Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

S-3,4-DCPG, a potent orthosteric agonist for the mGlu8 receptor, facilitates extinction and inhibits the reinstatement of morphine-induced conditioned place preference in male rats

The limbic system, particularly the NAc, shows a high concentration of metabotropic glutamate receptors (mGluRs). Recent evidence suggests the significant involvement of mGluRs in mental disorders, including substance abuse and addiction. The objective of this study was to examine the involvement of mGlu8 receptors in the NAc in the mechanisms underlying the extinction and reinstatement of conditioned place preference (CPP) induced by morphine. Male Wistar rats underwent surgical implantation of bilateral cannulas in the NAc and were assessed in a CPP protocol. In study 1 at the same time as the extinction phase, the rats were given varying doses of S-3,4-DCPG (0.03, 0.3, and 3 μg/0.5 μl). In study 2, rats that had undergone CPP extinction were given S-3,4-DCPG (0.03, 0.3, and 3 μg/0.5 μl) five minutes prior to receiving a subthreshold dose of morphine (1 mg/kg) in order to reactivate the previously extinguished morphine response. The findings demonstrated that administering S-3,4-DCPG directly into the accumbens nucleus resulted in a decrease in the duration of the CPP extinction phase. Moreover, dose-dependent administration of S-3,4-DCPG into the NAc inhibited CPP reinstatement. The observations imply that microinjection of S-3,4-DCPG as a potent orthosteric agonist with high selectivity for the mGlu8 receptor into the NAc promotes the process of extinction while concurrently exerting inhibitory effects on the reinstatement of morphine-induced CPP. This effect may be associated with the modulation of glutamate engagement within the NAc and the plasticity of reward pathways at the synaptic level.

Family-based interventions in youth to prevent HIV/AIDS: A systematic review

Parents are primary sex educators of their teenagers and also function as resources for advice and information about sexual decision-making and partner selection. So far, various family-based programs were carried out to prevent HIV infection in young people; however, their findings are contradictory and inconclusive. Therefore, we carried out the current systematic review to critically review the available literature regarding the role of family-based interventions among young people to prevent HIV infection. The available online databases including ISI Web of Science, Scopus, and PubMed were searched systematically up to November 2022. The risk of bias in the eligible studies was examined by two independent authors using the Cochrane Collaboration Risk of Bias tool. A total of 7 studies including 4952 participants were enrolled in the current study. They were conducted between 2006 and 2020. On the basis of the available literature, family-based HIV prevention interventions seem to be effective in terms of improving HIV/AIDS knowledge and also parent-youth communication. It seems that family-based interventions in youth to prevent HIV/AIDS are effective; however, further well-designed studies are needed to help the researchers reach a firm conclusion on this issue. The current systematic review may be used by investigators for future studies in terms of settings and the selection of educational approaches. Moreover, it strongly suggested that further studies investigating the role of family-based education in the prevention of HIV/AIDS utilize more sample size and also a more robust educational framework.

The effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players with upper cross syndrome

BACKGROUND

This study aims to investigate the effect of a course of selected corrective exercises on posture, scapula-humeral rhythm and performance of adolescent volleyball players.

METHODS

30 adolescent volleyball players with upper cross syndrome were purposefully selected and assigned into 2 control and training groups. The degree of back curvature was evaluated using a flexible ruler, forward head and forward shoulder size by photographic method, scapula-humeral rhythm by Lateral Scapular Slide Test (LSST), and performance by closed kinetic chain test. The training group performed the exercises for 10 weeks. After the exercises, the post-test was administered. To analyze the data, analysis of co-variance tests and paired t-test at the level of 0.05 were employed.

RESULTS

The research results showed that corrective exercises have a significant effect on abnormalities of forward head, forward shoulder, kyphosis, scapula-humeral rhythm and performance.

CONCLUSIONS

Corrective exercises can be effective in reducing shoulder girdle and spine abnormalities and improving scapula- humeral rhythm and performance of volleyball players.

Occupational Challenges of Intensive Care Nurses During the COVID-19 Pandemic: A Qualitative Study

Introduction

The coronavirus disease 2019 (COVID-19) has been spreading rapidly as a pandemic and posed numerous challenges to healthcare workers (HCWs), especially nurses. This study aimed to investigate the occupational challenges experienced by intensive care unit (ICU) nurses in caring for patients with COVID-19.

Methods

This qualitative study was conducted using a conventional content analysis method in September and October 2020. The study environment was the ICU wards dedicated to the patients of COVID-19 in a large hospital in east of Iran. The participants were selected by purposeful sampling method, and data were collected using semi-structured interviews with 17 nurses working in the COVID-19 ICUs. Data analysis was done with MAXQDA 2020.

Results

The data analysis led to the extraction of 6 main categories and 17 sub-categories. The main challenges included "payment system", "human resource management", "consumable resource supply", "psychological and ethical distress", "personal or family problems", and "staff motivation and welfare issues".

Conclusion

Considering the key and important role of nurses in the healthcare system, particularly during the COVID-19 pandemic, it is necessary to increase their motivation by applying a fair and non-discriminatory payment system and paying special attention to psychological issues. Also, managerial support and provision of required facilities and manpower have a significant impact on reducing their occupational challenges in caring for patients with COVID-19.

