Αρχειοθήκη ιστολογίου

Αναζήτηση αυτού του ιστολογίου

Κυριακή 29 Οκτωβρίου 2017

Immediately restored full arch-fixed prosthesis on implants placed in both healed and fresh extraction sockets after computer-planned flapless guided surgery. A 3-year follow-up study

Abstract

Background

The treatment of patients by the use of immediate implant placement in post-extractive site is a challenging procedure.

Purpose

A 3-year clinical and radiological study of post-extractive implants placed using flapless guided surgery and immediately functioning.

Materials and Methods

Thirty-two patients (23 females and 9 males), aged between 44 and 73 years (a mean age of 59.5) were treated with immediate full arch restorations and flapless implant surgery in fresh extraction and healed sites. A double-guide technique stent in conjunction with the NobelGuide system (Nobel Biocare AB, Göteborg, Sweden) was used.

Results

A total of 285 implants over 32 patients were assessed. The patients were clinically and radiologically followed for 3 years. One hundred and ninety-five implants were placed in the maxilla and 90 in the mandible. Eight patients received implants in both arches. One hundred and ninety-seven implants were placed in extraction sites (137 maxilla, 60 mandible) and 88 in healed sites (58 maxilla and 30 mandible). The overall cumulative implant survival rate (CISR) was 97.54%. Two implants failed in maxillary healed sites (CISR 96.55%), three in maxillary extraction sites (CISR 97.81%), and two in mandibular extraction sites (CISR 96.66%). No implant failed in healed mandibular sites (CSR 100%). All fixed prostheses maintained stability and good functionality during the follow-up, accounting for a cumulative prosthesis survival rate (CPSR) of 100%. The overall marginal bone level (MBL) was −0.52 mm (SD −0.18) after 6 months, −0.88 mm (SD −0.20) after 12 months, −1.05 mm (SD −0.21) after 24 months, and −1.32 mm (SD −0.41) after 36 months.

Conclusions

Computer-guided surgery using double-template technique (DTT) shows a predictable outcome in the medium term, decreasing treatment timing and patient discomfort.



http://ift.tt/2xyagoS

People Who Value Virtue Show Wiser Reasoning

From romantic dramas to tensions at work, we're often better at working through other people's problems than our own—while we may approach our friends' problems with wise, clear-eyed objectivity, we often view our own problems through a personal, flawed, emotional lens.

But new research suggests that not everyone may struggle to reason wisely about their own personal problems. People who are motivated to develop the best in themselves and others don't show this bias—they tend to reason just as wisely about their own problems as they do for others.

The findings are published in Psychological Science, a journal of the Association for Psychological Science.

"Our findings suggest that people who value virtuous motives may be able to reason wisely for themselves, and overcome personal biases observed in previous research," explains psychological scientist Alex Huynh of the University of Waterloo. "This is in part due to their ability to recognize that their perspectives may not be enough to fully understand a situation, a concept referred to as intellectual humility."

Previous research has typically focused on how situations can affect a person's level of wise reasoning, but these findings suggest that personal motivations may also play a role.

"To our knowledge, this is the first research that empirically ties this conceptualization of virtue with wisdom, a connection that philosophers have been making for over two millennia," says Huynh. "These findings open up new avenues for future research to investigate how to increase a person's level of wisdom."

To explore the connection between personal ideals and reasoning, Huynh and University of Waterloo coauthors Harrison Oakes, Garrett R. Shay, and Ian McGregor recruited 267 university students to participate in this study.

The participants reported the extent to which they were motivated to pursue virtue by rating their agreement with statements like "I would like to contribute to others or the surrounding world" and "I would like to do what I believe in." Then, they were randomly assigned to think about either a personal conflict or a close friend's conflict, imagine that the conflict was still unresolved, and describe how they thought and felt about the situation. Finally, they rated how useful different wise reasoning strategies (e.g. searching for compromise, adopting an outsider's perspective) would be in addressing the conflict in question.

As expected, participants who thought about a friend's dilemma considered wiser strategies to be more useful than did the participants who thought about their own personal issues.

But the motivation to pursue virtue seemed to close this gap—participants who thought about personal problems rated wise-reasoning strategies as more valuable as their motivation to pursue virtue increased.

Further analyses revealed two specific components of wise reasoning that mattered most: considering other people's perspectives and intellectual humility. People who valued virtue may show wise reasoning because they recognize that understanding the full scope of their problem necessitates going beyond their personal perspective.

A second online study with 356 participants produced a similar pattern of results.

"Everyone is susceptible to becoming too invested in their own perspectives, but this doesn't have to be the case for everybody. As these findings suggest, your own personality and motivational orientation can influence your ability to approach your personal problems in a calmer, wiser manner," says Huynh.

Huynh and colleagues hope to test this relationship in additional experimental studies, examining whether training people to value virtuous motives—i.e., to focus on their personal ideals and contributing to others—boosts their ability to use wise reasoning strategies.

All data have been made publicly available and the design and analysis plan for Study 2 was preregistered via the Open Science Framework. The complete Open Practices Disclosure is available online. This article has received badges for Open Data and Preregistration.



http://ift.tt/2iL24iz

Brain signal intensity changes as biomarkers in amyotrophic lateral sclerosis

Objectives

To evaluate the contribution of the demographical, clinical, analytical and genetic factors to brain signal intensity changes in T2-weighted MR images in amyotrophic lateral sclerosis (ALS) patients and controls.

Methods

Susceptibility-weighted and FLAIR sequences were obtained in a 3T MR scanner. Iron-related hypointensities in the motor cortex (IRhMC) and hyperintensities of the corticospinal tract (HCT) were qualitatively scored. Age, gender, family history and clinical variables were recorded. Baseline levels of ferritin were measured. C9orf72 was tested in all patients and SOD1 only in familial ALS patients not carrying a C9orf72 expansion. Patients who carried a mutation were categorized as genetic. Associations of these variables with visual scores were assessed with multivariable analysis.

Results

A total of 102 ALS patients (92 non-genetic and 10 genetic) and 48 controls (28 ALS mimics and 20 healthy controls) were recruited. In controls, IRhMC associated with age, but HCT did not. In ALS patients, both HTC and IRhMC strongly associated with clinical UMN impairment and bulbar onset. The intensity/extent of IRhMC in the different motor homunculus regions (lower limbs, upper limbs and bulbar) were linked to the symptoms onset site. Between genetic and sporadic patients, no difference in IRhMC and HCT was found.

Conclusions

IRhMC and HCT are reliable markers of UMN degeneration in ALS patients and are more frequent in bulbar onset patients, independently of the mutation status. Age should be considered when evaluating IRhMC. The regional measurement of IRhMC following the motor homunculus could be used as a measure of disease progression.



http://ift.tt/2yW3lda

Combining olfactory test and motion analysis sensors in Parkinson's disease preclinical diagnosis: a pilot study

Objectives

Preclinical diagnosis of Parkinson's disease (PD) is nowadays a topic of interest as the neuropathological process could begin years before the appearance of motor symptoms. Several symptoms, among them hyposmia, could precede motor features in PD. In the preclinical phase of PD, a subclinical reduction in motor skills is highly likely. In this pilot study, we investigate a step-by-step method to achieve preclinical PD diagnosis.

Material and methods

We used the IOIT (Italian Olfactory Identification Test) to screen a population of healthy subjects. We identified 20 subjects with idiopathic hyposmia. Hyposmic subjects underwent an evaluation of motor skills, at baseline and after 1 year, using motion analysis sensors previously created by us.

