One of the most common orthopedic problems is the incidence of pressure ulcer followed by immobility. This study aimed to investigate the effect of Aloe Vera gel on the prevention of pressure ulcer in patients ho...
https://ift.tt/2RaZLBW
Σάββατο 29 Σεπτεμβρίου 2018
The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: a randomized triple-blind clinical trial
Rush progression and fatal result of septic shock related to central line catheter infection in cirrhosis patient with brain stroke
Catheter-related blood stream infection (CRBSI) is one of the most common intractable healthcare-associated infections because catheters can be easily contaminated by resistant bacteria, and is associated with...
https://ift.tt/2xODLF4
Cases of visual impairment caused by cerebral venous sinus occlusion-induced intracranial hypertension in the absence of headache
Cerebral venous sinus thrombosis or stenosis (here collectively referred to as cerebral venous sinus occlusion, CVSO) can cause chronically-elevated intracranial pressure (ICP). Patients may have no neurologic...
https://ift.tt/2DGs1d5
Visual outcome is similar in optic neuritis patients treated with oral and i.v. high-dose methylprednisolone: a retrospective study on 56 patients
To investigate visual recovery after treatment of acute optic neuritis (ON) with either oral or intravenous high-dose methylprednisolone, in order to establish the best route of administration.
https://ift.tt/2xQWv6N
Phenotypic analysis of antibiotic resistance and genotypic study of the vacA, cagA, iceA, oipA and babA genotypes of the Helicobacter pylori strains isolated from raw milk
Foods with animal origins and particularly milk play a considerable role in transmission of Helicobacter pylori. The current study was performed to assess phenotypic characters of antibiotic resistance and genoty...
https://ift.tt/2NbzLDk
Send more data: a systematic review of mathematical models of antimicrobial resistance
Antimicrobial resistance is a global health problem that demands all possible means to control it. Mathematical modelling is a valuable tool for understanding the mechanisms of AMR development and spread, and ...
https://ift.tt/2zFB222
Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study
Infections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathog...
https://ift.tt/2zFAWHI
ABCC4 Variants Modify Susceptibility to Kawasaki Disease in a Southern Chinese Population
A previous family-based linkage study revealed that Kawasaki disease (KD) was associated with variations of the ATP-binding cassette subfamily C member 4 (ABCC4) gene in most European populations. However, significant differences exist among ethnic populations in European and Chinese subjects; therefore, whether ABCC4 variants indicate susceptibility to KD in Chinese children is unclear. The purpose of this research was to evaluate correlations between ABCC4 gene polymorphisms and susceptibility to KD in a Southern Chinese population. We genotyped six polymorphisms (rs7986087, rs868853, rs3765534, rs1751034, rs3742106, and rs9561778) in 775 KD patients and 774 healthy controls. Ninety-five percent confidence intervals (95% CIs) and odds ratios (ORs) were used to assess the strength of each association. We found that the rs7986087 T variant genotype was associated with significantly higher susceptibility to KD (adjusted OR = 1.30, 95% CI = 1.05–1.60 for rs7986087 CT/TT). However, the rs868853 T variant genotype was associated with significantly lower susceptibility to KD (adjusted OR = 0.74, 95% CI = 0.59–0.92 for rs868853 CT/CC). Compared with the patients with 0–4 ABCC4 risk genotypes, the patients with 5-6 ABCC4 risk genotypes had a significantly increased risk of KD (adjusted OR = 1.63, 95% CI = 1.07–2.47), and this risk was more significant in the subgroups of females, subjects aged 12–60 months, and individuals with coronary artery lesions. These results indicate that specific single-nucleotide polymorphisms in the ABCC4 gene may increase susceptibility to KD in a Southern Chinese population.
https://ift.tt/2Qiftdf
Validation of blood culture gram staining for the detection of Staphylococcus aureus by the ‘oozing sign’ surrounding clustered gram-positive cocci: a prospective observational study
Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The obje...
https://ift.tt/2NbQs1k
High prevalence and clonal dissemination of OXA-72-producing Acinetobacter baumannii in a Chinese hospital: a cross sectional study
Carbapenem resistance in Acinetobacter baumannii in China was mainly mediated by OXA-23-like carbapenemases, while OXA-24/40-like carbapenemases were rarely identified. OXA-72 is one variant of OXA-24/40-like car...
https://ift.tt/2xKPu7y
Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan
To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan.
https://ift.tt/2NaRfzF
Impact of alcohol consumption on tuberculosis treatment outcomes: a prospective longitudinal cohort study protocol
An estimated 10% of tuberculosis (TB) deaths are attributable to problematic alcohol use globally, however the causal pathways through which problem alcohol use has an impact on TB treatment outcome is not cle...
https://ift.tt/2xPAPb4
Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China
To evaluate the susceptibility rates of aerobic and facultative Gram-negative bacterial isolates from Chinese intra-abdominal infections (IAI) and urinary tract infections (UTI) focusing on carbapenems and com...