In Vitro and In Vivo Improvement of Islet Quality and Transplantation Successes following Islet Treatment with Biomaterials in Diabetic Rats

Background

Loss of islet survival and function, caused by native niche disruption and oxidative stress induction during mechanical and enzymatic isolation, limits the effectiveness of islet transplantation. Reconstitution of islet microenvironment, vascularization, and decreased oxidative stress with biomaterials may improve islet quality and graft outcomes. We investigated effects of two biomaterials, platelet-rich plasma and pancreatic islets homogenate combination on islet recovery and quality by evaluating in vitro islet survival, secretory function, and oxidative stress parameters and assessing in vivo transplantation outcomes.

Methods

In vitro, islet viability and secretory function of isolated islets were assessed after 24 h and 72 h incubation with biomaterials. Also, oxidative stress markers were measured once after isolation and 24 h after incubation with biomaterials. For evaluating in vivo effects, cultured islets for 24 h were transplanted into subscapular space of diabetic rat kidney, and outcomes were analyzed by measuring serum glucose and insulin concentrations, glucose tolerance test, level of oxidative parameters, and pancreatic gene expression.

Results

Treating islets with biomaterials significantly increased their viability and secretory function, reduced MDA level, and elevate SOD and CAT activity. Decreased level of glucose and MDA improved insulin level, increased SOD activity, and also enhanced pdx1 and insulin gene expression in diabetic rats after islet transplantation.

Conclusions

Biomaterials used in the present study should be consider as beneficial materials for increasing islet transplantation outcome. These materials may hamper transplantation limitation to some extent.

VU0155041, a positive allosteric modulator of mGluR4, in the nucleus accumbens facilitates extinction and inhibits the reinstatement of morphine-induced conditioned place preference in male rats

Nucleus accumbens (NAc) neurons appear to be at the hub of the reward circuit. New evidence suggests that the behavioural effects of morphine substances may be significantly regulated by glutamate-mediated transmission, notably by metabotropic glutamate (mGlu) receptors. Here, we examined the hypothesis that the mGlu4 receptor within that NAc has a role in the extinction and reinstatement of morphine-induced conditioned place preference (CPP). The animals received bilaterally microinjections of VU0155041, a positive allosteric modulator (PAM) and partial agonist of mGlu4 receptor, into the NAc. In Experiment 1, the rats received VU0155041 (10, 30 and 50μg/0.5μL) during the extinction period. In Experiment 2, the CPP extinguished rats received VU0155041 (10, 30 and 50μg/0.5μL) five minutes prior to the administration of morphine (1mg/kg) in order to reinstate the extinguished CPP. The results showed that the intra-accumbal administration of VU0155041 reduced the extinction period of CPP. Furthermore, the administration of VU0155041 into the NAc dose-dependently inhibited the reinstatement of CPP. The findings suggested that the mGluR4 in the NAc facilitates the extinction and inhibits the reinstatement of the morphine-induced CPP, which could be mediated by an increase in the release of extracellular glutamate.

Integrating health promotion with and for older people - eHealth (IHOPe) - evaluating remote integrated person-centred care : Protocol of a randomised controlled trial with effectiveness, health economic, and process evaluation

BACKGROUND

Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People - eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals.

METHODS

The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019-05364, Dnr 2020-03550, Dnr 2021-03255).

DISCUSSION

The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location.

TRIAL REGISTRATION

ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

Identification and Assessment of Home Accidents Risk in Children under 7 Years Old in Yazd City

Introduction: Home accidents means accidents that happen in the house or its surroundings, and are the main cause of death and disability of children. Risk assessment is an organized method to identify, predict and reduce risk to an acceptable level. Therefore, our goal in this study is to identify and evaluate domestic hazards in the homes of Yazd city for children under seven years old.  Methods and Materials: In this descriptive-analytical study, 322 home accidents were identified in a cluster method from different areas of Yazd city. Data were collected using a researcher-made questionnaire whose validity and reliability were measured by experts (α=0.764). After completing the questionnaires, the collected data were entered into SPSS software version 20 and were analyzed by descriptive tests, ANOVA and T-TEST in confidence level of 95% Results: The most injuries caused by hazards are cuts, bone fractures/dislocations and contusion with a frequency of 17%, 14.8%, and 9.6%, respectively. The highest risk assessment code belongs to minor risks with a frequency of 39.76%, and the lowest frequency is for critical risks (3.17%). There was a significant relationship between most of the risks in homes with the areas of Yazd city and the type of building (p-value<0.05). Conclusion: This study shows the importance of using from the risk assessment code method, which can be used to identify and determine the relative risk of hazards for each part of the house and provide prevention solutions based on priority. Also, by using appropriate training and policies to monitor compliance and full implementation of legal requirements in construction, home accidents and the resulting complications have been reduced, and safety culture and quality of life of families have been improved.

Comparable effects of circuit and traditional resistance exercise on platelet α2bβ3 receptor and platelet activation and function

BACKGROUND

Resistance exercise induces thrombocytosis and increases platelet activation and function. These changes might be related to exercise variables including exercise intensity and type.

OBJECTIVE

We compared the effects of traditional resistance exercise (TRE) and circuit resistance exercise (CRE) on cellular markers of platelet activation and function.

METHODS

In this crossover study ten healthy male (mean±SD: age, 25.6±2.4 years) subjects performed TRE encompassed 3 sets of 10 repetitions at 100% of 10-RM (10 repetition maximum) for 6 exercises, and CRE protocols included 3 sets of 10 repetitions at 100% of 10-RM for all 6 exercises consecutively, in two separate weeks. To measure platelet indices, PAC1, CD41a, CD42b and CD62P three blood samples were taken before, immediately after exercise, and after 30 min recovery.