Results

One subject showed significant worsening in motor measurements. In this subject, we further conducted a dopaminergic challenge test monitored with the same sensors and, finally, he underwent [123I]-FP/CIT (DaTscan) SPECT brain imaging. The results show that he is probably affected by preclinical PD.

Conclusions

Our pilot study suggests that the combined use of an olfactory test and motor sensors for motion analysis could be useful for a screening of healthy subjects to identify those at a high risk of developing PD.



http://ift.tt/2gUTRHR

The death of Ben Hall

Abstract

Ben Hall was a nineteenth-century Australian bushranger (outlaw) who was shot and killed by colonial police on May 5 1865. Popular belief is that Hall was shot while sleeping in his camp bedding. This contrasts with the official police version of Hall being shot while attempting to escape by running away. To evaluate this divergence of opinion a study of the gun belt allegedly worn by Hall at the time of his fatal shooting was undertaken. This revealed a nineteenth-century belt with a defect corresponding to an oblique bullet hole. The shelving was in keeping with the shooter being located to the rear and left of the decedent, in a position corresponding to police reports. Scanning electron microscopy (SEM) revealed the presence of lead, in addition to mercury, silver and sulfur, materials used as primers in nineteenth century ammunition. Thus, contemporary examination of the belt provides support for the police version of events.



http://ift.tt/2zYevM3

Screening of Natural Bioactive Metabolites and Investigation of Antioxidant, Antimicrobial, Antihyperglycemic, Neuropharmacological, and Cytotoxicity Potentials of Litsea polyantha Juss. Ethanolic Root Extract

This study was designed to identify some bioactive phytochemicals from ethanolic extract of roots of Litsea polyantha and to evaluate some of its pharmacological activities. Phytochemical tests indicated the presence of reducing sugar, combined reducing sugar, tannins, flavonoids, alkaloids, terpenoids, and phenol. In the antioxidant assay using 2-diphenyl-1-picryl-hydrazyl (DPPH) free radical scavenging method, the IC50 value was found to be 82.31 μg/mL. Total content of phenolic compounds, flavonoid, and tannin was found to be 152.69 mg GAE/gm, 85.60 mg QE/gm, and 77.22 mg GAE/gm of dry extract, respectively. In disc diffusion antibacterial assay, the extract exhibited highest zone of inhibition up to 12.25 mm against Escherichia coli at the concentration of 500 μg/disc. For brine shrimp lethality bioassay, the extract exhibited LC50 56.082 μg/mL. In in vivo antihyperglycemic activity test by oral glucose tolerance test using Swiss Albino mice at the oral dose of 250 and 500 mg/kg, the extract showed statistically significant antihyperglycemic effect. Finally, in vivo, the extract exhibited the dose dependent CNS depressant effects by reducing the locomotors of Swiss Albino mice which was confirmed through three different neuropharmacological activity tests such as open field, hole cross, and hole board test.

http://ift.tt/2gM7lCc

Chinese Herbal Medicine as an Adjunctive Therapy Ameliorated the Incidence of Chronic Hepatitis in Patients with Breast Cancer: A Nationwide Population-Based Cohort Study

We conducted a National Health Insurance Research Database-based Taiwanese nationwide population-based cohort study to evaluate whether Chinese herbal medicine (CHM) treatment decreased the incidence of chronic hepatitis in breast cancer patients receiving chemotherapy and/or radiotherapy. A total of 81171 patients were diagnosed with breast cancer within the defined study period. After randomly equal matching, data from 13856 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence and therapeutic potential of CHM in patients with breast cancer. The patients with breast cancer receiving CHM treatment exhibited a significantly decreased incidence rate of chronic hepatitis even across the stratification of age, CCI score, and treatments. The cumulative incidence of chronic hepatitis for a period of seven years after initial breast cancer diagnosis was also reduced in the patients receiving CHM treatment. The ten most commonly used single herbs and formulas were effective in protecting liver function in patients with breast cancer, where Hedyotis diffusa and Jia-Wei-Xiao-Yao-San were the most commonly used herbal agents. In conclusion, our study provided information that western medicine therapy combined with CHM as an adjuvant modality may have a significant impact on liver protection in patients with breast cancer.

http://ift.tt/2gKNcwh

Safety Assessment and Comparison of Sodium Selenite and Bioselenium Obtained from Yeast in Mice

Detailed safety assessment of sodium selenite and bioselenium (bio-Se) was conducted and the results were compared and discussed for the purpose of assessing safety of bio-Se for use in food applications. In this work, acute toxicity studies, micronucleus test, and sperm aberration study in mice, 30-day feeding test of mice, were conducted to evaluate the toxicity of bio-Se obtained from yeast with different fermentation time (transformative time: one month, three months, and six months), and the results were compared with that of inorganic Se (sodium selenite). LD50 of sodium selenite was calculated to be 21.17 mg/kg. LD50 of bio-Se obtained from yeast with different fermentation time was calculated to be 740.2 mg/kg, 915.3 mg/kg, and 1179.0 mg/kg, respectively. In the genotoxicity test, bio-Se did not show cytotoxicity and genotoxicity of mice while sodium selenite at all dose groups was significantly different from the negative group. In the 30-day subchronic oral toxicity study, sodium selenite may slow down the growth of the mice and lead to organic damage to some extent. Bio-Se had facilitated effect towards the body weight of the mice and had no significant effect on the shape and function of the important organs of the mice.

http://ift.tt/2gN0l80

The Roles of Thrombospondins in Hemorrhagic Stroke

Hemorrhagic stroke is a devastating cerebrovascular disease with significant morbidity and mortality worldwide. Thrombospondins (TSPs), as matricellular proteins, belong to the TSP family which is comprised of five members. All TSPs modulate a variety of cellular functions by binding to various receptors. Recently, TSPs gained attention in the area of hemorrhagic stroke, especially TSP-1. TSP-1 participates in angiogenesis, the inflammatory response, apoptosis, and fibrosis after hemorrhagic stroke through binding to various molecules including but not limited to CD36, CD47, and TGF-β. In this review, we will discuss the roles of TSPs in hemorrhagic stroke and focus primarily on TSP-1.

http://ift.tt/2ie69Ie

miRNAs: Important Targets for Oral Cancer Pain Research

Pain is a symptom shared by an incredible number of diseases. It is also one of the primary conditions that prompt individuals to seek medical treatment. Head and neck squamous cell carcinoma (HNSCC) corresponds to a heterogeneous disease that may arise from many distinct structures of a large, highly complex, and intricate region. HNSCC affects a great number of patients worldwide and is directly associated with chronic pain, which is especially prominent during the advanced stages of oral squamous cell carcinoma (OSCC), an anatomical and clinical subtype that corresponds to the great majority oral cancers. Although the cellular and molecular bases of oral cancer pain have not been fully established yet, the results of recent studies suggest that different epigenetic mechanisms may contribute to this process. For instance, there is strong scientific evidence that microRNAs (miRNAs), small RNA molecules that do not encode proteins, might act by regulating the mechanisms underlying cancer-related pain. Among the miRNAs that could possibly interfere in pain-signaling pathways, miR-125b, miR-181, and miR-339 emerge as some of the most promising candidates. In fact, such molecules apparently contribute to inflammatory pain. Moreover, these molecules possibly influence the activity of endogenous pain control systems (e.g., opioidergic and serotonergic systems), which could ultimately result in peripheral and central sensitization, central nervous system (CNS) phenomena innately associated with chronic pain. This review paper focuses on the current scientific knowledge regarding the involvement of miRNAs in cancer pain, with special attention dedicated to OSCC-related pain.

