Latinx Patients' Perceptions of Culturally Sensitive Health Care and their Association with Patient Satisfaction, Patient-Provider Communication, and Therapeutic Alliance

Latinx in the USA experience disparities in morbidity and mortality when compared to their non-Hispanic White counterparts. Patient-centered culturally sensitive health care (PC-CSHC) has been deemed a best practice approach to alleviate and eliminate these disparities. However, literature on how Latinx patients perceive their care and what indicators of PC-CSHC may be most related to treatment outcomes is limited. This study collected data from 81 adult Latinx participants who had been admitted to an inpatient care unit to understand the following: (a) their perception of their providers' PC-CSHC in three different areas: Competence/Confidence, Sensitivity/Interpersonal, and Respect/Communication; (b) whether there are differences between English- and Spanish-speaking Latinx patients in their perception of their providers' PC-CSHC; and (c) whether these PC-CSHC indicators were associated to patient satisfaction, patient-provider communication, and therapeutic alliance. Participants were mostly male, older than 55 years of age, and working or lower class, with English as their primary language. Results showed that patients rated their providers' Competence (M = 3.57, SD = .46) higher than both Sensitivity, t(68) = .04, p = .04, (M = 3.49, SD =.54), and Respect, t(53) = 2.765, p = .008, (M = 3.38, SD = .57). English-speaking Latinx were overall less satisfied with their providers than Spanish-speaking Latinx, in particular in their communication. Finally, higher provider cultural sensitivity appears to be a predictor of patient satisfaction, patient-provider communication, and working alliance. Implications for refining provider trainings to treat this vulnerable and understudied (i.e., Latinx) population are discussed.

Production of cadmium sulfide quantum dots by the lithobiontic Antarctic strain Pedobacter sp. UYP1 and their application as photosensitizer in solar cells

Background

Microbes are present in almost every environment on Earth, even in those with extreme environmental conditions such as Antarctica, where rocks may represent the main refuge for life. Lithobiontic communities are composed of microorganisms capable of colonizing rocks and, as it is a not so well studied bacterial community, they may represent a very interesting source of diversity and functional traits with potential for biotechnological applications. In this work we analyzed the ability of Antarctic lithobiontic bacterium to synthesize cadmium sulfide quantum dots (CdS QDs) and their potential application in solar cells.

Results

A basaltic andesite rock sample was collected from Fildes Peninsula, King George Island, Antarctica, and processed in order to isolate lithobiontic bacterial strains. Out of the 11 selected isolates, strain UYP1, identified as Pedobacter, was chosen for further characterization and analysis due to its high cadmium tolerance. A protocol for the biosynthesis of CdS QDs was developed and optimized for this strain. After 20 and 80 min of synthesis, yellow-green and orange-red fluorescent emissions were observed under UV light, respectively. QDs were characterized through spectroscopic techniques, dynamic light scattering analysis, high-resolution transmission electron microscopy and energy dispersive x-ray spectroscopy. Nanostructures of 3.07 nm, composed of 51.1% cadmium and 48.9% sulfide were obtained and further used as photosensitizer material in solar cells. These solar cells were able to conduct electrons and displayed an open circuit voltage of 162 mV, a short circuit current density of 0.0110 mA cm⁻², and had an efficiency of conversion up to 0.0016%, which is comparable with data previously reported for solar cells sensitized with biologically produced quantum dots.

Conclusions

We report a cheap, rapid and eco-friendly protocol for the production of CdS QDs by an Antarctic lithobiontic bacterium, Pedobacter, a genus that was not previously reported as a quantum dot producer. The application of the biosynthesized QDs as sensitizer material in solar cells was validated.

