Lineage-tracing hematopoietic stem cell origins in vivo to efficiently make human HLF+ HOXA+ hematopoietic progenitors from pluripotent stem cells

The developmental origin of blood-forming hematopoietic stem cells (HSCs) is a longstanding question. Here, our non-invasive genetic lineage tracing in mouse embryos pinpoints that artery endothelial cells generate HSCs. Arteries are transiently competent to generate HSCs for 2.5 days (∼E8.5-E11) but subsequently cease, delimiting a narrow time frame for HSC formation in vivo. Guided by the arterial origins of blood, we efficiently and rapidly differentiate human pluripotent stem cells (hPSCs) into posterior primitive streak, lateral mesoderm, artery endothelium, hemogenic endothelium, and >90% pure hematopoietic progenitors within 10 days. hPSC-derived hematopoietic progenitors generate T, B, NK, erythroid, and myeloid cells in vitro and, critically, express hallmark HSC transcription factors HLF and HOXA5-HOXA10, which were previously challenging to upregulate. We differentiated hPSCs into highly enriched HLF+ HOXA+ hematopoietic progenitors with near-stoichiometric efficiency by blocking formation of unwanted lineages at each differentiation step. hPSC-derived HLF+ HOXA+ hematopoietic progenitors could avail both basic research and cellular therapies.

The effects of nurses' use of personal protective equipment on their vital signs during the COVID-19 pandemic

BACKGROUND

In order for nurses to provide the desired/expected care during the COVID-19 pandemic, the personal protective equipment (PPE) they use should not cause additional damage.

OBJECTIVE

The current study examined the effect of nurses' use of PPE on their vital signs during the COVID-19 pandemic.

METHODS

The present study was executed in a public hospital located in Turkey between October 2020 and December 2020 with a total of 112 nurses, 54 of them were serving in COVID-19 clinics, and 58 of them were working in other clinics. The data of the study was collected by using the introductory information form, the vital signs measurement, and the Visual Analogue Scale. The numbers, percentages, means, standard deviation, Chi-square, ANOVA, Mann-Whitney U and Wilcoxon tests were used to analyze the data.

RESULTS

The mean scores of SpO2, respiratory rate, body temperature, heart rate and blood pressure measurements of the nurses in the experimental group were compared before and after putting on the PPE. It was found that the difference between the two averages was statistically significant (p < 0.05).

CONCLUSION

It was found that the use of PPE for a long time causes a decrease in SpO2, increase in respiratory rate, pulse and blood pressure, as well as the aches in face, ear, nose and head.

[Cutaneous vascular anomalies in children]

INTRODUCTION

Vascular anomalies, which are erroneously categorized under the term angiomas, are a highly heterogeneous group of lesions that are poorly understood and affect a mean of 5 to 10 % of children. The fortuitous discovery of propranolol's efficacy in one of these entities has made them a topical issue.

OBJECTIVES

The paper's main objective is to inform family doctors of the various types of vascular anomalies, clarify their classification, and provide a common terminology. Its secondary objective is to provide a decision tree that enables primary care doctors to avoid diagnostic pitfalls, successfully detect cases, and optimize management.

METHODS

Systematic review.

CONCLUSIONS

According to a recent study, 71,3 % of publications use the term hemangioma erroneously, regardless of the authors' field. The key for family doctors is to use one international classification only, that of the International Society for the Study of Vascular Anomalies (ISSVA), in order to facilitate management and comprehension between the different healthcare levels. The diagnosis of vascular anomalies is clinical in 90 % of cases, so all family doctors can, whilst using a decision tree, diagnose a vascular anomaly and refer only those that are complex for specialist care. The most common vascular anomaly is infantile hemangioma in infants, which spontaneously regresses around the age of 5-7 years in 90 % of cases. Watchful waiting and regular follow-up suffice, therefore, in such settings.

[Infantile hemangioma: a new indication for propranolol? Retrospective study: a case-series of 25 infants]

BACKGROUND

In 2008, the New England Journal of Medicine reported a new indication for propranolol: treatment of complicated infantile hemangioma (IH). The objective of this study is to identify any adverse events and to measure the efficacy of propranolol in children with complicated IH, through a retrospective, observational, case-series study of 25 patients treated with propranolol at the Hôpital Universitaire des Enfants Reine Fabiola in Belgium.