https://ift.tt/2Nc1tjd
Author’s Response
The intriguing questions raised by Campbell deserve several comments:.
https://ift.tt/2DHTbAb
Fidelity and feasibility of a brief emergency department intervention to empower adults with serious illness to initiate advance care planning conversations
Emergency Department (ED) visits provide opportunities to empower patients to discuss advance care planning (ACP) with their outpatient clinicians, but systematically developed, feasible interventions do not currently exist. Brief negotiated interview (BNI) interventions, which allow ED clinicians to efficiently motivate patients, have potential to meet this need.
https://ift.tt/2DHSVBd
Concordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial
Care consistent with goals is the desired outcome of advance care planning (ACP).
https://ift.tt/2DHTj2D
Comparability of the Australian national Cancer Symptom Trials (CST) group’s study populations to national referrals to non-CST specialist palliative care services participating in the Palliative Care Outcomes Collaboration (PCOC)
Utilising the results of phase III studies in clinical practice depends on how representative study participants are of the clinical population to whom the results will be applied. The closer the characteristics between the sub-group who participate in a clinical trial and the whole population, the easier it is for clinicians to apply the results directly to the patient that he/she is treating. Trial participation is generally more happenstance than a systematic sampling of a population, and is limited by eligibility criteria that do not reflect the entire clinical population.
https://ift.tt/2zFfWRa
Prognostication using SCORTEN in SJS and TEN
Often in cases of severe injury or pathology, unclear prognosis and the lack of availability of concrete mortality measurements make goals of care (GOC) discussions with patients and their families difficult. Palliative care providers are sometimes involved in the care of patients with severe dermatological illnesses, such as Steven's Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), and knowledge of the prognostic tools used in these conditions is helpful. The incidence of SJS is estimated at 1-6 cases/million people and the incidence of TEN is 0.4-1.2 cases/million people; the mortality rates are 1-5% and 25-35%, respectively (1).
https://ift.tt/2DHTeMn
Review of Muriel Gillick: Old and Sick in America
I began following the work of Muriel Gillick in the 1990s, when I was a doctoral student in health care ethics. At a time when the ethics literature was focused on genetics and new technologies driving critical care in academic medical centers, Gillick was one of the few writing cogently about the ethical questions I found compelling: how best to care for elderly persons outside the hospital, especially when such persons can no longer make decisions for themselves. From frequent nursing-home-to-hospital transfers, to feeding tubes for dementia patients, to the possibilities and limitations of advance care planning, Gillick writes with a clarity and real-world perspective that I have always found helpful.
https://ift.tt/2zG8XaZ
Family caregivers’ subjective caregiving burden, quality of life, and depressive symptoms are associated with terminally ill cancer patients’ distinct patterns of conjoint symptom distress and functional impairment in their last 6 months of life
Family caregivers constitute a critical component of the end-of-life (EOL) care system with considerable cost to themselves. However, the joint association of terminally ill cancer patients' symptom distress and functional impairment with caregivers' subjective caregiving burden, quality of life (QOL), and depressive symptoms remains unknown.
https://ift.tt/2zEv4hJ
Heart Rate Variability as an indicator of nociceptive pain in disorders of consciousness?
Heart rate variability (HRV) is thought to reflect the affective and physiological aspects of pain and is emerging as a possible descriptor of the functional brain organization contributing to homeostasis.
https://ift.tt/2DHT8Ev
Centering Care: The Role of Labyrinths for Fostering Reflection in Pediatric Palliative and Critical Care Settings
The labyrinth represents an ancient symbol of wholeness and is thus applicable to health care settings as patients and providers alike seek healing and wholeness. A labyrinth combines the imagery of winding spirals together to compose a meandering but purposeful path.1 The labyrinth shape represents a journey toward the center (centering) and back again out into the world (caring re-entry).2 The labyrinth tradition dates back 3500 years ago with varying geographies from Crete to Egypt to Scandinavia claiming original origin.
https://ift.tt/2zFdSIV
Patients’ Hopes for Advanced Cancer Treatment
Little is known about the hopes patients with advanced (incurable) cancer have for their treatment.
https://ift.tt/2DHT7QX
Response to Hyoscine butylbromide for the management of death rattle: sooner rather than later
I read the recent paper regarding death rattle treatment with great interest (1). The authors are commended for giving consideration to this naturally occurring patient noise that is distressing to clinicians and families.
https://ift.tt/2zFBqgT
When we document end-of-life care, words still matter
In the September, 2018 edition of the Journal of Pain and Symptom Management, the study "Language used by health care professionals to describe dying at an acute care hospital" focused on specific word choices when documenting about end-of-life care. (1) They accurately note that, in acute care settings, the patient's medical record often becomes the primary mechanism for communication between providers. Imprecise documentation can lead to poor transfer of knowledge and even implicit bias. (2) Wentlandt et al describe the "implied state" category as most frequently used by non-palliative care providers, which labels patients by the care they receive (e.g.