http://ift.tt/2ie8xhY

EMCrit Podcast 211 – Expertise with Anders Ericsson

SNAG-8-6-2017-3.36.03-PM-0004.png?resize

Expertise & Deliberate Practice with Anders Ericsson and @resuspadawan

EMCrit by Scott Weingart.



http://ift.tt/2ycX78Y

Use of Synaptic Zinc Histochemistry to Reveal Different Regions and Laminae in the Developing and Adult Brain

We describe a histochemical procedure that reveals characteristic laminar and areal zinc staining patterns in different brain regions. The zinc-staining pattern may be used in conjunction with other anatomical markers to reliably distinguish layers and regions in the developing and adult brain.

http://ift.tt/2gU1LBf

How Well Can Modern Nonhabitual Barefoot Youth Adapt to Barefoot and Minimalist Barefoot Technology Shoe Walking, in regard to Gait Symmetry

We aim to test how well modern nonhabitual barefoot people can adapt to barefoot and Minimalist Bare Foot Technology (MBFT) shoes, in regard to gait symmetry. 28 healthy university students (22 females/6 males) were recruited to walk on a 10-meter walkway randomly on barefoot, in MBFT shoes, and in neutral running shoes at their comfortable walking speed. Kinetic and kinematic data were collected using an 8-camera motion capture system. Data of joint angles, joint forces, and joint moments were extracted to compute a consecutive symmetry index. Compared to walking in neutral running shoes, walking barefoot led to worse symmetry of the following: ankle joint force in sagittal plane, knee joint moment in transverse plane, and ankle joint moment in frontal plane, while improving the symmetry of joint angle in sagittal plane at ankle joints and global (hip-knee-ankle) level. Walking in MBFT shoes had intermediate gait symmetry performance as compared to walking barefoot/walking in neutral running shoes. We conclude that modern nonhabitual barefoot adults will lose some gait symmetry in joint force/moment if they switch to barefoot walking without fitting in; MBFT shoe might be an ideal compromise for healthy youth as regards gait symmetry in walking.

http://ift.tt/2yW2V3I

NLRP1 Overexpression Is Correlated with the Tumorigenesis and Proliferation of Human Breast Tumor

Recent studies suggest that nucleotide-binding domain leucine-rich repeat protein 1 (NLRP1) is a pivotal factor in the inflammatory process. However, the role of NLRP1 in breast cancer pathogenesis remains unclear. The aim of this study was to examine the expression and function of NLRP1 in breast cancer. We found that NLRP1 was widely expressed in 83% (60/72) of primary breast cancer tissue. NLRP1 expression level was higher in primary breast cancer tissue than in adjacent noncancerous tissue () and NLRP1 expression was associated with lymph node metastasis (), TNM stage (), and Ki-67 levels (). Overexpression of NLRP1 in the breast cancer cell line MCF-7 promotes proliferation, migration, invasion, and tumorigenicity in nude mice. Restoration of NLRP1 expression resulted in the EMT occurrence that downregulation of epithelial marker E-cadherin and upregulation mesenchymal marker vimentin, C-myc, MMP-9, and snail. In summary, NLRP1 promotes cell line MCF-7 the proliferation, migration, and invasion through inducing EMT.

http://ift.tt/2z2hSDo

Protective Effects of Pyridoxamine Supplementation in the Early Stages of Diet-Induced Kidney Dysfunction

Pyridoxamine, a structural analog of vitamin B6 that exerts antiglycative effects, has been proposed as supplementary approach in patients with initial diabetic nephropathy. However, the molecular mechanism(s) underlying its protective role has been so far slightly examined. C57Bl/6J mice were fed with a standard diet (SD) or a diet enriched in fat and fructose (HD) for 12 weeks. After 3 weeks, two subgroups of SD and HD mice started pyridoxamine supplementation (150 mg/kg/day) in the drinking water. HD fed mice showed increased body weight and impaired glucose tolerance, whereas pyridoxamine administration significantly improved insulin sensitivity, but not body weight, and reduced diet-induced increase in serum creatinine and urine albumin. Kidney morphology of HD fed mice showed strong vacuolar degeneration and loss of tubule brush border, associated with a drastic increase in both advanced glycation end products (AGEs) and AGEs receptor (RAGE). These effects were significantly counteracted by pyridoxamine, with consequent reduction of the diet-induced overactivation of NF-kB and Rho/ROCK pathways. Overall, the present study demonstrates for the first time that the administration of the antiglycative compound pyridoxamine can reduce the early stages of diet-dependent kidney injury and dysfunction by interfering at many levels with the profibrotic signaling and inflammatory cascades.

http://ift.tt/2yUFTuj

Current Tissue Molecular Markers in Colorectal Cancer: A Literature Review

Background. Colorectal cancer (CRC) is one of the most spread neoplasia types all around the world, especially in western areas. It evolves from precancerous lesions and adenomatous polyps, through successive genetic and epigenetic mutations. Numerous risk factors intervene in its development and they are either environmental or genetic. Aim of the Review. Alongside common screening techniques, such as fecal screening tests, endoscopic evaluation, and CT-colonography, we have identified the most important and useful biomarkers and we have analyzed their role in the diagnosis, prevention, and prognosis of CRC. Conclusion. Biomarkers can become an important tool in the diagnostic and therapeutic process for CRC. But further studies are needed to identify a noninvasive, cost-effective, and highly sensible and specific screening test for their detection and to standardize their use in clinical practice.

http://ift.tt/2zZfwDt

Scorpion Venom Active Polypeptide May Be a New External Drug of Diabetic Ulcer

Background. The epidermal growth factor (EGF) is recognized medicine of therapy in ulcer. However, its efficacy has been challenged. We compared scorpion venom active polypeptide and EGF of therapeutic effects in diabetic ulcer. Methods. The scorpion venom active polypeptide is made into gel. Fourteen diabetic SD rats were randomly divided into scorpion peptide gel group (SPG group) and EGF group. Before treatment, the rat model of diabetic ulcer was created. The levels of IL-1, IL-6, IL-8, and TNF-α in the wound tissue were measured at different time points during the treatment, secretions of wound were collected for bacterial culture, and the wound healing was recorded. Results. Wound healing was faster in SPG group compared to EGF group (3 weeks versus 5 weeks, -test, ). The levels of IL-1, IL-6, IL-8, and TNF-α were not statistically different when the wounds were formed but showed significant differences from the 2nd to the 5th week between two groups. The infection rate was higher in the EGF group (42.86% versus 0, Chi-square test, ). Conclusions. Scorpion venom active polypeptide shortens wound healing with a stronger anti-inflammation and antibacterial effect and may be a new and effective topical drug for the treatment of diabetic ulcers.

http://ift.tt/2gThkcz

Systems Pharmacological Approach to the Effect of Bulsu-san Promoting Parturition

