bioavailability. A former drug candidate obtained from Sanofi Pharmaceutical Company (Hungary) was investigated to explore its polymorphism, to distinguish the morphologies generated by analytical examinations and to investigate their relative stabilities. An Avantium Crystal 16 automatic laboratory reactor system was used for the polymorph studies and the studies of their dissolution. Eight polymorphs were obtained by crystallization and transformation methods then characterized by XRPD, DSC, and Raman spectroscopy, scanning electron microscopy, and light microscopy. All the morphologies could be stored in solid without any form transformation for a long time (2 years investigated). According to the first relative stability results, Form I, III, IVa, V, VI, VII are unambiguously metastable forms. Form II and IVb have similar thermodynamic stabilities, that were higher than those of the other polymorphs. A special dissolution medium was developed in which the eight polymorphs showed clear differences in the rate of dissolution.

DSC, X-ray and FTIR studies of a gemfibrozil/dimethyl-β-cyclodextrin inclusion complex produced by co-grinding

The steps of formation of an inclusion complex produced by the co-grinding of gemfibrozil and dimethyl-β-cyclodextrin were investigated by differential scanning calorimetry (DSC), X-ray powder diffractometry (XRPD) and Fourier transform infrared (FTIR) spectroscopy with curve-fitting analysis. The endothermic peak at 59.25°C reflecting the melting of gemfibrozil progressively disappeared from the DSC curves of the products on increase of the duration of co-grinding. The crystallinity of the samples too gradually decreased, and after 35min of co-grinding the product was totally amorphous. Up to this co-grinding time, XRPD and FTIR investigations indicated a linear correlation between the cyclodextrin complexation and the co-grinding time. After co-grinding for 30min, the ratio of complex formation did not increase. These studies demonstrated that co-grinding is a suitable method for the complexation of gemfibrozil with dimethyl-β-cyclodextrin. XRPD analysis revealed the amorphous state of the gemfibrozil-dimethyl-β-cyclodextrin product. FTIR spectroscopy with curve-fitting analysis may be useful as a semiquantitative analytical method for discriminating the molecular and amorphous states of gemfibrozil.

Observation of few-cycle, strong-field phenomena in surface plasmon fields

We present experimental evidence of the generation of few-cycle propagating surface plasmon polariton wavepackets. These ultrashort plasmonic pulses comprised of only 2-3 field oscillations were characterized by an autocorrelation measurement based on electron photoemission. By exploiting plasmonic field enhancement, we achieved plasmon-induced tunnelling emission from the metal surface at low laser intensity, opening perspectives for strong-field experiments with low pulse energies. All-optical electron acceleration up to keV kinetic energy is also demonstrated in these surface-confined, few-cycle fields with only 1.35×10(12) W/cm2 focused laser intensity. The experimental results are found to be in excellent agreement with the model.

Polymorphisms of beta defensins are associated with the risk of severe acute pancreatitis

AIMS

Bacterial translocation from the intestinal tract plays an important role in severe acute pancreatitis (AP). Human β-defensins are a family of antimicrobial peptides present at the mucosal surface. The aim of this study was to investigate the relevance of single nucleotide polymorphisms (SNPs) in the DEFB1 gene and copy number polymorphisms of the DEFB4 genes in AP.

METHODS

124 AP patients (30 with mild and 94 with severe disease) and 100 healthy controls were enrolled in the study. Three SNPs of the DEFB1 gene [G-20A (c.-20G→A), C-44G (c.-44C→G) and G-52A (c.-52G→A)] were genotyped by Custom TaqMan assay. The DEFB4 gene copy number was determined by means of a TaqMan real-time PCR assay.

RESULTS

Significantly higher frequencies of the AA genotype of G-20A (c.-20G→A) and the AA genotype of G-52A (c.-52G→A) were observed among the patients with severe AP (SAP) compared with the healthy controls (38 vs. 20 and 41 vs. 18%, respectively). The GG protective genotype of C-44G (c.-44C→G) SNP was much less frequent (1%) among the patients than among the controls (9%). A higher frequency of a lower (<4) copy number of the DEFB4 gene was observed in the patients with SAP compared with the healthy controls (62 vs. 24%, respectively).