https://ift.tt/2DHT4EL
Molding Idle Musings into Art: What reflective writing does for me
"For me, no experience is complete until I've written about it." Michael Longley, Irish poet. The Vitality of Ordinary Things (2018) [podcast] On Being with Krista Tippett. Available at: https://ift.tt/2qtDHpM
https://ift.tt/2zFJ7nu
PC-FACS
PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pc-facs@aahpm.org.
https://ift.tt/2zEyMba
Physicians’ Attitudes Towards Euthanasia and Assisted Suicide In Italy
Euthanasia and assisted suicide are matter of discussion all over the world 1. In Italy, many cases raised by media recently provided the impetus for a new law regulating the living will. Of concern, it has been recently reported that there is a lack of knowledge among patients about the meaning of end-of-life issues 2. Physician-assisted suicide and euthanasia have been increasingly debated in the public arena, and in some European countries, legislation exists to regulate these end-of-life issues 3.
https://ift.tt/2DI7FjE
Walking but not talking: Laryngeal separation as a novel approach to improve quality of life in bulbar amyotrophic lateral sclerosis
Patients diagnosed with bulbar amyotrophic lateral sclerosis (ALS) inevitably experience acute aspiration due to progressive facial and laryngeal weakness. As they develop complete dysphagia and loss of speech, patients with bulbar ALS often experience a sensation of "drowning" with acute life-threatening airway obstruction during these aspiration events. Here we present a case of utilizing laryngotracheal separation (LTS) as a strategy to eliminate oropharyngeal aspiration with the goal of improving symptom management in a patient with bulbar ALS.
https://ift.tt/2zFBixV
Pain and Emergency Department Use in the Last Month of Life Among Older Adults with Dementia
Pain may be a potentially modifiable risk factor for expensive and burdensome Emergency Department (ED) visits near the end-of-life for older adults with dementia.
https://ift.tt/2zEX6K8
Managing medicines for patients dying at home: A review of family caregivers’ experiences
Increased life expectancy, technical advances in treatment and symptom control, and the extension of palliative care in community settings not only lengthen life, but make it possible for many patients to be cared for, and to die, at home. Moreover, death increasingly occurs in late old age and after a prolonged period of co-morbidity and/or frailty. This has far reaching consequences for the way that professional services are resourced and organised, and for the informal carers who are often responsible for providing the greater part of patient care, including management of complex medication regimes.
https://ift.tt/2DHSSW3
Hydrogen Sulfide Protects against Chemical Hypoxia-Induced Injury via Attenuation of ROS-Mediated Ca2+ Overload and Mitochondrial Dysfunction in Human Bronchial Epithelial Cells
Oxidative stress induced by hypoxia/ischemia resulted in the excessive reactive oxygen species (ROS) and the relative inadequate antioxidants. As the initial barrier to environmental pollutants and allergic stimuli, airway epithelial cell is vulnerable to oxidative stress. In recent years, the antioxidant effect of hydrogen sulfide (H2S) has attracted much attention. Therefore, in this study, we explored the impact of H2S on CoCl2-induced cell injury in 16HBE14o- cells. The effect of CoCl2 on the cell viability was detected by Cell Counting Kit (CCK-8) and the level of ROS in 16HBE14o- cells in response to varying doses (100–1000 μmol/L) of CoCl2 (a common chemical mimic of hypoxia) was measured by using fluorescent probe DCFH-DA. It was shown that, in 16HBE14o- cells, CoCl2 acutely increased the ROS content in a dose-dependent manner, and the increased ROS was inhibited by the NaHS (as a donor of H2S). Moreover, the calcium ion fluorescence probe Fura-2/AM and fluorescence dye Rh123 were used to investigate the intracellular calcium concentration ([Ca2+) and mitochondria membrane potential (MMP) in 16HBE14o- cells, respectively. In addition, we examined apoptosis of 16HBE14o- cells with Hoechst 33342. The results showed that the CoCl2 effectively elevated the Ca2+ influx, declined the MMP, and aggravated apoptosis, which were abrogated by NaHS. These results demonstrate that H2S could attenuate CoCl2-induced hypoxia injury via reducing ROS to perform an agonistic role for the Ca2+ influx and MMP dissipation.