RESULTS

Lactate concentration, blood pressure, platelet count (PLT), and mean platelet volume (MPV) were significantly (p <  0.05) increased following both resistance exercise trials. Significant increases in PAC1, and CD62P; and significant reductions for CD42b and CD41a were detected following both REs (p <  0.05). However, changes in PAC1 and CD62P were significantly different between the two protocols (p <  0.05), with higher increases detected following CRE.

CONCLUSIONS

Acute RE increases platelet indices and platelet activation; and that CRE results in higher platelet activation than TRE, probably due to exercise-induced increases in shear stress.

Change Management in Hospitals: A Framework Analysis

BACKGROUND

Hospitals are complex organizations that frequently need changes especially in service delivery processes, organizing, human resource management, monitoring and evaluation and technologies. Maintaining and improving productivity is a key requirement in hospital change management. Therefore, we need to develop and expand an appropriate model for management of changes in hospitals; which is the main purpose of this study.

METHOD

A qualitative approach was used to conduct semi-structured interviews in 2019-2020 with 12 expert managers at Mashhad University of Medical Sciences, Mashhad, Iran. A pre-structured framework was applied for the data analysis.

RESULTS

Four main themes and nine sub-themes were identified as the main phases or stages of the framework that can be used to manage changes that aim to improve efficiency in hospitals. The main themes were problem identification and initial support; studying, designing and planning; participation in implementation; considering executive requirements; and implementation, assessment, feedback and stabilization.

CONCLUSION

Management of changes that aim to improve hospital efficiency requires a practical model that was specifically developed by this study. This model should consider all the key elements that were identified; and should consider the expectations of the key stakeholders and their contribution in implementing the change.

Management of Cancer Patients in the COVID-19 Crisis Using Telemedicine: A Systematic Review

BACKGROUND

Telemedicine can provide a solution for disease management during the COVID-19 pandemic. This literature review aims to explore the role of telemedicine during the COVID-19 pandemic for management of cancer patients.

METHOD

A comprehensive systematic search was conducted in PubMed, Science Direct, EMBASE, and Web of Science databases for the papers published until April 2021. Studies were included in case they had practically used telemedicine in the management of cancer patients during the COVID-19 crisis.

RESULTS

After screening 2614 titles and abstracts and reviewing 305 full-texts, 16 studies were found to be eligible. The results indicated that most of the patients contacted by telemedicine services mostly used to intract with patients breast cancer (n=4, 25%). The most common use of telemedicine was the provision of virtual visit services (n=10, 62.25%). Besides, communication was most frequently provided by live video conferences (n=11, 68.75%).

CONCLUSION

Telemedicine can provide continued access to necessary health services in oncology care and serve as an important role in pandemic planning and response.

Preparatory Brain Activity and Anticipatory Postural Control in Cervical Myofascial Trigger Point

Introduction: Neck pain is a highly prevalent disorder in developed countries. A myofascial trigger point (MTrP) is distinguished under the name of the fundamental excessive menstruation for it and certain reason for musculoskeletal dysfunction. MTrP refers to a sensitive spot in a taut band whose stretch and compression can induce pain. Modifications in the motor cortex, sensory input, irritability, and integration are the adaptive mechanisms to pain. Accordingly, this study aimed to investigate the preparatory brain activity and anticipatory postural control in chronic neck pain. Materials and Methods: The study participants included 25 women with an active MTrP in the upper trapezius muscle and 25 healthy women in the control group. We recorded the brain activities from Cz, Pz, and Fz regions and muscle activities of both sides of the upper trapezius, anterior deltoid, cervical and lumbar paraspinal, sternocleidomastoid, and medial head of the gastrocnemius. The participants had to flex their arms in reply to the second sound stimulus, followed by the first sound. Then, their reaction time and brain activity were evaluated. Results: Significant differences between the two groups were detected in brain activities’ measurements and the onset of muscle activation (P<0.001). The exception was the onset of gastrocnemius muscle activation (P>0.05). Conclusion: The current study suggests that active MTrP induces latency and lengthens the muscle reaction time; thus, the production of suitable motion after the stimulus will be affected. Brain alteration after pain damages movement changes and postural control mechanism.

Effect of 8% arginine toothpaste on Streptococcus mutans in patients undergoing fixed orthodontic treatment: randomized controlled trial

Objective:

To assess the effect of toothpaste containing 8% arginine on Streptococcus mutans (S. mutans) in dental plaque around orthodontic brackets, and to draw a comparison with a regular fluoride toothpaste.

Trial design:

A single-center, parallel-arm, triple-blind, randomized controlled trial was conducted.

Methods:

The clinical trial was conducted at the Orthodontic Clinic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. Seventy-two patients (age range: 15-30 years) who required fixed orthodontic treatment were recruited and randomly assigned to arginine and fluoride groups. Randomization was performed using RANDOM.ORG online software, and the participants were divided into two parallel groups, with a 1:1 allocation ratio. Patients were requested to brush their teeth twice daily for 30 days with an experimental toothpaste. Plaque sampling was performed at two intervals, namely at the beginning of the study (T₀) and 30 days later (T₁). Real-time PCR was used to assess plaque samples in terms of the number of S. mutans surrounding stainless steel brackets in orthodontic patients. A triple-blind design was employed.

Results:

The baseline characteristics (age, sex, and the relative number of S. mutans) between the groups were similar (p>0.05). Only the arginine group showed a significant decrease in the relative number of bacteria between T₀ and T₁ (p=0.02).

Conclusion:

Arginine is an important prebiotic agent in maintaining healthy oral biofilms, and prevent dental caries during fixed orthodontic treatments.