Canine gastric carcinoma: immunohistochemical expression of cell cycle proteins (p53, p21, and p16) and heat shock proteins (Hsp27 and Hsp70)

Immunohistochemical staining for cell cycle proteins and heat shock proteins was performed on 17 canine gastric carcinomas. The immunoexpression of p53, p21, p16, Hsp27, and Hsp70 was investigated. A study was conducted to determine the histological type and parameters related to tumor malignancy. Possible associations and trends were assessed between the immunoexpression of each protein and tumor type as well as specific parameters of malignancy. High intratumor frequency of cellular p53 immunostaining was observed (61.96% average), but lower frequencies of p21 and p16 expression were present (34.65% and 10.41%, respectively). The p53 overexpression was associated with tumor infiltration (P = .0258). Expression of p21 was lower in undifferentiated carcinomas, and the loss of expression was associated with histopathological parameters characteristic of a poor prognosis such as lymphatic vessel invasion (P = .0258). The lack of p16 immunoreactivity was related to histopathological characteristics of malignancy such as the presence of evident and multiple nucleoli (P = .0475). In contrast, deep tumor infiltration was observed in those carcinomas with a high p16 index (P = .0475). Hsp70 appeared to be overexpressed in all gastric neoplasms included in this study. This is in contrast to Hsp27, because a group of tumors showed complete lack of Hsp27 immunoexpression, whereas the others displayed extensive Hsp27 immunostaining. The differences in Hsp27 did not correlate with any of the histopathological parameters, but Hsp27 immunoexpression was higher in the undifferentiated carcinoma. No significant differences in the expression of the proteins were found in canine gastric carcinomas according to their histological type. These findings may be useful for establishing a prognosis for canine gastric carcinoma.

Successful outcome of a cirrhotic patient with postoperative haematuria treated with a single high dose of recombinant factor VIIa

Recombinant factor VIIa (rfVIIa) has been widely used for the treatment and prevention of bleeding episodes in haemophiliacs with high-titre inhibitors. High single doses are the treatment of choice for joint and muscle bleeds in those patients. There are only a few reports on the value of rfVIIa in cirrhotic patients with haemostatic impairment but this drug can consistently correct the prothrombin time in these individuals. We report a case of a good response to a single high dose of rfVIIa in a patient with advanced liver disease who suffered from severe refractory postoperative haematuria.

Kinetics and toxicity of direct reaction between ozone and 1,2-dihydrobenzene in dilute aqueous solution

The presence of toxic aromatic organic compounds in industrial wastewater affects the efficiency of conventional biological treatment. The oxidizing power of ozone represents an interesting pretreatment to reduce toxicity and increase biodegradability. At low pH, ozone is known to attack electron-rich structures by direct electrophilic reactions which open aromatic rings, and generate smaller oxidized compounds. This paper reports experimental results on kinetic and toxicity aspects of ozone direct reactions with 1,2-dihydrobenzene. This toxic compound is frequently found in cellulose bleaching effluents. Although the reaction pathway is rather complex, 4-carbon compounds, such as maleic acid, are readily formed during the first stage of ozonation. These 4-carbon compounds are further oxidized to form smaller molecules (mostly 2-carbon, such as oxalic acid). The apparent kinetics of 1,2-dihydrobenzene follows a second order law, with a rate constant around 0.36 (dm3 mmol-1s-1), at pH 2 and 20 degrees C. Results show that the BOD:COD ratio increase five-fold as ozonation progresses. Furthermore, the mutagenicity of 1,2-dihydrobenzene totally disappears as the aromatic compound is destroyed by ozonation.

Sodium nitroprusside/nitric oxide causes apoptosis in spiral ganglion cells

OBJECTIVE

In the cochlea, excitatory amino acid receptor overstimulation induces toxicity in spiral ganglion neurons by an unknown mechanism. In the central nervous system, excitatory amino acid-induced toxicity is mediated by nitric oxide, which induces apoptosis in neurons. This study tested the hypothesis that cochlear nitric oxide-mediated toxicity is the result of induction of apoptosis in spiral ganglion neurons.