https://ift.tt/2P0E322
Upregulation of BUB1B, CCNB1, CDC7, CDC20, and MCM3 in Tumor Tissues Predicted Worse Overall Survival and Disease-Free Survival in Hepatocellular Carcinoma Patients
Objective. To evaluate the association between upregulated differentially expressed genes (DEGs) and the outcomes of patients with hepatocellular carcinoma (HCC). Methods. Using Gene Expression Omnibus (GEO) datasets including GSE45436, GSE55092, GSE60502, GSE84402, and GSE17548, we detected upregulated DEGs in tumors. KEGG, GO, and Reactome enrichment analysis of the DEGs was conducted to clarify their function. The impact of the upregulated DEGs on patients' survival was analyzed based on TCGA profile. Results. 161 shared upregulated DEGs were identified among GSE45436, GSE55092, GSE60502, and GSE84402 profiles. Cell cycle was the shared pathway/biological process in the gene sets investigation among databases of KEGG, GO, and Reactome. After being validated in GSE17548, 13 genes including BUB1B, CCNA2, CCNB1, CCNE2, CDC20, CDC6, CDC7, CDK1, CDK4, CDKN2A, CHEK1, MAD2L1, and MCM3 in cell cycle pathway were shared in the three databases for enrichment. The expression of BUB1B, CCNB1, CDC7, CDC20, and MCM3 was upregulated in HCC tissues when compared with adjacent normal tissues in 6.67%, 7.5%, 8.06%, 5.56%, and 9.72% of HCC patients, respectively. Overexpression of BUB1B, CCNB1, CDC7, CDC20, and MCM3 in HCC tissues accounted for poorer overall survival (OS) and disease-free survival (DFS) in HCC patients (all log rank P
https://ift.tt/2NQzZot
Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration
Here, we present a protocol to produce an adipose tissue-derived stromal vascular fraction and its application to improve knee functions by regenerating cartilage-like tissue in human patients with osteoarthritis.
https://ift.tt/2QiPQsJ
Purification and characterization of an amyloglucosidase from an ericoid mycorrhizal fungus (Leohumicola incrustata)
This study aimed to purify and characterize amyloglucosidase (AMG) from Leohumicola incrustata. AMG was purified to homogeneity from cell-free culture filtrate of an ERM fungus grown in a modified Melin–Norkrans ...
https://ift.tt/2NPgfBY
Probe-free label system for rapid detection of Cronobacter genus in powdered infant formula
Cronobacter species previously known as Enterobacter sakazakii poses high risks to neonates and infants. In this work a rapid detection method was developed which combined loop-mediated isothermal amplification w...
https://ift.tt/2Nd8Yqt
Porcine As a Training Module for Head and Neck Microvascular Reconstruction
Here we present a protocol for the use of the pig superior epigastric artery perforator flap as a learning module for head and neck microvascular reconstruction.
https://ift.tt/2xZtAwt
Treatment Patterns, Healthcare Resource Utilization and Costs Among Schizophrenia Patients Treated with Long-Acting Injectable Versus Oral Antipsychotics
Abstract
Introduction
Long-acting injectable (LAI) antipsychotic use may reduce healthcare resource utilization compared with oral antipsychotic use by improving adherence and reducing dosing frequency. Our goal was to examine treatment patterns, healthcare utilization, and costs among recently diagnosed schizophrenia patients receiving oral versus LAI antipsychotics.
Methods
The MarketScan Multi-state Medicaid database was used to identify schizophrenia patients aged ≥ 18 years who received an LAI or oral antipsychotic between January 1, 2011 and December 31, 2014. Primary outcomes included treatment patterns such as adherence (measured as proportion of days covered-PDC), persistence, discontinuation, switching, and healthcare resource utilization and costs. Propensity score matching (PSM) was used to control for differences in baseline characteristics between the cohorts. Outcomes were assessed over a 12-month post-index period and compared between treatment cohorts.
Results
After PSM, 2302 patients were included in each of the LAI and oral antipsychotics cohorts. There were no differences in PDC or therapy switching between the two cohorts. Compared with the oral cohort, patients receiving LAIs had lower discontinuation rates (46.1 vs. 61.6%, p < 0.001), fewer inpatient admissions (0.5 vs. 0.9, p < 0.001), hospital days (3.9 vs. 6.5, p < 0.001), and ER visits (2.4 vs. 2.9, p = 0.007), and a higher number of prescription fills (29.5 vs. 25.3, p < 0.001). Patients prescribed LAIs had lower monthly inpatient ($US4007 vs. 8769, p < 0.001) and ER visits costs ($682 vs. 891, p < 0.001) but higher monthly medication costs ($10,713 vs. $655, p < 0.001) compared with the oral cohort over the 12-month post-index period. Overall, both cohorts had similar total medical costs (LAI vs. oral: $24,988 vs. 23,887, p = 0.354) during the follow-up period.
Conclusion
Patients receiving LAIs were more likely to remain on medication compared with the oral group, which may account for reduced inpatient admissions. Hospitalization cost reductions offset the higher costs of LAI medications, resulting in no increase in total healthcare costs relative to oral antipsychotic use.