Trial registration:

The trial was registered at the Iranian Registry of Clinical Trials (IRCT20181121041713N2), https://en.irct.ir/user/trial/42409/view.

Platelet-rich plasma in the treatment of scars, to suggest or not to suggest? A systematic review and meta-analysis

Despite the rising trend for applying platelet-rich plasma (PRP) in the management of various types of scars, there is no convincing evidence supporting its use. This motivated us to review the randomized clinical trials that examine the effectiveness and safety of PRP, alone or in combination with other methods, for the management of atrophic or hypertrophic/keloidal scars. The Web of Science, Scopus, Google Scholar, and Cochrane Library databases were systematically searched until September 1^st , 2020. Thirteen clinical trials were enrolled in the meta-analysis, and 10 more were reviewed for their results. The random effect meta-analysis method was used to assess the effect size of each outcome for each treatment type, and I² was used to calculate the statistical heterogeneity between the studies. Patients treated with PRP experienced an overall response rate of 23%, comparable to the results seen with laser or micro-needling (22% and 23%, respectively) When used alone, moderate improvement was the most frequently observed degree of response with PRP (36%) whereas, when added to laser or micro-needling, most patients experienced marked (33%, 43%, respectively) or excellent (32% and 23%, respectively) results. Concerning the hypertrophic/keloid scars, the only study meeting the required criteria reported a better improvement and fewer adverse effects when PRP was added to the intralesional corticosteroids. Platelet-rich plasma appears to be a safe and effective treatment for various types of atrophic scars. In addition, when added to ablative lasers or micro-needling, it seems to considerably add to the efficacy of treatment and reduce the side effects.

Continuous multidimensional assessment system of medical residents in teaching hospitals

Background and aims

Evaluation of learners is considered as one of the most important principles in education, especially in the clinical fields. Continuous assessment can be used to provide appropriate feedback to students about their strengths and weaknesses. In this regard, this study is aimed to design a system of continuous assessment of medical residents (SCMARs).

Methods

This study was performed using a combination of qualitative methods, including focus group discussion, expert panel, and Delphi technique. The study population consisted of all the stakeholders involved in the evaluation process of medical residents in Imam Reza Hospital Complex (IRHC) in Iran. This study was conducted in three phases, including identification of subthemes and indicators, production of a primary framework for the SCMAR, and agreement on the subthemes of the SCMAR. The nominal group technique was used for generating priority information. Data analysis was performed during the agreement review stage with the Excel software version 2016.

Results

The finalized SCMAR consisted of 10 main themes and 38 subthemes. The themes included objectives, evaluators, areas, and indicators of evaluation, evaluation periods, evaluation requirements, data collection, data sources, point assignment and data analysis methods, reporting, and feedback dissemination methods. Five areas of evaluation and 11 indicators of evaluation were proposed.

Conclusion

A comprehensive assessment system that continuously evaluates the performance of Medical Residents can be used as a stimulus to improve the quality of educational processes. The present study was aimed to address this need by designing a framework for such a system.

Therapeutic potentials of CRISPR-Cas genome editing technology in human viral infections

Viral infections are a common cause of morbidity worldwide. The emergence of Coronavirus Disease 2019 (COVID-19) has led to more attention to viral infections and finding novel therapeutics. The CRISPR-Cas9 system has been recently proposed as a potential therapeutic tool for the treatment of viral diseases. Here, we review the research progress in the use of CRISPR-Cas technology for treating viral infections, as well as the strategies for improving the delivery of this gene-editing tool in vivo. Key challenges that hinder the widespread clinical application of CRISPR-Cas9 technology are also discussed, and several possible directions for future research are proposed.

The Experiences of Nurses of Infectious and Non- Infectious Wards of Caring COVID-19 Patients in a Big Hospital in Iran: A Qualitative Study

Background

Nurses play a very important role in caring for patients with coronavirus disease-19 (COVID-19). They are on the frontline fighting COVID-19. The objective was to explore the experiences of nurses in the surgical and infectious wards about caring for patients with COVID-19 in a large and tertiary care hospital in Iran.

Materials and Methods

This was a qualitative study. Semi-structured qualitative interviews were conducted with 18 nurses in the Imam Reza Hospital Complex from April to May 2020, Mashhad, Iran. Data analysis was performed using the method proposed by Lundman and Granheim. The Maxqda10 software was used.

Results

The experiences were summarized into three categories: (1) experiencing new feelings and relationships with colleagues and patients, (2) viewpoints about managers' performance, and (3) concern about getting infected with COVID-19. Findings reflected similar experiences on personal protective equipment between nurses in the surgical and infectious wards. Experiencing new feelings and relationships with colleagues and patients and concern about getting infected and spreading the COVID-19 were mostly expressed by infectious nurses and surgical nurses, respectively.

Conclusions

This research results provide evidence of the experiences of infectious and non-infectious disease nurses who are currently caring for COVID-19 patients. Due to some differences between the experiences of these two groups in COVID-19, it is suggested to pay more attention to the needs and required skills in the staff mix during a crisis.

A convenient green protocol for oxidative esterification of arylaldehydes over Pd NPs decorated polyplex encapsulated Fe3O4 microspheres

A mild, competent and eco-friendly protocol has been developed for oxidative esterification of various aldehydes over a post-synthetically modified and Pd fabricated chitosan-starch dual functionalized Fe₃O₄ microspheres as a magnetically isolable heterogeneous and biocompatible nanocatalyst. Molecular O₂ was used as an oxidant in the reaction. A series of aldehydes was directly esterified with MeOH in excellent yields without any pre-activation and involvement of harsh chemicals/conditions. Structural features of the catalyst were assessed through FT-IR, FE-SEM, TEM, EDX, molecular mapping, XRD, VSM and ICP-OES techniques. Due to magnetic core, the catalyst was easily isolated using an external magnet and reused for 8 times in succession, retaining its morphology and catalytic activity.