Bulsu-san (BSS) has been commonly used in oriental medicine for pregnant women in East Asia. The purpose of this research was to elucidate the effect of BSS on ease of parturition using a systems-level in silico analytic approach. Research results show that BSS is highly connected to the parturition related pathways, biological processes, and organs. There were numerous interactions between most compounds of BSS and multiple target genes, and this was confirmed using herb-compound-target network, target-pathway network, and gene ontology analysis. Furthermore, the mRNA expression of relevant target genes of BSS was elevated significantly in related organ tissues, such as those of the uterus, placenta, fetus, hypothalamus, and pituitary gland. This study used a network analytical approach to demonstrate that Bulsu-san (BSS) is closely related to the parturition related pathways, biological processes, and organs. It is meaningful that this systems-level network analysis result strengthens the basis of clinical applications of BSS on ease of parturition.

http://ift.tt/2yUoDYs

Reversal of Proximal Renal Tubular Dysfunction after Nucleotide Analogue Withdrawal in Chronic Hepatitis B

Aims. Proximal renal tubular dysfunction (PRTD) is an infrequent complication after nucleotide analogue therapy. We evaluated the outcomes of PRTD and nephrotoxicity after nucleotide analogue withdrawal in chronic hepatitis B (CHB). Methods. A longitudinal follow-up study was performed in patients with PRTD after nucleotide analogue discontinuation. Serum and urine were collected at baseline and every 3 months for one year. The fractional excretion of phosphate (PO4), uric acid (UA), and potassium and tubular maximal reabsorption rate of PO4 to glomerular filtration rate (TmPO4/GFR) were calculated. Renal losses were defined based on the criteria of substance losses. Subclinical PRTD and overt PRTD were diagnosed when 2 and ≥3 criteria were identified. Results. Eight subclinical and eight overt PRTD patients were enrolled. After nucleotide analogue withdrawal, there were overall improvements in GFR, serum PO4, and UA. Renal loss of PO4, UA, protein, and 2-microglobulin reduced over time. At one year, complete reversal of PRTD was seen in 13 patients (81.2%). Improvements in PRTD were seen in all but one patient. Conclusion. One year after nucleotide analogue withdrawal, PRTD was resolved in most patients. Changes in TmPO4/GFR, urinary protein, and 2-microglobulin indicate that urinary biomarkers may represent an early sign of PRTD recovery.

http://ift.tt/2yV2vuA

Invasive Nontyphoidal Salmonella Infection in a Patient with Early-Stage Chronic Lymphocytic Leukemia

We describe a case of a 72-year-old man with early-stage chronic lymphocytic leukemia (CLL) who presented with invasive nontyphoidal Salmonella (iNTS) infection, necrotizing pneumonia, and chronic infection of a hilar lymph node. Infection is a major cause of death in patients with CLL. Though few cases of iNTS infection associated with CLL have been described in the literature, to our knowledge this is the first reported case of iNTS-associated necrotizing pneumonia. Immunocompromised state in patients, even with early-stage CLL, likely predisposes them to invasive infection with intracellular organisms, such as Salmonella spp. In this case, successful treatment was achieved with prolonged course of intravenous followed by oral antibiotics without any surgical removal of infected focus.

http://ift.tt/2yZMENq

Glycolipid-peptide conjugate vaccines enhance CD8(+) T cell responses against human viral proteins.

Related Articles

Glycolipid-peptide conjugate vaccines enhance CD8(+) T cell responses against human viral proteins.

Sci Rep. 2017 Oct 27;7(1):14273

Authors: Speir M, Authier-Hall A, Brooks CR, Farrand KJ, Compton BJ, Anderson RJ, Heiser A, Osmond TL, Tang CW, Berzofsky JA, Terabe M, Painter GF, Hermans IF, Weinkove R

Abstract
An important goal of vaccination against viruses and virus-driven cancers is to elicit cytotoxic CD8(+) T cells specific for virus-derived peptides. CD8(+) T cell responses can be enhanced by engaging help from natural killer T (NKT) cells. We have produced synthetic vaccines that induce strong peptide-specific CD8(+) T cell responses in vivo by incorporating an NKT cell-activating glycolipid. Here we examine the effect of a glycolipid-peptide conjugate vaccine incorporating an NKT cell-activating glycolipid linked to an MHC class I-restricted peptide from a viral antigen in human peripheral blood mononuclear cells. The vaccine induces CD1d-dependent activation of human NKT cells following enzymatic cleavage, activates human dendritic cells in an NKT-cell dependent manner, and generates a pool of activated antigen-specific CD8(+) T cells with cytotoxic potential. Compared to unconjugated peptide, the vaccine upregulates expression of genes encoding interferon-γ, CD137 and granzyme B. A similar vaccine incorporating a peptide from the clinically-relevant human papilloma virus (HPV) 16 E7 oncoprotein induces cytotoxicity against peptide-expressing targets in vivo, and elicits a better antitumor response in a model of E7-expressing lung cancer than its unconjugated components. Glycolipid-peptide conjugate vaccines may prove useful for the prevention or treatment of viral infections and tumors that express viral antigens.

PMID: 29079845 [PubMed - in process]



http://ift.tt/2ybN4kN

γδ T Cells Are Required for the Induction of Sterile Immunity during Irradiated Sporozoite Vaccinations.

Related Articles

γδ T Cells Are Required for the Induction of Sterile Immunity during Irradiated Sporozoite Vaccinations.

J Immunol. 2017 Oct 27;:

Authors: Zaidi I, Diallo H, Conteh S, Robbins Y, Kolasny J, Orr-Gonzalez S, Carter D, Butler B, Lambert L, Brickley E, Morrison R, Sissoko M, Healy SA, Sim BKL, Doumbo OK, Hoffman SL, Duffy PE

Abstract
Whole-sporozoite vaccines confer sterilizing immunity to malaria-naive individuals by unknown mechanisms. In the first PfSPZ Vaccine trial ever in a malaria-endemic population, Vδ2 γδ T cells were significantly elevated and Vγ9/Vδ2 transcripts ranked as the most upregulated in vaccinees who were protected from Plasmodium falciparum infection. In a mouse model, absence of γδ T cells during vaccination impaired protective CD8 T cell responses and ablated sterile protection. γδ T cells were not required for circumsporozoite protein-specific Ab responses, and γδ T cell depletion before infectious challenge did not ablate protection. γδ T cells alone were insufficient to induce protection and required the presence of CD8α(+) dendritic cells. In the absence of γδ T cells, CD8α(+) dendritic cells did not accumulate in the livers of vaccinated mice. Altogether, our results show that γδ T cells were essential for the induction of sterile immunity during whole-organism vaccination.

PMID: 29079696 [PubMed - as supplied by publisher]



http://ift.tt/2hlZ1db

Immunization against full-length protein and peptides from the Lutzomyia longipalpis sand fly salivary component maxadilan protects against Leishmania major infection in a murine model.

Related Articles

Immunization against full-length protein and peptides from the Lutzomyia longipalpis sand fly salivary component maxadilan protects against Leishmania major infection in a murine model.