OBSERVATIONS

25 patients were submitted to this therapy. The treatment was stopped prematurely for two of them, by parental fear of side effects and 48 % presented one or more adverse events; all of which were transient and rapidly controlled by adjusting the doses administered. Mean age at the start of treatment was 4,8 months. A clearly favorable response was observed in 100 % of patients at their first visit after treatment initiation ; a total response was seen in 9 patients, with subtotal and partial responses observed in 9 and 3 patients, respectively, by the end of treatment.

CONCLUSION

The real efficacy of propranolol for complicated IH was confirmed by the clearly evident improvement observed in all patients and the absence of non-responders. As global tolerance was also good, propranolol can therefore be considered to be an appropriate first- line treatment for complicated IH.

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach, over 8 years, in 11 cities of Turkey

AIMS

To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance.

DESIGN

An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback.

RESULTS

We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6-93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79-0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73-0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54-0.60, p 0.0001).

CONCLUSIONS

Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.

[Infantile hemangioma and propranolol: a therapeutic "revolution". Literature review]

Infantile hemangioma (IH) is the most common benign vascular tumour affecting children. Most infantile hemangiomas are self-limiting, but some require specific treatment. Propranolol has been proposed for the treatment of infantile hemangiomas. The aim of this study is to explore the mechanism of action of propranolol for the treatment of infantile hemangiomas and to demonstrate its safety and efficacy through a review of the literature. The non cardioselective bêta-blocker propranolol has been used in a pediatric setting for 40 years and, since 2008, has a new indication. A clearly significant improvement has been observed in the condition of children with complicated IH (10%) treated with propranolol. This new indication has been widely described in the international literature. Various explanations have been put forward for the mechanism of action including a vasoconstrictor, antiangiogenic and apoptotic effect of propranolol on the different cells making up an IH. Overall tolerance is good and the efficacy markedly superior to that of any other treatments used for this purpose. In conclusion, with its good tolerance profile and superior efficacy versus all the other available therapies, propranolol can be considered to be a first-line treatment for complicated IH.

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Background

Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.

Methods

We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.

Results

During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.

Conclusions

The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

A membrane-based co-treatment strategy for the recovery of print- and beck-dyeing textile effluents

This paper describes the final part of a study on the recovery of print- and beck-dyeing wastewaters of the carpet manufacturing industry by membrane processes. These wastewaters had been previously treated separately where the print dyeing wastewaters were recovered by chemical precipitation followed by nanofiltration (NF) and beck-dyeing wastewaters were subjected to microfiltration (MF) and pH neutralization prior to NF. In this study, a co-treatment scheme after separate pre-treatment stages was adopted to simplify the overall process. The effect of mixing ratio on membrane fouling was also investigated. The co-treatment strategy was found advantageous since the number of NF units was minimized and the pH neutralization step in separate treatment of beck-dyeing wastewaters was eliminated, providing a reduction of chemical usage.

Decolorization of wastewater of a Baker's yeast plant by membrane processes

The aim of this study is to develop a membrane-based treatment scheme to remove colorants from the effluent of a baker's yeast plant. For this purpose microfiltration (MF), ultrafiltration (UF) and nanofiltraton (NF) membranes with differing molecular weight cut-offs (MWCOs) were tested. To evaluate the effectiveness of membrane processes in treating the waste stream, optical density (OD), COD, color measurements together with permeation fluxes were used. Effects of pretreatment methods (coagulation and coarse filtration) and feed composition on OD, color, COD were studied. In addition, gel filtration analysis was employed to characterize feed and permeate streams in terms of MW distribution of organics that are present. Maximum rejections obtained were 94%, 89% and 72% for OD, color and COD, respectively, when 0.8 microm microfiltration membrane and 400 Da NF membrane were used in series. It was also observed that addition of intermediate UF steps did not increase overall rejections and final permeate flux of NF membrane. Based on these observations, an efficient scheme was offered.