Cutaneous granular cell tumor: A case series, review, and update

Background

Granular cell tumor (GCT) or Abrikossoff's tumor is an uncommon neuro-derived tumor in which Schwann cells are found and express S-100 protein. Often, it is a benign lesion. Histopathologically, there are granular cell infiltrations through the entire dermis without necrosis which are periodic acid Schiff (PAS) stain positive and reactive with S-100. The aim of this study is the clinicopathological evaluation of GCT.

Material and Methods

In this paper, we described the experience of 6 patients with a GCT in different locations (4 cases in the skin and 2 cases in the mucosa), for example, a case with a tumor in the abdomen and a keloidal-like presentation with a highly sclerotic pattern (an uncommon pathological feature). Another case developed a lesion secondary to physical trauma.

Result

In one case, the presence of a lesion in the lower lip associated with actinic damage secondary to chronic sun exposure resulted in misdiagnosis with actinic cheilitis and squamous cell carcinoma.

Conclusion

Histopathologically, there were granular cell infiltrations through the entire dermis without necrosis which are PAS-positive and reactive with S-100.

The modulatory potential of herbal antioxidants against oxidative stress and heavy metal pollution: plants against environmental oxidative stress

Free radicals, principally reactive oxygen species (ROS), contribute to oxidative stress in human beings. Free radicals have different mechanisms of action and affect lipids, proteins, and DNA. Heavy metals including cadmium (Cd), lead (Pb), and arsenic are environmental pollutants that may induce oxidative stress and produce ROS, leading to harmful effects on different body systems such as the liver and brain. On the other side, antioxidants can have protective effects against oxidative stress and decrease their toxicity. Herbal antioxidants have potential antioxidative effects. These antioxidants positively affect neurodegenerative diseases, atherosclerotic diseases, lung fibrosis, kidney injuries, and liver toxicities induced by oxidative agents, including heavy metals. In this manuscript, we explained the mechanisms of oxidative stress, and also discussed heavy metals which contribute to human oxidative stress. We further discussed different herbal antioxidants, their mechanisms of action, and their clinical use for various diseases.

Effects of Dry Needling of the Upper Trapezius Active Trigger Points on Pain and Pain Pressure Threshold in Women With Chronic Non-Specific Neck Pain

Background and Objectives: The purpose of the present study was to examine the effectiveness of dry needling as local treatment of upper trapezius trigger points related to chronic neck pain on pain and pain pressure threshold in women with chronic nonspecific neck pain. Methods: Thirty females with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the intervention for three weeks. The outcomes were pain intensity and pain pressure threshold. Every outcome was recorded at baseline and 2 days after the fifth session. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. The results of the independent t-test showed a significant difference in measurements between the dry needling and passive stretch groups (P<0.05). Conclusion: Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in women with nonspecific neck pain.

Person-centred care: looking back, looking forward

An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three 'simple routines' to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016-20). Clinical implications and future research in PCC are also suggested.

The role of mGlu4 receptors within the nucleus accumbens in acquisition and expression of morphine-induced conditioned place preference in male rats

Background

Several studies have shown that glutamate neurotransmission in the nucleus accumbens (NAc) is required for the development of morphine-induced conditional place preference (CPP). In addition, metabotropic glutamate receptors (mGluRs) in NAc play important roles in the reward pathways. However, the precise role of mGluR4 in different steps of the morphine-induced CPP is less well known. In the present study the effect of bilateral intra-accumbal infusion of VU0155041, as a specific mGluR4 agonist on the acquisition and expression of morphine induced CPP in male Wistar rats was investigated. The animals were bilaterally implanted with guide cannulae above the NAc. In the first step of the study, the VU0155041 was administered at doses of 10, 30 and 50 μg/0.5 μL saline per side into the NAc during the 3 days of morphine (5 mg/kg) conditioning (acquisition) phase of morphine-induced CPP. In the second step of the study, the rats bilaterally received VU0155041 at the dose of 50 μg/0.5 μL, 5 min before the post-conditioning test in order to check the effect of VU0155041 on the expression of morphine-induced CPP.

Results

The results showed that the intra-accumbal injection of VU0155041 inhibits the acquisition of morphine-induced CPP in a dose dependent manner, but had no effect on expression.

Conclusions

The data indicated that intra-NAc administration of VU0155041 dose dependently blocks the establishment of morphine-induced CPP and reduces the rewarding properties of morphine. These effects may be related to changes in glutamate activity in the NAC and/or learning dependent mechanism of glutamate neurotransmission in reward pathway(s).

The effect of the mGlu8 receptor agonist, (S)-3,4-DCPG on acquisition and expression of morphine-induced conditioned place preference in male rats

Background

The nucleus accumbens (NAc) plays a principal role in drug reward. It has been reported that metabotropic glutamate receptors (mGlu receptors) play a key role in the rewarding pathway(s). Previous studies have shown the vast allocation of the different types of mGlu receptors, including mGlu8 receptors, in regions that are associated with opioid rewards, such as the NAc. The aim of the present study was to evaluate the role of mGlu8 receptors within the NAc in the acquisition and expression phases of morphine induced conditioned place preference (CPP). Adult male Wistar rats were bilaterally implanted by two cannulas' in the NAc and were evaluated in a CPP paradigm. Selective mGlu8 receptor allosteric agonist (S-3,4-DCPG) was administered at doses of 0.03, 0.3, and 3 μg/0.5 μL saline per side into the NAc on both sides during the 3 days of morphine (5 mg/kg) conditioning (acquisition) phase, or before place preference test, or post-conditioning (expression) phase of morphine-induced CPP.