Funding
Alkermes Inc.
https://ift.tt/2R7QN8x
Relationship between folate concentration and expression of folate-associated genes in tissue and plasma after intraoperative administration of leucovorin in patients with colorectal cancer
Abstract
Purpose
The aim of study was to investigate the relationship between folate concentration and expression of folate-associated genes in tumour, mucosa and plasma of patients with colorectal cancer, after intraoperative administration of bolus leucovorin (LV).
Methods
Eighty patients were randomized into four groups to receive 0, 60, 200, or 500 mg/m2 LV, respectively. Tissue and plasma folate concentrations were assessed by LC–MS/MS. Gene expression of ABCC3/MRP3, FPGS, GGH, MTHFD1L, SLC46A1/PCFT, and SLC19A1/RFC-1 was determined using quantitative PCR.
Results
The folate concentration in tumour increased with increasing dosage of LV. Half of the patients treated with 60 mg/m2 did not reach a level above the levels of untreated patients. A significant correlation between folate concentration in tumour and mucosa was found in untreated patients, and in the group treated with 60 mg/m2 LV. The 5-MTHF/LV ratio correlated negatively with folate concentration in mucosa, whereas a positive correlation was found in tumour of patients who received 200 or 500 mg/m2 LV. A positive correlation was found between folate concentration and expression of all genes, except MTHFD1L, in patients who received LV. There was a negative correlation between 5-MTHF concentration in plasma of untreated patients and expression of GGH and SLC46A1/PCFT in tumour.
Conclusions
The results indicate the possibility of using the individual plasma 5-MTHF/LV ratio after LV injection as a surrogate marker for tissue folate concentration. Expression of several folate-associated genes is associated with folate concentration in tissue and plasma and may become useful when predicting response to LV treatment.
https://ift.tt/2NNAgJ0
Liquid biopsies to track trastuzumab resistance in metastatic HER2-positive gastric cancer
Objective
To monitor trastuzumab resistance and determine the underlying mechanisms for the limited response rate and rapid emergence of resistance of HER2+ metastatic gastric cancer (mGC).
DesignTargeted sequencing of 416 clinically relevant genes was performed in 78 paired plasma and tissue biopsy samples to determine plasma-tissue concordance. Then, we performed longitudinal analyses of 97 serial plasma samples collected from 24 patients who were HER2+ to track the resistance during trastuzumab treatment and validated the identified candidate resistance genes.
ResultsThe results from targeted sequencing-based detection of somatic copy number alterations (SCNA) of HER2 gene were highly consistent with fluorescence in situ hybridisation data, and the detected HER2 SCNA was better than plasma carcinoembryonic antigen levels at predicting tumour shrinkage and progression. Furthermore, most patients with innate trastuzumab resistance presented high HER2 SCNA during progression compared with baseline, while HER2 SCNA decreased in patients with acquired resistance. PIK3CA mutations were significantly enriched in patients with innate resistance, and ERBB2/4 genes were the most mutated genes, accounting for trastuzumab resistance in six (35.3%) and five (29.4%) patients in baseline and progression plasma, respectively. Patients with PIK3CA/R1/C3 or ERBB2/4 mutations in the baseline plasma had significantly worse progression-free survival. Additionally, mutations in NF1 contributed to trastuzumab resistance, which was further confirmed through in vitro and in vivo studies, while combined HER2 and MEK/ERK blockade overcame trastuzumab resistance.
ConclusionLongitudinal circulating tumour DNA sequencing provides novel insights into gene alterations underlying trastuzumab resistance in HER2+mGC.
https://ift.tt/2xK7j6I
Distributed and adaptive location identification system for mobile devices
Indoor location identification and navigation need to be as simple, seamless, and ubiquitous as its outdoor GPS-based counterpart is. It would be of great convenience to the mobile user to be able to continue ...
https://ift.tt/2zEdNWa
Connection between 'chalky teeth' in children and the uptake of Bisphenol A not likely
Medical associations are reporting increased occurrences of disturbed dental mineralization in children. The so-called 'chalky teeth' show discoloration and can be extremely sensitive to pain. Furthermore they tend to react sensitively to heat, cold and brushing.
https://ift.tt/2Qfm1cL
Blood pressure targeting by partial REBOA is possible in severe hemorrhagic shock in pigs and produces less circulatory, metabolic and inflammatory sequelae than total REBOA
Publication date: Available online 29 September 2018
Source: Injury
Author(s): Mitra Sadeghi, Tal Martin Hörer, Daniel Forsman, Emanuel Moses Dogan, Kjell Jansson, Csaba Kindler, Per Skoog, Kristofer Fredrik Nilsson
Abstract
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in exsanguinating torso hemorrhage, but causes ischemic injury to distal organs. The aim was to investigate whether blood pressure targeting by partial REBOA (pREBOA) is possible in porcine severe hemorrhagic shock and to compare pREBOA and total REBOA (tREBOA) regarding hemodynamic, metabolic and inflammatory effects.