CONCLUSIONS

The variations in the genes encoding human β-defensin-1 and -2 may be associated with the risk of SAP. and IAP.

Plasma concentrations of high-mobility group box protein 1, soluble receptor for advanced glycation end-products and circulating DNA in patients with acute pancreatitis

AIMS

High-mobility group box protein 1 (HMGB1), a late-acting proinflammatory cytokine, is secreted actively by inflammatory cells, and released passively from necrotic cells. From the aspect that both inflammation and necrosis are involved in the pathogenesis in acute pancreatitis, the aim of the study was a joint investigation of the plasma concentrations of HMGB1, its soluble receptor for advanced glycation end-products (sRAGE), and the circulating DNA as a marker of cell death.

METHODS

62 patients with acute pancreatitis (30 mild, 32 severe), 20 patients with sepsis, and 20 healthy controls were enrolled in the study. HMGB1 and sRAGE plasma levels were measured by means of ELISA. Plasma DNA concentrations were estimated by real-time quantitative PCR for the beta-globin gene.

RESULTS

The circulating HMGB1 level was significantly higher in patients with severe acute pancreatitis (13.33 +/- 2.11 ng/ml) than in healthy controls (0.161 +/- 0.03 ng/ml) or than in patients with mild pancreatitis (2.64 +/- 0.185 ng/ml). The plasma concentration of sRAGE was highest in patients with sepsis (2,210 +/- 252 pg/ml), while the levels of sRAGE correlated inversely with that of HMGB1 in patients with acute pancreatitis. The plasma DNA level was significantly elevated in patients with severe acute pancreatitis (2,206 +/- 452 ng/ml).

CONCLUSION

A complex study of the plasma levels of HMGB1, sRAGE and circulating DNA can be informative in evaluations of acute pancreatitis with different levels of severity.

Polymorphism in the IL-8 gene, but not in the TLR4 gene, increases the severity of acute pancreatitis

BACKGROUND/AIM

Activated granulocytes and inflammatory mediators of the innate immune response play fundamental roles in the pathogenesis of acute pancreatitis. We studied whether polymorphisms of interleukin-8 (IL-8) and Toll-like receptor 4 (TLR4) genes correlate with the severity of acute pancreatitis.

METHODS

Patients with acute pancreatitis (n = 92) were grouped according to the severity of the disease on the basis of the Ranson scores. Healthy blood donors (n = 200) served as controls. The IL-8 -251 gene polymorphism was analyzed by amplification-refractory mutation system; the single-nucleotide polymorphisms (Asp299Gly and Thr399Ile) of TLR4 were investigated by using a real-time polymerase chain reaction method with melting point analysis.

RESULTS

The IL-8 A/T heterozygote mutant variants were detected with a significantly higher frequency among the patients with severe pancreatitis than among the healthy blood donors (60 vs. 42%; p = 0.0264, odds ratio = 2.071, 95% confidence interval = 1.101-3.896), while the frequency of the normal allelic genotype (TT) was higher among the patients with mild pancreatitis than in the group with severe pancreatitis (35 vs. 16%; p = 0.051, odds ratio = 2.917, 95% confidence interval = 1.089-7.811). There was no significant correlation between TLR4 polymorphisms and the acute pancreatitis itself, but nonsignificantly increased frequencies of Asp299Gly and Thr399Ile heterozygotes among patients with severe infected pancreatic necrosis could be observed relative to the patients with mild pancreatitis.

CONCLUSIONS

Determination of the frequency of IL-8 polymorphism in acute pancreatitis may be informative and may provide further evidence concerning the role of IL-8 in the severe form of this disease. The possible role of TLR4 polymorphism in the outcome of severe acute pancreatitis requires further investigations in a larger series of patients.

Organ-preserving pancreatic head resection in chronic pancreatitis

BACKGROUND

Twenty to thirty per cent of patients with chronic pancreatitis develop inflammatory enlargement of the head of the pancreas. A safe procedure has been developed for duodenum-preserving pancreatic head resection; this report describes the preliminary results achieved.