Results

The results revealed that intra-accumbal administration of S-3,4-DCPG (0.3 and 3 μg) markedly decreased the acquisition in a dose-dependent manner but had no effect on expression of morphine-induced CPP.

Conclusions

The findings suggest that activation of mGlu8 receptors in the NAc dose-dependently blocks the establishment of morphine-induced CPP and reduces the rewarding properties of morphine which may be related to the glutamate activity into the NAc and in reward pathway(s). These data suggest that mGlu8 receptor may be involved in conditioned morphine reward.

CeO2 foam-like nanostructure: biosynthesis and their efficient removal of hazardous dye

In this study, CeO₂ (cerium oxide) nanoparticles were synthesized using Pinus halepensis pollen and were characterized by field emission scanning electron microscopy (FESEM), powder X-ray diffraction (PXRD) and Raman spectroscopy. The results showed that the ensuing CeO₂ nanostructures, ranging in size from 5 to 25 nm, had high porosity. Synthesized CeO₂ showed the effective catalytic activity towards the photocatalytic removal of dyes. In this work, the photocatalytic activity to removal dye (methyl violet 2B), in the absence of UV radiation, using cerium dioxide nanoparticles (CeO₂-NP) was determined. In this research, four main factors such as effect on color, concentration and pH were examined and maximum %R was obtained about was 97% in 75 min in presence of 50 mg of hydrogen peroxide.

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings

THE PURPOSE

of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+).

METHOD

A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish.

RESULTS

In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation.

CONCLUSION

Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.

Overcoming the blood-brain barrier in neurodegenerative disorders and brain tumours

Drug delivery is one of the major challenges in the treatment of central nervous system disorders. The brain needs to be protected from harmful agents, which are done by the capillary network, the so-called blood-brain barrier (BBB). This protective guard also prevents the delivery of therapeutic agents to the brain and limits the effectiveness of treatment. For this reason, various strategies have been explored by scientists for overcoming the BBB from disruption of the BBB to targeted delivery of nanoparticles (NPs) and cells and immunotherapy. In this review, different promising brain drug delivery strategies including disruption of tight junctions in the BBB, enhanced transcellular transport by peptide-based delivery, local delivery strategies, NP delivery, and cell-based delivery have been fully discussed.

Delivery of genome editing tools: A promising strategy for HPV-related cervical malignancy therapy

INTRODUCTION

Persistent high-risk human papillomavirus infection is the main cause of various types of cancer especially cervical cancer. The E6 and E7 oncoproteins of HPV play critical roles in promoting carcinogenesis and cancer cell growth. As a result, E6 and E7 oncogenes are considered as promising therapeutic targets for cervical cancer. Recently, the development of genome-editing technologies including transcription activator-like effector nucleases (TALEN), meganucleases (MNs), zinc finger nucleases (ZFN), and more importantly clustered regularly interspaced short palindromic repeat-CRISPR-associated protein (CRISPR-Cas) has sparked a revolution in the cervical cancer-targeted therapy. However, due to immunogenicity, off-target effect, renal clearance, guide RNA (gRNA) nuclease degradation, and difficult direct transportation into the cytoplasm and nucleus, the safe and effective delivery is considered as the Achilles' heel of this robust strategy.

AREAS COVERED

In this review, we discuss cutting-edge available strategies for in vivo delivery of genome-editing technologies for HPV-induced cervical cancer therapy. Moreover, the combination of genome-editing tools and other therapies has been fully discussed.

EXPERT OPINION

The combination of nanoparticle-based delivery systems and genome-editing tools is a promising powerful strategy for cervical cancer therapy. The most significant limitations of this strategy that need to be focused on are low efficiency and off-target events.

Comparison the effects of chitosan and hyaluronic acid-based thermally sensitive hydrogels containing rosuvastatin on human osteoblast-like MG-63 cells

Background and purpose:

Bone regeneration can be accelerated by localized delivery of statins. Here, we aimed to evaluate the effect of two thermosensitive hydrogels containing rosuvastatin (RSV) on proliferation and differentiation of human osteoblast-like MG-63 cells.

Experimental approach:

Firstly, chitosan (CTS)/glycerophosphate (GP)/gelatin (G) thermosensitive hydrogel was prepared and characterized based on rheological properties, in vitro erosion, and release pattern of RSV and then the optimized mixture was loaded with nanoparticles containing RSV(NRSV). Secondly, the effect of NRSV-embedded in CTS/GP/G on cell viability, alkaline phosphate activity, and cell calcification was evaluated using MG-63 cells and compared with RSV-embedded into hyaluronic acid (HA)/Pluronic^® F127 (PF127) hydrogel.

Findings / Results:

CTS/GP mixtures with 1 and 1.5 % gelatin existing in solution with low viscosity at 4 °C were solidified at 32-34 °C while the mixture containing 2% gelatin was jellified at room temperature. The gelation times of CTS/GP/G with 1 and 1.5% gelatin were 72 and 44 s, respectively. The hydrogel containing 3% w/v NRSV was also converted to a semisolid upon increasing the temperature to 33-36 °C. Due to the higher gel strength of CTS/GP/G compared to HA/PF127 hydrogel, the release rate of RSV from the NRSV-embedded CTS/GP/G hydrogel was significantly slower than that of HA/PF127 system. As revealed by alkaline phosphatase and mineralization assays, NRSV-embedded in CTS/GP/G hydrogel had the most promotive effect on differentiation of osteoblasts among other mixtures.