Vaccine. 2017 Oct 24;:

Authors: Wheat WH, Arthun EN, Spencer JS, Regan DP, Titus RG, Dow SW

Abstract
Leishmaniasis is an arthropod vectored disease causing considerable human morbidity and mortality. Vaccination remains the most realistic and practical means to interrupt the growing number and diversity of sand fly vectors and reservoirs of Leishmania. Since transmission of Leishmania is achieved exclusively by sand fly vectors via immune-modulating salivary substances, conventional vaccination requiring an unmodified host immune response for success are potentially destined to fail unless immunomodulatory factors are somehow neutralized. Using cationic liposome DNA complexes (CLDC) as an adjuvant system along with Lu. longipalpis sand fly salivary component maxadilan (MAX) as antigen (Ag), we show that mice are protected from the MAX-induced exacerbation of infection with Leishmania major (Lm). The CLDC adjuvant and alum were comparable in terms of lesion induration and decreased parasite burden, however the alum adjuvant imposed more inflammation at the injection site. BALB/c, C3H and C57BL/6 mice vaccinated with MAX-CLDC containing either the full-length MAX or peptides spanning the N- and C-terminal regions of MAX are protected against footpad challenges with Lm co-injected with MAX. When compared to unvaccinated controls, all strains of mice immunized with CLDC containing either peptides encompassing the first 20 N-terminal AA or those spanning the last 15 AA of the C-terminal domain of MAX demonstrated decreased parasite burden after 9 or 18 weeks post challenge with Lm + MAX. MAX-CLDC immunized mice showed increased IFNγ-secreting and decreased IL-4-secreting CD4(+) cells in footpad-draining lymph nodes. Antisera from C-terminal peptide (P11) MAX-CLDC-vaccinated animals was capable of recognizing FL-MAX and its C-terminal domain and also blocked MAX-mediated reprogramming of bone marrow-derived dendritic cells (BM-DC) in vitro. This peptide vaccine targeting sand fly MAX, improves host immunity against MAX-mediated immunomodulation.

PMID: 29079105 [PubMed - as supplied by publisher]



http://ift.tt/2yYV4EQ

Antimicrobial Activities and Time-Kill Kinetics of Extracts of Selected Ghanaian Mushrooms

The rapid rise of antimicrobial resistance is a worldwide problem. This has necessitated the need to search for new antimicrobial agents. Mushrooms are rich sources of potential antimicrobial agents. This study investigated the antimicrobial properties of methanol extracts of Trametes gibbosa, Trametes elegans, Schizophyllum commune, and Volvariella volvacea. Agar well diffusion, broth microdilution, and time-kill kinetic assays were used to determine the antimicrobial activity of the extracts against selected test organisms. Preliminary mycochemical screening revealed the presence of tannins, flavonoids, triterpenoids, anthraquinones, and alkaloids in the extracts. Methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea showed mean zone of growth inhibition of to , to , to , and to  mm, respectively. The minimum inhibitory concentration of methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea ranged from 4.0 to 20, 6.0 to 30.0, 8.0 to 10.0, and 6.0 to 20.0 mg/mL, respectively. Time-kill kinetics studies showed that the extracts possess bacteriostatic action. Methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea exhibited antimicrobial activity and may contain bioactive compounds which may serve as potential antibacterial and antifungal agents.

http://ift.tt/2iIDuim

The Effects of Thai Herbal Ha-Rak Formula on COX Isoform Expression in Human Umbilical Vein Endothelial Cells Induced by IL-1β

Objective. To investigate the modulated effects of HRF on cyclooxygenase isoform expression and its activity, using the human umbilical vein endothelial cell (HUVEC) model induced by interleukin-1 beta (IL-1β). Methods. Cells were treated with indomethacin (positive control), HRF, and its components at various concentrations prior to treatment with IL-1β at 24 h. Cell viability was determined by MTT assay. Moreover, the anti-inflammatory effects of HRF and its components through mRNA and protein expression were established using real-time quantitative PCR and Western blot, respectively. COX activity was identified via exogenous and endogenous PGE2 productions using the EIA. Result. There was no cytotoxicity in HUVECs treated with HRF. None of the experimental conditions used in the study affected the expression of COX-1, but COX-2 protein expression was inhibited at concentrations under 10 µg/mL. Despite the significantly increased levels of exogenous PGE2, HRF had no effect on COX-2 mRNA expression. However, the production of PGE2 was lower at a concentration of 100 µg/mL HRF than at a concentration below 10 µg/mL. Interestingly, each component of HRF revealed different effects of the Ha-Rak formula. Conclusion. Our preliminary findings suggest that HRF and its components provide diverse modulation of COX-2 and PGE2 at the in vitro level.

http://ift.tt/2zf9HEK

Complications of Trans Arterial Embolization During the Resuscitation of Pelvic Fractures

Publication date: Available online 28 October 2017
Source:Injury
Author(s): Boopalan Ramasamy, Dominic Thewlis, Mary J. Moss, Francois Fraysse, Mark Rickman, Lucian Bogdan Solomon
IntroductionTrans arterial embolization (TAE) can stem uncontrolled bleeding associated with pelvic fractures, but is associated with potential complications. This study investigated and compared the early to midterm complications in two patient cohorts: one who did and one who did not undergo TAE.MethodologyThe results of 14 patients who underwent TAE in the resuscitation phase, and then had their pelvic fractures managed non-operatively, the study group (Group 1), were compared with those of a control group (Group 2) of 14 patients matched for age, sex, injury and management, that did not undergo TAE. All patients were examined clinically and answered a questionnaire on bowel and urinary function, pain and limp. Gluteus medius structure and volume were assessed on MRI. The hip girdle muscle function was assessed using a hand held dynamometer, surface electromyography as well as quantitative gait analysis.ResultsSeven patients in Group 1 (50%), but none in Group 2, had persistent urological dysfunctions, in the absence of any recognized previous pathology or urologic trauma at the time of injury. No gluteal muscle demonstrated fibrosis or fatty infiltration. The median gluteal muscle volume was not significantly decreased compared with the uninjured side in either group (P=0.421). The muscle strengths of gluteus maximus, gluteus medius, tensor fasciae latae and iliopsoas when compared to the uninjured side were significantly less in Group 1 compared to Group 2. However, no patient had a discernable limp and gait analysis showed no significant differences between the left and right sides in the study and control groups in the gluteal activation timing (p=0.171 and 0.354) and duration (p=0.622 and 0.435). There were no skin complications, and no patient reported any persistent bowel dysfunction.ConclusionTAE was associated with a high rate of persistent urological dysfunction. TAE could lead to decreased hip muscles strength, however this does not seem to affect gait.



http://ift.tt/2iKjCex

What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial species of the previous patient. Biofilm formation, even on dry surfaces, may play a role in reducing the efficacy of terminal cleaning procedures since it enables bacteria to survive in the environment for a long period and provides increased resistance to commonly used disinfectants. No-touch methods (e.g., UV-light, hydrogen peroxide vapour) are under investigation and further studies with patient-centred outcomes are needed, before considering them the standard of terminal cleaning in ICUs. Healthcare workers should be aware of the role of environmental contamination in the ICU and consider it in the broader perspective of infection control measures and stewardship initiatives.

http://ift.tt/2yTCuhP

Effect of Sheng-Jiang Powder on Obesity-Induced Multiple Organ Injuries in Rats

Background and Aims. Obesity has become the main public health issue nowadays with poor control and has been associated with increased risk of multiorgan disease, but the specific mechanism and effective medication are still to be addressed. Sheng-jiang powder (SJP) showed great potential in preventing obesity in Chinese researches but has no trace in English reports. This study was designed to investigate the effect of SJP on obesity and obesity-mediated multiorgan injuries. Methods. Rats were randomized into normal group (NG), obese group (OG), and SJP treatment group (SG). Obesity was induced by high-fat diet feeding. Rats were gavaged with SJP/normal saline daily from the third week and all rats were sacrificed after 12 weeks' feeding. Tissues were obtained for cytokines tests. Results. Firstly, high-fat diet feeding led to significant obesity. Compared to NG, the level of SOD in the liver, spleen, lung, and kidney was much lower in OG (), while the pathological scores of pancreas, liver, spleen, lung, and kidney were much higher. SJP significantly increased SOD level in the liver, spleen, and lung and reduced the pathological scores of pancreas, liver, spleen, lung, and kidney correspondingly (). Conclusions. SJP ameliorates inflammatory response and mitigates obesity-induced multiple organ injuries.