Methods
Eighteen anesthetized pigs were exposed to induced controlled hemorrhage to a systolic blood pressure (SBP) of 50 mmHg and randomized into three groups of thoracic REBOA: 30 min of pREBOA (target SBP 80-100 mmHg), tREBOA, and control. They were then resuscitated by autologous transfusion and monitored for 3 h. Hemodynamics, blood gases, mesenteric blood flow, intraperitoneal metabolites, organ damage markers, histopathology from the small bowel, and inflammatory markers were analyzed.
Results
Severe hemorrhagic shock was induced in all groups. In pREBOA the targeted blood pressure was reached. The mesenteric blood flow was sustained in pREBOA, while it was completely obstructed in tREBOA. Arterial pH was lower, and lactate and troponin levels were significantly higher in tREBOA than in pREBOA and controls during the reperfusion period. Intraperitoneal metabolites, the cytokine response and histological analyses from the small bowel were mostly affected in the tREBOA compared to the pREBOA and control groups.
Conclusion
Partial REBOA allows blood pressure titration while maintaining perfusion to distal organs, and reduces the ischemic burden in a state of severe hemorrhagic shock. Partial REBOA may lower the risks of post-resuscitation metabolic and inflammatory impacts, and organ dysfunction.
https://ift.tt/2OfbVeH
The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats
Publication date: Available online 28 September 2018
Source: Injury
Author(s): Gang Zhao, Xin Zhang, Peng Xu, Jing-Yi Mi, Yong-Jun Rui
Abstract
Background
Ischemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats.
Methods
A total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of "choke vessels" was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day.
Results
On the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001).
Conclusion
Irisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.
https://ift.tt/2QffEWT
Impact of body mass index on outcomes after thoracic trauma – a matched-triplet analysis of the TraumaRegister DGU®
Publication date: Available online 28 September 2018
Source: Injury
Author(s): Mark Schieren, Andreas Böhmer, Rolf Lefering, Thomas Paffrath, Frank Wappler, Jerome Defosse, TraumaRegister DGU
Abstract
Introduction
Chest trauma and obesity are both associated with increased risks for respiratory complications (e.g. hypoxia, hypercarbia, pneumonia), which are frequent causes of posttraumatic morbidity and mortality. However, as there is only limited and inconsistent evidence, the aim of our study was to analyse the effect of body mass index (BMI) on patient outcomes after thoracic trauma.
Patients and Methods
We screened 50.519 patients entered in TraumaRegister DGU®, between 2004-2009, when the BMI was part of the standardized dataset. After matching for injury patterns and severity of trauma we performed a matched tripled analysis with regard to the BMI (group 1: < 25.0 kg/m2; group 2: 25.0-29.9 kg/m2; group 3: > 30.0 kg/m2). Data are shown as percentages and mean values with standard deviation.
Results
The matching process yielded a cohort of 828 patients with serious blunt thoracic trauma, evenly distributed over the 3 BMI groups (276 triplets). BMI did not have an impact on the need for prehospital or emergency department interventions. There was a trend towards more liberal use of whole-body-CT scanning with increasing BMI (group 1: 68.8%; group 2: 73.2%; group 3: 75.0%). Additional abdominal injuries were more common in normal weight patients (Group 1: 28.3%; Group 2: 14.9%; Group 3: 17.8%). Obesity (BMI > 30.0 kg/m2) had a significant impact on the duration of mechanical ventilation (in days; group 1: 6.5 (9.4); group 2: 6.4 (8.9); group 3: 9.1 (14.4); p = 0.002), ICU days (in days; group 1: 11.5 (11.5); group 2: 10.9 (9.6); group 3: 14.1 (16.7); p = 0.005) and hospital length of stay (in days; group 1: 27.8 (19.3); group 2: 27.4 (19.2); group 3: 32.2 (25.9); p = 0.009). There were no significant differences regarding overall mortality (group 1: 3.6%; group 2: 1.8%; group 3: 4.0%; p = 0.26).
Conclusions
Obesity has a negative impact on outcomes after blunt chest trauma, as it is associated with prolonged duration of mechanical ventilation, ICU and hospital length of stay. Mortality did not seem to be affected, yet, further research is required to confirm these results in a larger cohort.
https://ift.tt/2OfbmBB
Low back pain intensity among childbearing women and associated predictors. A cohort study
Publication date: Available online 28 September 2018
Source: Women and Birth
Author(s): Mette G. Backhausen, Jane M. Bendix, Peter Damm, Ann Tabor, Hanne K. Hegaard
Abstract
Background
Low back pain is a common condition among childbearing women, causing physical disability and an increased risk of sick leave and obstetric complications.
Aims
To assess the prevalence and intensity of low back pain during pregnancy, to describe the physical disability and sick leave in relation to the severity of low back pain and to identify predictors of moderate to severe low back pain in socio-demographic, health and obstetric characteristics among childbearing women.