Conclusion and implication:

NRSV-embedded in CTS/GP/G hydrogel could be efficiently used in the future for bone defects such as osteoporosis and bone fractures.

Attenuation of Sulfite-Induced Testicular Injury in Rats by Zingiber officinale Roscoe

Sulfite salts, including sodium metabisulfte, are widely used as preservatives in foods and pharmaceutical agents. Previous studies suggest that oxidative stress may be an important mediator of testicular injury. The present study was designed to elucidate the effect of exposure to sodium metabisulfite by gavage without or with Zingiber officinale (ginger) extract on the rat testes. Thirty-two male Wistar rats were randomly divided into control, ginger-treated (500 mg/kg/day), sodium metabisulfite- (SMB-) treated (260 mg/kg/day), and SMB + ginger- (SZ-) treated groups. After 28 days, the rats were anesthetized by ether and, after laparotomy, blood was collected from the heart to determine testosterone level by the enzyme-linked immunosorbent assay (ELISA) kit. Then left testes and cauda epididymis of all animals were removed for histological examination and sperm analysis, and right testes were removed for assessing lipid peroxidation (indexed by malondialdehyde [MDA]) and antioxidant enzymes. The results showed that spermatogenesis, epididymal morphometry, and sperm parameters were affected by SMB. There was a significant increase in MDA level and a significant reduction in the activities of glutathione peroxidase (GPx), glutathione reductase (GR), and catalase (CAT) in the SMB-treated rats compared to the control. Ginger treatment of SMB-exposed rats significantly increased testosterone level and the number of different spermatogenic cells. The level of MDA reversed to the control levels and the activities of GPx and GR were significantly increased when SMB was coadministered with ginger extract. It is concluded that coadministration of ginger, through its antioxidant and androgenic properties, exerts a protective effect against SMB-induced testicular oxidative stress.

Effects of a continuum of care intervention on frail elders’ self-rated health, experiences of security/safety and symptoms: A randomised controlled trial

We aimed to evaluate effects of the intervention on self-rated health, experiences of security/safety and symptoms. A non-blinded controlled trial was performed with participants randomised to either the intervention group or a control group, with follow-ups at 3, 6 and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of older adults, with a case manager from the municipality as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Mölndal and who were discharged to their own homes in the Mölndal municipality were asked to participate. Inclusion criteria were age 80 years and older, or 65 to 79 years with at least one chronic disease and dependency in at least one activity of daily living. Analyses were conducted on the basis of the intention-to-treat principle. Outcome measures were self-rated health, experiences of security/safety and symptoms. These were analysed using Svensson’s method. Of 161 participants, 76 were allocated to the control group and 85 to the intervention group. Positive effects of the intervention were observed for frail older adult’s symptoms and self-rated health.

Poly (I:C)-DOTAP cationic nanoliposome containing multi-epitope HER2-derived peptide promotes vaccine-elicited anti-tumor immunity in a murine model

In the current study we aimed at developing a vaccine delivery/adjuvant system to enhance anti-tumor immunity against the natural multi-epitope HER2/Neu-derived P5 peptide. Polyriboinosinic: polyribocytidylic acid [Poly (I:C)] is a strong immunoadjuvant able to enhance specific antitumor immunity induced by peptide-based vaccines. Nevertheless, delivering the peptide and adjuvant intracellularly into their target site remains a challenging issue. We hypothesized this barrier could be overcome through the use of a cationic nanoliposome carrier system which can carry and protect the antigen and adjuvant in the extracellular environment and augment the induction of antitumor immunity. P5 was encapsulated in cationic nanoliposomes composed of 1,2-dioleoyl-3-trimethylammonium propane (DOTAP)-Cholesterol either alone or complexed with Poly (I:C). Immunocompetent BALB/c mice were immunized with the formulations 3 times in two-week intervals and the efficiency and type of immune response were then evaluated both in vitro and in vivo. The groups immunized with Lip-P5+PIC (DOTAP-Cholestrol-P5+Poly (I:C)) and Lip+PIC (DOTAP-Cholestrol+Poly (I:C)) enhanced the release of Interferon (IFN)-γ in comparison with other groups. Flow cytometry analysis revealed that Lip-P5+PIC formulation induced the highest level of IFN-γ in CD8(+) lymphocytes. Lip-P5+PIC, Lip+PIC and Lip-P5 (DOTAP-Cholestrol-P5) provided some extent of protection in terms of tumor regression in TUBO tumor mice model during the first 65days post tumor challenge but at the end only the tumors of mice immunized with Lip-P5+PIC were significantly smaller than all other groups. Furthermore, tumors of mice receiving Lip-P5+PIC grew at a significantly slower rate throughout the observation period. Our results showed that the combination of Poly (I:C) and DOTAP with the tumor antigen and without applying additional T-helper epitope induced strong antitumor responses. The observations presented here are of great interest for future vaccine studies.