http://ift.tt/2hjkraM

Feasibility of Round Window Stimulation by a Novel Electromagnetic Microactuator

Introduction. Most implantable hearing aids currently available were developed to compensate the sensorineural hearing loss by driving middle ear structures (e.g., the ossicles). These devices are successfully used in round window (RW) stimulation clinically, although this was initially not the intended use. Here, a novel microactuator, specifically designed for RW stimulation, was tested in human temporal bones to determine actuator performance and applicability. Methods. Stapes footplate response to RW stimulation was determined experimentally in human temporal bones and the obtained sound pressure output level was estimated. Results. The actuator had a flat displacement response between 0.125 and 4 kHz, a resonance between 4 and 7 kHz, and a roll-off above. At increasing contact force, the stapes footplate displacement decreased by 5–10 dB re μm for forces ≥ 2 mN. The equivalent sound pressure level between 0.125 and 4 kHz amounted to 87–97 eq dB SPL and increased to 117 eq dB SPL for frequencies of 4–7 kHz. The total harmonic distortion (THD) of the actuator ranged within 15–40% for static forces of 5 mN. Conclusion. The feasibility of an electromagnetic actuator that may be placed into the RW niche was demonstrated but requires further optimization in terms of THD and static force sensitivity.

http://ift.tt/2zP3R9l

Fabrication and In Vitro Study of Tissue-Engineered Cartilage Scaffold Derived from Wharton’s Jelly Extracellular Matrix

The scaffold is a key element in cartilage tissue engineering. The components of Wharton's jelly are similar to those of articular cartilage and it also contains some chondrogenic growth factors, such as insulin-like growth factor I and transforming growth factor-β. We fabricated a tissue-engineered cartilage scaffold derived from Wharton's jelly extracellular matrix (WJECM) and compared it with a scaffold derived from articular cartilage ECM (ACECM) using freeze-drying. The results demonstrated that both WJECM and ACECM scaffolds possessed favorable pore sizes and porosities; moreover, they showed good water uptake ratios and compressive moduli. Histological staining confirmed that the WJECM and ACECM scaffolds contained similar ECM. Moreover, both scaffolds showed good cellular adherence, bioactivity, and biocompatibility. MTT and DNA content assessments confirmed that the ACECM scaffold tended to be more beneficial for improving cell proliferation than the WJECM scaffold. However, RT-qPCR results demonstrated that the WJECM scaffold was more favorable to enhance cellular chondrogenesis than the ACECM scaffold, showing more collagen II and aggrecan mRNA expression. These results were confirmed indirectly by glycosaminoglycan and collagen content assessments and partially confirmed by histology and immunofluorescent staining. In conclusion, these results suggest that a WJECM scaffold may be favorable for future cartilage tissue engineering.

http://ift.tt/2gLmbJ9

Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study

imageObjective: Acute mesenteric ischemia (AMI) is a life-threatening condition requiring time-dependent treatment; thus, early recognition may improve outcomes. We hypothesized that clinician-performed mesenteric vessels duplex ultrasound (DUS) could facilitate early identification of patients with AMI in high-risk patients presenting with abdominal pain. Methods: This was a single-operator, observational, prospective cohort study. Patients aged at least 65 presenting to Emergency Departments with acute abdominal pain and no clear diagnosis after an initial work-up were enrolled. All patients underwent multidetector computed tomography and these findings provided the reference standard in this study. DUS of the celiac artery and superior mesenteric artery (SMA) were obtained to measure the peak systolic velocity (PSV) and were performed within 24 h of admission. PSVs outside the normal range were considered to indicate AMI. Results: Of 49 patients identified, 47 were consented to enrollment and diagnostic images were obtained in 45 (96%). Fifteen patients (33%) had AMI (six occlusive, nine nonocclusive disease). Among these, 12 (80%) had abnormal DUS velocities. SMA PSV showed a sensitivity of 78.57% [95% confidence interval (CI): 49.2–95.34], a specificity of 64.52% (95% CI: 45.37–80.77), a positive predictive value of 50% (95% CI: 28.22–71.78), and a negative predictive value of 86.96% (95% CI: 66.41–97.22) for AMI. DUS had a sensitivity of 100%, a specificity of 64%, and a negative predictive value of 100% for occlusive AMI. Assessment of celiac artery PSV did not improve diagnostic performance. Conclusion: In this single-operator pilot study, mesenteric vessel DUS was performed successfully in the Emergency Department, with a high proportion of diagnostic images obtained. A normal SMA PSV was associated with a low risk of occlusive AMI.

http://ift.tt/2gWgH1P

Mortality in Spanish pediatric emergency departments: a 5-year multicenter survey

imageBackground: Analysis of the causes of death in children in the pediatric emergency department (ED) may aid the development of management and prevention practices. Objective: To identify the causes of death in Spanish pediatric EDs and to analyze the management of these children in the prehospital and hospital settings. Methods: This was a retrospective descriptive multicenter survey including all patients whose death was certified in 18 Spanish pediatric EDs between 2008 and 2013. Results: During the study period, 3 542 426 episodes were registered in the EDs. Of these, 54 patients died (mortality rate: 1.5/100 000 visits). Data of 53 patients are analyzed (male 36, 67%, 31 younger than 2 years old and 43.3% nonpreviously healthy children). The main causes of death were related to their previous illnesses (24.5%), sudden infant death syndrome (20.7%), and traumatism (18.8%). Prehospital cardiopulmonary resuscitation (CPR) was performed in 31 patients, and exclusively by health workers in 19 patients. In 35 patients, the parents witnessed the event and seven began CPR. Thirty children were transferred to the pediatric EDs by medical transport (56.6%) and all of them received prehospital CPR (vs. one patient out of 23 arrived in a nonmedical transportation). In 37 patients, CPR was performed in the pediatric EDs. Overall, CPR lasted 40±23 min (range, 10–120 min). CPR was not performed in seven patients at any time. Conclusion: The main causes of death in Spanish pediatric EDs are related to previous illnesses, sudden infant death syndrome, and nonintentional lesions. Several actions have to be considered to improve the quality of care of these children in prehospital and emergency settings.