METHODS

The cochleas of 15 gerbils randomly assigned to different groups were perfused for 30 minutes with a test solution of 1 mmol/L sodium nitroprusside, a nitric oxide donor, or a control solution of artificial perilymph. Animals were killed at varying times, including 2, 3, 4, 8, and 18 hours after perfusion. DNA fragmentation or in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling analysis was done on cochleas for detection of apoptosis.

RESULTS

Analysis by both techniques demonstrated marked apoptotic cell changes in spiral ganglion neurons of sodium nitroprusside-treated cochleas evident 4 to 8 hours after perfusion, as compared with minimal to no evidence of apoptosis in spiral ganglion neurons of control specimens.

CONCLUSIONS

Exposure to high levels of nitric oxide induces apoptosis in spiral ganglion neurons. Because apoptosis is a delayed, potentially reversible cell death pathway, this may present an opportunity for intervention to prevent or attenuate hearing damage induced by excitotoxic stimuli.

Inhibition of nitric oxide synthase causes elevation of hearing thresholds

OBJECTIVE

Nitric oxide mediates the effects of excitatory amino acids in the central nervous system. The excitatory amino acids are thought to be the neurotransmitters at the cochlear hair cell-afferent nerve synapse. Nitric oxide synthase is present in spiral ganglion cells. This study investigated the role of nitric oxide in cochlear neurotransmission.

METHODS

In gerbils, cochlear compound action potential thresholds were recorded before and after cochlear perfusions with control solutions of artificial perilymph solution and test solutions of S-methyl-L-thiocitrulline (MTC), a competitive inhibitor of nitric oxide synthase. Cochleas were also preperfused with L-arginine before perfusion with a mixture of MTC/L-arginine (to overcome competitive inhibition by MTC with L-arginine, the natural substrate of nitric oxide synthase).

RESULTS

Cochlear perfusion with MTC caused significant elevations of compound action potential threshold of 51 dB as opposed to insignificant elevations of only 10 dB in control animals. An insignificant threshold shift of 9 dB was observed when L-arginine was coperfused with MTC.

CONCLUSIONS

Nitric oxide is involved in neurotransmission/neuromodulation in the cochlea. Because nitric oxide is both a mediator of neurotoxicity and an initiator of apoptosis in the central nervous system, nitric oxide may play a role in these processes in the cochlea.

Role of nitric oxide in kainic acid-induced elevation of cochlear compound action potential thresholds

Nitric oxide (NO) has specifically been found to mediate the effects of excitatory amino acids in the central nervous system (CNS). Excitatory amino acids are the primary neurotransmitters at the cochlear hair cell afferent nerve synapse. Recent studies in our laboratory demonstrate that NO synthase is an active enzyme in the spiral ganglion cells of the cochlea. Given our current understanding of neurotransmission in the cochlea, it is reasonable to postulate that the actions of NO in cochlear neuronal tissue are similar to the actions of NO in the CNS, and that NO acts as a neurotransmitter/neuromodulator in the cochlea. In addition, NO is implicated as a mediator of excitotoxicity in the CNS and may therefore play a similar role in excitotoxicity in the cochlea. To further elucidate the role of NO in cochlear excitotoxicity, this study investigated the effects of 7-nitroindazole (7-NI), a competitive inhibitor of neuronal nitric oxide synthase, with regard to kainic acid (KA)-induced elevation of compound action potential (CAP) thresholds. KA is a conformationally restricted analog of glutamate with well-known excitotoxic effects on SGC's and previously described inhibitory actions on cochlear CAP thresholds. In anesthetized gerbils, CAP thresholds were recorded before and after cochlear perfusions with control solutions of artificial perilymph solution and test solutions of KA. 7-NI was administered i.p. prior to KA perfusion in an effort to block its depolarizing and toxic effects. Results showed that cochlear perfusion with KA caused significant elevation (p < 0.05) of the mean CAP threshold. This threshold shift was significantly reduced (p < 0.05) in animals pretreated with 7-NI. These results indicate that NO is involved in the toxic effects on CAP thresholds elicited by KA in the cochlea.