N-Acetylcysteine improves oocyte and embryo quality in polycystic ovary syndrome patients undergoing intracytoplasmic sperm injection: an alternative to metformin

Polycystic ovary syndrome (PCOS) is associated with low-quality oocytes. The aim of the present study was to investigate the effects of metformin (MET), N-acetylcysteine (NAC) and their combination on follicular fluid parameters, oocytes and embryo quality in PCOS patients. A prospective randomised placebo-controlled pilot study on 60 Iranian women with PCOS (aged 25–35 years) undergoing intracytoplasmic sperm injection (ICSI) was designed. Women were divided into four groups (n = 15 in each): (1) an MET, administered 1500 mg day–1 MET; (2) an NAC group, administered 1800 mg day–1 NAC; (3) an NAC + MET group; and (4) a placebo group. Drugs were administered from the 3rd day of previous cycle until the day of oocyte aspiration (6 weeks treatment in total). Data were analysed by one-way ANOVA, with significance set at P < 0.05. The number of immature and abnormal oocytes decreased significantly in the NAC compared with placebo group, with a concomitant increase in the number of good-quality embryos in the NAC group (P < 0.05). Malondialdehyde levels decreased significantly in the NAC and NAC + MET groups compared with the placebo-treated group (P < 0.02). In addition, there were significant decreases in leptin levels in the NAC, MET and NAC + MET groups compared with the placebo group (P < 0.001). Insulin and LH levels were significantly lower in the MET and NAC groups compared with the placebo-treated group (P < 0.02). We concluded that NAC improves oocyte and embryo quality and could be administered as an alternative to MET.

Sodium metabisulfite-induced changes on testes, spermatogenesis and epididymal morphometric values in adult rats

BACKGROUND

Sulphites are widely used as a preservative and antioxidant additives in the food and pharmaceutical industries. Many types of biological and toxicological effects of sulphites in multiple organs of mammals have been shown in previous studies.

OBJECTIVE

The aim of this study was to investigate the effects of sodium metabisulfite (SMB) on testicular function and morphometric values of epididymis in adult male Wistar rats.

MATERIALS AND METHODS

A total of 32 rats were randomly divided into four groups. The experimental groups received SMB at doses of 10 mg/kg (S10), 100mg/kg (S100), and 260 mg/kg (S260) while an equal volume of normal saline was administered to the control group via gavage. The rats were anaesthetized after 28 days and the left testis with the head of epididimis was excised following abdominal incision for histological observation using hematoxylin and eosin staining. Serum samples were collected for assay of testosterone level. The initial epididymis was analyzed for motility, morphology, and the number of sperms.

RESULT

The results of this study showed that normal morphology, count, and motility of sperms and testosterone level were decreased in the SMB treated groups. In comparison with the control group, SMB resulted in a lower total number of spermatogonia, primary spermatocyte, spermatids, and Leydig cells.

CONCLUSION

It is suggested that SMB decreases the sperm production and has the potential to affect the fertility adversely in male rats.

Co-Administration of Metformin and N-Acetyl Cysteine Fails to Improve Clinical Manifestations in PCOS Individual Undergoing ICSI

BACKGROUND

Studies have demonstrated the efficacy of metformin (MTF ) in reducing insulin resistance and N-acetyl cysteine (NAC) in inhibiting oxidative stress which are involved in the pathogenesis of polycystic ovarian syndrome (PCOS). We aimed to compare the effects of MTF and NAC combination on serum metabolite and hormonal levels during the course of ovulation induction in PCOS individual candidates of intracytoplasmic sperm injection (ICSI).

MATERIALS AND METHODS

In this prospective randomized clinical trial, placebo con- trolled pilot study, 80 patients of polycystic ovarian syndrome at the age of 25-35 years were divided into 4 groups (n=20): i. NAC=treated with N-acetyl cysteine (600 mg three times daily), ii. MTF=treated with metformin (500 mg three times daily), iii. MTF+NAC=treated with N-acetyl cysteine plus metformin (the offered doses) and iv. placebo (PLA). A total number of 20 patients (6 from MTF group, 4 from NAC group, 6 from MTF+NAC group and 4 from PLA group) were dropped of the study. The drugs were administrated from day 3 of menses of previous cycle until ovum pick-up.

RESULTS

Serum levels of luteinizing hormone (LH), total testosterone, cholester- ol and triglyceride, insulin and leptin significantly reduced in the MTF and NAC groups compared to the placebo (p<0.01). But levels of LH, total testosterone, cholesterol and triglyceride had no significant reduction in the MTF+NAC groups compared to the placebo. The serum levels of malonyldialdehyde (MDA), insulin and leptin reduced significantly after treatment in the MTF+NAC group compared to the placebo (p<0.05).

CONCLUSION

CONSIDERING THE ADVERSE EFFECT OF COMBINATION THERAPY, WE PROPOSED THE CONADMINISTRATION MIGHT HAVE NO BENEFICIAL EFFECT FOR PCOS PATIENT DURING COURSE OF OVULATION INDUCTION OF ICSI (REGISTRATION NUMBER: IRCT201204159476N1).

Frail elders' experiences with and perceptions of health

In this study we explored frail elders' experiences with and perceptions of the phenomenon of health so as to develop a deeper understanding of living with diseases and disorders in old age. Frail elders participated in qualitative interviews that explored the meaning of the phenomenon of health for them. Eleven men and 11 women, who had diverse ratings of self-perceived health ranging from poor to excellent, were selected by means of a purposeful strategic sampling of frail elders taken from a broader sample that participated in a larger quantitative study on health. In total, 22 individual interviews were analyzed using Giorgi's descriptive phenomenology. We found that frail elders described health as being in harmony and balance in everyday life, and this occurred when participants were able to adjust to the demands of their daily lives in the context of their resources and capabilities.