http://ift.tt/2gR2DXp

Strengths and weaknesses in team communication processes in a UK emergency department setting: findings using the Communication Assessment Tool-Team

imageIntroduction: Identifying weaknesses in emergency department (ED) communication may highlight areas where quality improvement may be beneficial. This study explores whether the Communication Assessment Tool-Team (CAT-T) survey can identify communication strengths and weaknesses in a UK setting. Objectives: This study aimed to determine the frequency of patient responses for each item on the CAT-T survey and to compare the proportion of responses according to patient and operational characteristics. Methods: Adults presenting to the minors area of a semi-urban ED between April and May 2015 were included. Those lacking capacity or in custody were excluded. Multivariate analysis identified associations between responses and demographic/operational characteristics. Results: A total of 407/526 eligible patients responded (77.3%). Respondents were mostly White British (93.9%), with a median age of 45 years. Most responses were obtained during daytime hours (84.2% between 08 : 00 and 18 : 00). The median reported times to triage, assessment and disposition were 15, 35 and 90 min, respectively. Items most frequently rated as 'very good'/'excellent' (strengths) were 'ambulance staff treated me with respect' (86.7%), ED staff 'let me talk without interruptions' (85%) and 'paid attention to me' (83.7%). Items most frequently rated as 'poor'/'fair' (weaknesses) were 'encouraged me to ask questions', 'reception treated me with respect' (10.4%) and 'staff showed an interest in my health' (6.8%). Arrival time, analgesia at triage and time to assessment were associated with significantly increased odds of positive perception of team communication for a range of items. Conclusion: The CAT-T survey may be used within a UK setting to identify discrete strengths and weaknesses in ED team communication.

http://ift.tt/2gT10Zb

Prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest: a retrospective study in Tyrol, Austria

imageAim: The aim of this study is to describe the prehospital management and outcome of avalanche patients with out-of-hospital cardiac arrest in Tyrol, Austria, for the first time since the introduction of international guidelines in 1996. Patients and methods: This study involved a retrospective analysis of all avalanche accidents involving out-of-hospital cardiac arrest between 1996 and 2009 in Tyrol, Austria. Results: A total of 170 completely buried avalanche patients were included. Twenty-eight victims were declared dead at the scene. Of 34 patients with short burial, cardiopulmonary resuscitation (CPR) was performed in 27 (79%); 15 of these patients (56%) were transported to hospital with ongoing CPR and four patients were rewarmed with extracorporeal circulation; no patient survived. Of 108 patients with long burial, 49 patients had patent or unknown airway status; CPR was performed in 25 of these patients (51%) and 14 patients (29%) were transported to hospital. Four patients were rewarmed, but only one patient with witnessed cardiac arrest survived. Since the introduction of guidelines in 1996, there has been a marginally significant increase in the rate of documenting airway assessment, but no change in documenting the duration of burial or CPR. Conclusion: CPR is continued to hospital admission in patients with short burial and asphyxial cardiac arrest, but withheld or terminated at the scene in patients with long burial and possible hypothermic cardiac arrest. Insufficient transfer of information from the accident site to the hospital may partially explain the poor outcome of avalanche victims with out-of-hospital cardiac arrest treated with emergency cardiac care.

http://ift.tt/2gSyJSO

Does it matter who places the intravenous? An inter-professional comparison of prehospital intravenous access difficulties between physicians and paramedics

imageObjectives: Depending on the specific national emergency medical systems, venous cannulations may be performed by physicians, paramedics or both alike. Difficulties in the establishment of vascular access can lead to delayed treatment and transport. Our study investigates possible inter-professional differences in the difficulties of prehospital venous cannulation. Methods: Paramedics were interviewed for their personal attitudes towards and experiences in venous access. We analysed 47 candidate predictor variables in terms of cannulation failure and exceedance of a 2 min time threshold. Multivariable logistic regression models were fitted for variables of potential predictive value (P0.60) of their respective receiver operating characteristic curve. Results were compared with previously published data from emergency physicians. Results: A total of 552 cannulations were included in our study. All 146 participants voted that paramedics should be eligible to perform venous catheterizations. Despite ample experience in the task, almost half of them considered prehospital venous cannulations more difficult than those performed in hospital. However, the multivariable logistic regression found only patient-related and puncture site factors to be predictive of cannulation failure (patient age, vein palpability with tourniquet, insufficient ambient lighting: model AUC: 0.72) or cannulation delay (vein palpability with tourniquet: model AUC: 0.60). Conclusion: Our study shows that venous cannulation is well established among paramedics. It presents itself with similar difficulties across medical professions. Not the numerous specific circumstances of prehospital emergency care, but universal factors inherent to the task will influence the success at venous catheterization.

http://ift.tt/2gT0NFn

Intermediate-term and long-term mortality among acute medical patients hospitalized with community-acquired sepsis: a population-based study

imageObjective: Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit. Patients and methods: This was a population-based study of all adults admitted to an acute medical admission unit, Odense University Hospital, Denmark, from September 2010 to August 2011, identified by symptoms and clinical findings. We categorized the mortality periods into intermediate-term (31–180 days) and long-term (181–365, 366–730, and 731–1096 days). Mortality hazard ratios (HRs), comparing patients admitted with sepsis with those of a well-defined background population, were estimated using multivariable Cox regression. HRs were presented with 95% confidence intervals. Results: In total, 621 (36.3%) presented with sepsis, 1071 (62.5%) presented with severe sepsis, and 21 (1.2%) presented with septic shock. Thirty-day all-cause mortality for patients with sepsis, severe sepsis, and septic shock was 6.1, 18.8, and 38.1%, respectively. The adjusted HR among patients with sepsis of any severity within the time periods 31–180, 181–365, 366–720, and 721–1096 days was 7.1 (6.0–8.5), 2.8 (2.3–3.5), 2.1 (1.8–2.6), and 2.2 (1.7–2.9), respectively. Long-term mortality was unrelated to sepsis severity [721–1096 days: sepsis HR: 2.2 (1.5–3.2), severe sepsis HR: 2.1 (1.5–3.0)]. Conclusion: Patients admitted with community-acquired sepsis showed high intermediate-term mortality, increasing with sepsis severity. Long-term mortality was increased two-fold compared with sepsis-free individuals, but might be explained by unmeasured confounding. Further, long-term mortality was unrelated to sepsis severity.

http://ift.tt/2gT0Ktb

Implementing an electronic observation and early warning score chart in the emergency department: a feasibility study

imageBackground: Use of automated systems to aid identification of patient deterioration in routine hospital practice is limited and their impact on patient outcomes remains unclear. This study was designed to evaluate the feasibility of implementing an electronic observation chart with automated early warning score (EWS) calculation in the high-acuity area of an emergency department. Methods: This study enrolled 3219 participants before and 3352 after implementation of an automated system, using bedside vital-sign entry on networked mobile devices. The primary outcome measure was the percentage of participants for whom an EWS was accurately recorded at each stage. Results: Of the participants, 52.7% before and 92.9% after implementation of the electronic system had an accurate EWS recorded on charts available to the study team. Participant groups were well balanced for baseline characteristics and acuity. Conclusion: In this study, the feasibility and limitations of implementing an electronic observation chart in the ED were demonstrated. Accurate EWS documentation was more frequent after implementation of the electronic observation chart. Retrospective analysis suggests that the use of an electronic observation system may lead to a greater percentage of observations being taken from those patients with a higher EWS.

http://ift.tt/2gT0IS5

Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients

imageObjective: To evaluate the effect of routine use of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) on the diagnosis rate of delirium in elderly Emergency Department (ED) patients and the validity of the CAM-ICU in the ED setting. Methods: This was a prospective observational study in a tertiary care academic ED. We compared the diagnosis rate of delirium before implementation of the CAM-ICU, without routine use of a screening tool, with the diagnosis rate after implementation of the CAM-ICU. All consecutive patients aged 70 years or older were enrolled. The diagnosis rate before implementation was based on chart review and after implementation on a positive CAM-ICU score. In a subsample, the presence of delirium was evaluated independently according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) criteria to assess the validity of the CAM-ICU. Results: The total study population included 968 patients: 490 before and 478 after implementation of the CAM-ICU. The two groups were not significantly different in patient characteristics. Before implementation of the CAM-ICU, delirium was diagnosed in 14 patients (3%) and after implementation in 48 patients (10%) (P

http://ift.tt/2gT0I4x

What will emergency care look like 10 years from now?