Methods
A cohort study was undertaken (n = 566) during August 2015 to March 2016. Questionnaires were used to obtain information about low back pain intensity, physical disability due to low back pain and sick leave at 20 and 32 weeks of gestation. Of the 654 eligible women, 87% completed the first questionnaire.
Findings
Three out of four reported any low back pain at 20 weeks of gestation, and nine out of ten women at 32 weeks. Of these women, one in three reported moderate to severe pain at 20 weeks, increasing to half of the women at 32 weeks. Both sick leave and physical disability increased with increasing low back pain scores. Pre-pregnancy low back pain, multiparity and lower level of education were all identified as predictors of moderate to severe low back pain.
Conclusions
Women with pre-pregnancy low back pain, multiparity and lower level of education, represent the group of women with the highest risk of moderate to severe low back pain during pregnancy and should be payed special attention.
https://ift.tt/2RfNIn8
The association between social support and postpartum depression in women: A cross sectional study
Publication date: Available online 28 September 2018
Source: Women and Birth
Author(s): Atefeh Vaezi, Fatemeh Soojoodi, Arash Tehrani Banihashemi, Marzieh Nojomi
Abstract
Background
Prevalence of postpartum depression is estimated to be about 10–15% worldwide. Many risk factors are supposed to play a role leading a new mother to maternal postpartum depression which can considerably affect the baby, mother, family and also the society.
Objective
To investigate the prevalence of maternal postpartum depression and its association with social support.
Methods
Using a cross-sectional study, 200 new mothers who attended three teaching hospitals in Tehran, Iran were selected with a convenience sampling. Postpartum depression was assessed using the Iranian version of Edinburgh Postpartum Depression Scale and women's levels of social support were measured using the Iranian version of Social Support Questionnaire.
Results
Prevalence of postpartum depression was 43.5% in new mothers. The mean (±Standard Deviation) score of social support network was 2.09 ± 0.99; which is lower in depressed mothers in comparison to non-depressed mothers (1.78 ± 0.87 vs. 2.33 ± 1.00 respectively, P < 0.001). A reverse significant association was found between social support and postpartum depression after adjusting for confounding variables such as past history of depression, illness of baby and medication consumption during pregnancy (Odds Ratio = 0.47, 95% Confidence Interval = 0.33–0.67).
Conclusion
The bigger the social network of a mother, the less postpartum depression occurs. It is suggested to educate the family about the very important role of social support and improve it in every aspect of health care in order to prevent postpartum depression.
https://ift.tt/2QkpYNr
The relationship between maternal weight gain in pregnancy and newborn weight
Publication date: Available online 28 September 2018
Source: Women and Birth
Author(s): Danhua Zhang, Longfei Zhang, Zhiping Wang
Abstract
Aim
This study investigated the impacts of different pre-pregnancy body mass indexes and gestational weight gain on the risk of delivering a high birth weight infant in China.
Methods
A retrospective cohort study was conducted from 2013 to 2014 in the Maternal and Child Health Care Hospital of Jinan City, Shandong Province and 2415 women who had a singleton birth were included in the study. A logistic regression model and restricted cubic spline regression were used to analyse the association.
Findings
The risk of delivering a high birth weight infant increases when the mother's pre-pregnancy body mass index exceeds 24 kg/m2. Compared with women whose pre-pregnancy body mass index was 21 kg/m2, the adjusted risk of delivering a high birth weight infant doubled when the mother's pre-pregnancy body mass index was 29 kg/m2, and nearly tripled when the mother's pre-pregnancy body mass index was 31 kg/m2. Compared with women who had a gestational weight gain of 12.0 kg, women having a gestational weight gain of 20.0 kg, 22.0 kg, and 26.0 kg had a 1.7-, 2.2-, and 3.5-fold increased risk of delivering a high birth weight infant. When the mother experiences a gestational weight gain greater than 27 kg, the risk of delivering a high birth weight infant is at least 4-fold greater than that for a mother who has a gestational weight gain of 12.0 kg.
Conclusions
Proposed strategies to raise public awareness of the risks to infants posed by high maternal pre-pregnancy body mass index and gestational weight gain are required. All clinical recommendations and measures are for all pregnant women, not just overweight and obese pregnant women.
https://ift.tt/2RfNxZ0
Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: A systematic review
Publication date: Available online 28 September 2018
Source: Women and Birth
Author(s): Yi Huang, Yan-Qiong Ouyang, Sharon R. Redding
Abstract
Problem
Despite widely recognized benefits of breastfeeding, the worldwide rate of six months exclusive breastfeeding has not up to the WHO recommendation. Multiparas are considered more likely to initiate breastfeeding and breastfeed much longer. This, however, is not always the case if they have unsuccessful previous breastfeeding experience. Therefore, whether and how previous breastfeeding experience affect subsequent breastfeeding outcomes need to be explored sufficiently.