Effect of sodium nitroprusside on compound action potential thresholds in the gerbil cochlea

The presence of active nitric oxide synthase (NOS) in the spiral ganglion cells of the cochlea suggests that the neuromodulator nitric oxide (NO) may play a role in hearing. This study investigated the effects of sodium nitroprusside (SNP), an NO donor, upon cochlear function mediated through its activation of guanylate cyclase. In gerbils, cochlear compound action potential (CAP) thresholds were recorded after cochlear perfusions of control and test solutions in four experimental groups. Perfusions were performed using the following: artificial perilymph solution (APS); the NO donor SNP; the guanylate cyclase inhibitor methylene blue (MB); and sodium dodecyl sulfate (SDS), which facilitates MB entrance into cells. SNP caused significant elevations of CAP thresholds from baseline (25 dB SPL +/- 1.54 dB to 64.3 dB SPL +/- 2.54 dB). SNP with MB also resulted in significant CAP threshold elevations (29.4 dB SPL +/- 4.27 dB to 38.1 dB SPL +/- 4.0 dB); however, these elevations were significantly lower than those seen in SNP perfusions without MB. Drilling perfusion holes and perfusion of APS, APS/SDS, and MB/SDS/APS solutions did not significantly affect CAP thresholds. These results suggest that the NO donor nitroprusside does affect cochlear neuromodulation and effects this mediation in part through NO activation of guanylate cyclase.

[Combined treatment with factor VIII and immunosuppressive agents in a young woman with acquired factor VIII inhibitor]

A twenty seven year-old woman is reported with severe haemorrhagic symptoms caused by an acquired coagulant factor VIII inhibitor eleven months after delivery. The inhibitor was quantified as 77 units according to the Bethesda method. Steroids treatment and high-dose immunoglobulins failed to elicit any response. Combined chemotherapy will cyclophosphamide, vincristine and prednisone after intravenous factor VIII, every fourth week, succeeded in eradicating the acquired inhibitor and progressively restoring the rates of factor VIII in this patient with acquired haemophilia.

A New Technique for CT/MR Fusion For Skull Base Imaging

This paper presents our initial experience utilizing a new technique which allows CT and MR image fusion in patients with skull base lesions. Eleven patients with a variety of skull base lesions underwent CT and MR imaging prior to surgery. Both sets of images were coregistered using customized software. The CT and MR data sets were then combined and viewed in a single interactive image formar using a high-speed graphic computing system. Image fusion allowed simultaneous visualization of the bony skull base anatomy (CT) and detailed soft tissue anatomy (MR) using a single image format. Combining both modalities was felt to provide a better assessment of the extent of lesions and improve understanding of their relationship to adjacent bony and neurovascular anatomy. Specifically, image fusion enhanced awareness of location of skill base lesions with respect to the cavernous sinuses. Gasserian ganglia, carotid arteries, and jugular foramina. For tumors arising within the internal auditory canal (IAC), fused images allowed better delineation of the lateral aspect of the lesion with respect to the fundus of the IAC. Thus, fusion of CT and MR studies provides a unique image format which has advantages over single modality display. We believe image fusion is beneficial for surgical planning and for treatment planning of complex skull base malignancies treated with radiotherapy.

BCR-ABL rearrangement and 'variant' Philadelphia chromosome in de novo acute myelogenous leukaemia FAB subtype M1

We report a case of de novo acute myelogenous leukaemia FAB subtype M1 that presents a cytogenetic complex translocation between chromosomes 7, 9 and 22, producing a 'variant' Philadelphia chromosome. Molecular analysis revealed a BCR-ABL rearrangement involving exons b3 and a2 (b3a2). Haematological parameters and genetic analysis again raise the problem of the true nature of this disease, which is briefly discussed.