METHODS

Thirty patients, 27 men and three women of mean age 44 years, underwent surgical resection following the development of an inflammatory mass in the pancreatic head. All patients had weight loss and frequent abdominal pain. Jaundice was present in three and diabetes mellitus in ten patients. The diagnosis of chronic pancreatitis was made by a combination of endoscopic retrograde cholangiopancreatography, sonography and computed tomography. Pancreatic function was assessed by amylum tolerance test (ATT), oral glucose tolerance test and stool elastase measurement. The surgical procedure involved wide local resection of the inflammatory tumour in the pancreatic head, without division of the pancreas over the portal vein. Reconstruction involved drainage via a jejunal Roux-en-Y loop. In three icteric cases, prepapillary bile duct anastomosis was also performed using the same jejunal loop.

RESULTS

There were no hospital deaths or major complications. After a median follow-up of 10 (range 6-14) months, all patients were symptom free. The mean increase in body-weight was 8.9 (range 4-20) kg. The ATT and stool elastase level demonstrated improved exocrine function but there was no change in endocrine function.

CONCLUSION

This type of pancreatic head resection is a safe procedure that provides good short-term relief of symptoms associated with inflammatory changes in the head of the pancreas in chronic pancreatitis.

Treatment of Candida infection in patients with infected pancreatic necrosis

Background

The purpose of this review was to determine the incidence of Candida infection in patients with infected pancreatic necrosis, to determine the most frequent risk factors and to assess the best treatment approach for disseminated candidal infections.

Methods

Of 145 patients with infected pancreatic necrosis identified, 30 (21 per cent) were infected with C. albicans. Risk factors identified in patients with Candida infection included the presence of necrotic tissue, and the use of broad-spectrum antibiotics, intravascular catheters and parenteral nutrition.

Results

With one exception, all cases involved mixed bacterial and fungal infections. The positive fungal result was obtained either during or after operation. Sixteen of the 30 patients displayed fungal colonization, while the other 14 had disseminated fungal infection. There were two deaths in the disseminated group, but none in the colonization group. In both fatal cases, flucytosine was applied. When fluconazole was used against disseminated fungal infection, no death was noted. Recently, prophylactic fluconazole has also been used in 20 patients with infected pancreatic necrosis, with no evidence of fungal infection after operation.

Conclusion

The combination of adequate surgical treatment with effective antibiotics and early antifungal therapy is the ideal management approach for infected pancreatic necrosis with Candida infection. Fluconazole may be regarded as an efficient drug for the prophylaxis of candidiasis.

[Dose-dependent effect of pancreatin replacement upon the pancreatic function in the period after pancreatic surgery]

AIMS

Disturbance of the exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recover exocrine function, but the effect can depend on dosage.

METHODS

A placebo-controlled trial of enteric-coated pancreatin (Kreon 25,000 U lipase [A] and Kreon 10,000 U lipase [B]; 3 x 1 caps/day) was performed for 2 weeks following pancreatic surgery (resection or drainage operation in each group). A total of 60 patients were randomized, 20 to A and B pancreatin groups each, and 20 to the placebo group. We tested exocrine function via faecal elastase determinations, amylum tolerance test (ATT) and checks on the symptoms of maldigestion.

RESULTS

After medication for 10 days, in group A there was evidence of the beneficial effect of pancreatin suggested by 35% improvement in ATT, unchanged body weight and disappearance of maldigestion. In group B, positive influence of pancreatin was confirmed only in those patients who underwent drainage operation, with moderate improvement of the symptoms of maldigestion and an almost unchanged body weight. In the control group and in resected patients in group B, abnormal ATT and maldigestion remained, while average body weight decreased by 3.5 kg. In all groups, no significant change was noted in the elastase concentration.

CONCLUSION

The results suggest that dose-dependent enteric-coated pancreatin treatment after pancreatic surgery may lead to rapid improvement in the exocrine pancreatic function, probably by reducing the cholecystokinin response to food stimulation. This is an important indication for enteric-coated pancreatin medication.