No abstract available

http://ift.tt/2yTYTvi

The Abbreviated Mental Test 4 for cognitive screening of older adults presenting to the Emergency Department

imageObjectives: A commonly cited reason for the infrequent detection of cognitive impairment in the Emergency Department (ED) is the lack of an appropriate screening tool. The Abbreviated Mental Test 4 (AMT4) is a brief instrument recommended for cognitive screening of older adults in the ED. However, its exact utility in the detection of altered mental status in the ED is yet to be fully determined. Methods: The present study evaluated the ability of the AMT4 to identify impaired mental status in the ED, defined as positive scores on either the Confusion Assessment Method-ICU for delirium, the standardized Mini Mental State Examination as a general cognitive screener or the Eight-item Interview to Differentiate Aging and Dementia for dementia. Results: Of 196 adults at least 70 years of age (mean: 78.5±5.9), the AMT4 had a sensitivity of 0.53 (0.42–0.63) and a specificity of 0.96 (0.89–0.99) for impaired mental status in the ED. The AMT4 was positive in almost all patients (92%; 24/26) screening positive for delirium, but less than half (47.8%; 22/46) of those screening positive for probable dementia, and less than a quarter (22.2%; 6/27) of those screening positive for probable cognitive impairment. Conclusion: The present study found that the limited sensitivity of the AMT4 in identifying the majority of cognitively impaired persons restricts its use in isolation as a general cognitive screener in the ED.

http://ift.tt/2yTm1dt

Intranasal fentanyl for the prehospital management of acute pain in children

imageIntroduction: Acute pain is the most common symptom in the emergency setting and its optimal management continues to challenge prehospital emergency care practitioners, particularly in the paediatric population. Difficulty in establishing vascular access and fear of opiate administration to small children are recognized reasons for oligoanalgesia. Intranasal fentanyl (INF) has been shown to be as safe and effective as intravenous morphine in the treatment of severe pain in children in the Emergency Department setting. Aim: This study aimed to describe the clinical efficacy and safety of INF when administered by advanced paramedics in the prehospital treatment of acute severe pain in children. Methods: A 1-year prospective cross-sectional study was carried out of children (>1 year,

http://ift.tt/2yWis6i

How do patients with chest pain access Emergency Department care?

imageBackground: It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). Objective: This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Methods: Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Results: Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). Conclusion: In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.

http://ift.tt/2yUhszj

Adolescent tracheal intubation in an adult urban emergency department: a retrospective, observational study

imageObjectives: Tracheal intubation is the cornerstone of advanced emergency airway management in children and adults and there is good-quality data characterizing intubation in both groups. There are, however, few published studies on emergency tracheal intubation in adolescents. We carried out an observational study to characterize tracheal intubation in adolescents. Methods: We analysed data from a previously collected Emergency Department Intubation Registry. We included all attempts at tracheal intubation performed in our adult emergency department between 1999 and 2011. We recorded the indication for intubation, the staff involved, the technique and drugs used, and the rates of successful intubation and adverse events. We classified patients into three age groups: 13–16 years (adolescent), 17–24 years (young adult) and at least 25 years (older adult). Results: Trauma was the most common indication for intubation in adolescents, and rapid sequence induction was used in 88% of cases. Ninety-nine percent of tracheal intubations in adolescent patients were successful on the first or the second attempt, no adolescent underwent more than three attempts and none required a surgical airway. The initial intubation attempt in adolescents was more likely to be performed by an anaesthetist (P

http://ift.tt/2yUmZ9o

Prognosis of patients with syncope seen in the emergency room department: an evaluation of four different risk scores recommended by the European Society of Cardiology guidelines

imageAim: To apply, analyze, and evaluate the four syncope risk scores recommended by the 2009 European guidelines and the different parameters that they use to predict death, syncope recurrence, and hospital readmission in the population seen in the emergency room department (ERD) for syncope. Methods and results: A total of 323 patients aged older than 14 years [mean age 59 (32–75) years] and seen in ERD for syncope over a 2-month period were included in the study; 50.7% were women. Patients were evaluated using the four risk scores and were followed up for at least 2 years. In all, 275 patients (85.2%) were discharged directly from ERD after evaluation. During 28±5 months of follow-up, 8% died, 18.3% presented a further syncopal episode, and 18.6% were readmitted to hospital. Only two of the four risk scores were useful in risk discrimination, but no statistically significant differences were detected between predicted risk and observed risk. Multivariate analysis indicated relationships between age and death, a history of cardiovascular disease and syncope recurrence, and between presyncopal palpitations and hospital readmission. Conclusion: Although a large number of events occur after syncope, the risk scores recommended by guidelines overestimate risk, but there were no statistically significant differences between observed and predicted risk.

http://ift.tt/2ySZNbo

Contamination of urinary cultures in initial-stream versus later-stream urine in children undergoing bladder catheterization for the diagnosis of urinary tract infection

imageBackground: Urine cultures obtained by bladder catheterization can be contaminated by bacteria colonizing the distal urethra. Data are inconclusive regarding the potential advantage of discarding the first few urine drops obtained by bladder catheterization and testing only the sample of late-stream urine, thus reducing the likelihood of urine culture contamination. Aim: The aim of this study was to evaluate whether the incidence of contaminated urine cultures obtained by bladder catheterization can be reduced by splitting urine samples into 'initial' and 'late' samples and using only 'late' samples for culture. Methods: Urine samples obtained by bladder catheterization from children younger than 2 years being evaluated for urinary tract infection were prospectively collected. Quantitative culture results were compared between initial-stream and late-stream urine samples. Results: A total of 199 urine culture pairs of initial and late samples were compared. When using a cutoff value of at least 10 000 colony forming units/ml, late samples were superior to the initial ones in reducing contamination of urine cultures (P=0.029). Conclusion: When obtaining urine cultures by bladder catheterization in children younger than 2 years, discarding the first few urine drops and using only the late stream for culture reduces false-positive culture results and improves the accuracy of urinary tract infection diagnosis.

http://ift.tt/2yUhs2h

Characteristics and outcome of patients presenting to the emergency department after autologous/allogeneic stem cell transplantation

imageIntroduction: Hematopoietic stem cell transplantations are still associated with a high risk of complications. Here, we characterize patients after autologous or allogeneic transplantation presenting to the emergency department and investigate factors associated with patients' outcome after hospitalization. Methods: Patients who had previously undergone autologous or allogeneic stem cell transplantation were included in this study and data were collected retrospectively. We analyzed patients' characteristics and outcome, and identified factors associated with outcome. Results: A total of 35% of presenting autologous and 52% of allogeneic patients were hospitalized for more than 7 days. In-hospital mortality was 4% (autologous) and 11% (allogeneic patients). In patients with a history of autologous transplantation, multivariate analysis indicated radiologic signs of pneumonia as an independent factor associated with the endpoint 'hospitalization of more than 7 days' (P

http://ift.tt/2yTYQQ8

Top Ten Abstracts of the Tenth European Congress on Emergency Medicine, Vienna, October 2016.

No abstract available

http://ift.tt/2gUhnF9