Alendronate in rheumatoid arthritis patients treated with methotrexate and glucocorticoids

Rheumatoid arthritis (RA) is a systemic inflammatory disease. Along with synovial joint inflammation, extra-articular involvement is a common feature of RA. Periarticular and generalized osteoporosis are seen both as an extra-articular feature of the disease itself and due to various medications like glucocorticoids and methotrexate (MTX). In this study, we investigated the effects of oral alendronate in RA patients treated with MTX and prednisolone by comparing the effects of "alendronate+calcium" and "only calcium" on bone mineral density (BMD). Fifty RA patients classified according to American Rheumatism Association (ARA) criteria were included in the study. The control group consisted of 20 postmenopausal osteoporotic patients. The RA patients were divided randomly into two groups. All patients were started on MTX 7.5 mg/week, 2.5-mg daily folic acid, and 7.5-mg daily prednisolone. The first group, consisting of 25 female RA patients, was also given 10-mg daily alendronate and 1000-mg daily calcium. The second group also consisted of 25 female patients and was given only 1000-mg calcium per day. The postmenopausal control group was given daily 10-mg alendronate and 1000-mg calcium. Bone mineral densities were measured by dual-energy x-ray absorptiometry (DEXA) and again at the end of the sixth month. At the end of the study, RA patients given only calcium had reduced mean BMD, and patients treated with alendronate and calcium showed increased mean BMD almost in all regions. This increase was significant in the L2 and L1-4 total regions. In postmenopausal osteoporotic patients, we saw statistically significant increases in BMD in all regions. The increase in BMD values in RA patients treated with alendronate was smaller than in those of the control group of postmenopausal osteoporosis patients. In conclusion, RA itself has a risk factor for osteoporosis in addition to the risks of the medications like corticosteroids and MTX. In the prevention and treatment of RA-associated osteoporosis, alendronate and calcium therapy is effective and well tolerated.

Clinical course of a pituitary macroadenoma in the first trimester of pregnancy: probable lymphocytic hypophysitis

Recent findings revealed that the clinical features of lymphocytic hypophysitis are more complicated than previously thought. It is rarely described in the first trimester of pregnancy and signs of meningeal irritation are infrequently reported. In this study, a pregnant woman in her first trimester of pregnancy with clinical and radiological characteristics of a pituitary macroadenoma is described. The patient's pituitary profile revealed a relatively low prolactin for her stage of pregnancy. Unusual findings were neck stiffness associated with headache, nausea and vomiting. She was treated conservatively. Spontaneous complete resolution of the pituitary mass in the postpartum period led us to conclude that the correct diagnosis should be hypophysitis. Hypophysitis should be considered in the differential diagnosis of a pituitary mass presenting in early stages of pregnancy with symptoms mimicking hyperemesis gravidarum and/or meningeal irritation.

Cleidocranial dysostosis: report of a case

This case of cleidocranial dysostosis showed nearly 40 accessory teeth and the unerupted teeth on radiological examinations. Other diagnostic procedures found hypoplasia in maxillary and zygomatic bones, deep palate, open fontanel and open sutures, the collapse of sagittal suture, and aplasia of the clavicle. There were some abnormalities of the fingers. Under general anesthesia eleven supernumerary teeth in the mandible and eight in the maxilla were surgically extracted. Upper and lower removable acrylic appliances were fabricated.

Primary hypothyroidism with hyperprolactinaemia and pituitary enlargement mimicking a pituitary macroadenoma

Hyperprolactinaemia can occur in patients with hypothyroidism. A 32-year-old woman with primary hypothyroidism presented with amenorrhoea and galactorrhoea of two years' duration. She had hyperprolactinaemia, low basal morning cortisol levels and evidence of a pituitary macroadenoma on magnetic resonance imaging. Therapy with L-thyroxine resulted in induction of regular menses, resolution of galactorrhoea, normalisation of hormone levels and disappearance of the image of pituitary macroadenoma. It seems that enlargement of the pituitary due to thyrotroph and/or lactotroph cell hyperplasia secondary to hypothyroidism is responsible for this 'pseudotumour' image on radiological study. Recovery of her low basal cortisol values during treatment could also be explained by the dissolution of the pressure effect of enlarged pituitary in addition to the regression of hypothyroidism. In subjects with primary hypothyroidism and hyperprolactinaemia and pituitary enlargement, thyroid hormone replacement should be a first line treatment preceding pituitary surgery and bromocriptine use.