Objective
The objective of this review is to summarize the evidence of association between previous breastfeeding experience and subsequent breastfeeding outcomes.
Methods
A systematic search of Embase, Web of Science, PubMed, Cochrane Library and CINAHL databases from inception to March, 2018 is conducted for cohort studies regarding "previous breastfeeding experience" as an influencing factor to subsequent breastfeeding initiation and duration. A narrative synthesis is used in this review according to PRISMA and study quality is assessed using the Newcastle-Ottawa Scale.
Findings
Fifteen articles were eligible for this review. Previous breastfeeding experience was consistently correlated with subsequent breastfeeding initiation and duration. However, previous short breastfeeding duration and unsatisfactory experience negatively affected subsequent breastfeeding.
Conclusions
Robust evidence for the effect of previous breastfeeding experience on subsequent breastfeeding is present. Midwives and breastfeeding/lactation consultants need to provide customized interventions for mothers according to detailed previous breastfeeding experience in order to improve breastfeeding initiation and breastfeeding duration.
https://ift.tt/2QgUQOu
Cancers, Vol. 10, Pages 367: Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy
Cancers, Vol. 10, Pages 367: Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy
Cancers doi: 10.3390/cancers10100367
Authors: Nishida Nishimura Kaido Minaga Yamao Kamata Takenaka Ida Hagiwara Minami Sakurai Watanabe Kudo
Hepatocellular carcinoma (HCC) causes one of the most frequent cancer-related deaths; an HCC subset shows rapid progression that affects survival. We clarify molecular features of aggressive HCC, and establish a molecular scoring system that predicts metastasis after curative treatment. In total, 125 HCCs were examined for TP53, CTNNB1, and TERT promoter mutation, methylation of 8 tumor suppressor genes, and 3 repetitive DNA sequences to estimate promoter hypermethylation and global hypomethylation. A fractional allelic loss (FAL) was calculated to represent chromosomal instability through microsatellite analysis. Molecular subclasses were determined using corresponding and hierarchical clustering analyses. Next, twenty-five HCC patients who underwent liver transplantation were analyzed for associations between molecular characteristics and metastatic recurrence; survival analyses were validated using a publicly available dataset of 376 HCC cases from the Cancer Genome Atlas (TCGA). An HCC subtype characterized by TP53 mutation, high FAL, and global hypomethylation was associated with aggressive tumor characteristics, like vascular invasion; CTNNB1 mutation was a feature of the less-progressive phenotype. A number of molecular risk factors, including TP53 mutation, high FAL, significant global hypomethylation, and absence of CTNNB1 mutation, were noted to predict shorter recurrence-free survival in patients who underwent liver transplantation (p = 0.0090 by log-rank test). These findings were validated in a cohort of resected HCC cases from TCGA (p = 0.0076). We concluded that molecular risks determined by common genetic and epigenetic alterations could predict metastatic recurrence after curative treatments, and could be a marker for considering systemic therapy for HCC patients.
https://ift.tt/2NcKnlk
Cross-sectional increase of adherence to multidisciplinary tumor board decisions
Abstract
Background
Cancer research has made great progress in the recent years. With the increasing number of options in diagnosis and therapy the implementation of tumorboards (TUBs) has become standard procedure in the treatment of cancer patients. Adherence tests on tumor board decisions are intended to enable quality assurance and enhancement for work in tumor boards in order to continuously optimize treatment options for cancer patients.
Methods
Subject of this study was the adherence of the recommendations made in three of 14 tumorboards, which take place weekly in the Center for Integrated Oncology (CIO) at the University Hospital Bonn. In total, therapy recommendations of 3815 patient cases were checked on their implementation. A classification into four groups has been made according to the degree of implementation. A second classification followed regarding the reasons for differences between the recommendation and the therapy which the patient actually received.
Results
The study showed that 80.1% of all recommendations in the three TUBs were implemented. 8.3% of all recommendations showed a deviance. Most important reasons for the deviances were patient wish (36.5%), patient death (26%) and doctoral decision, due to the patient's comorbidities or side effects of the treatment (24.1%).Interestingly, deviance in all three tumor boards in total significantly decreased over time.
Conclusions
Aim of the study was to clarify the use of tumor boards and find approaches to make them more efficient. Based on the results efficiency might be optimized by increased consideration of patients` preferences, improved presentation of patient-related data, more detailed documentation and further structuring of the tumor board meetings.
https://ift.tt/2OYboL8
Expression signatures of exosomal long non-coding RNAs in urine serve as novel non-invasive biomarkers for diagnosis and recurrence prediction of bladder cancer
Abstract
Recently, expression signatures of exosomal long non-coding RNAs (lncRNAs) have been proposed as potential non-invasive biomarkers for cancer detection. In this study, we aimed to develop a urinary exosome (UE)-derived lncRNA panel for diagnosis and recurrence prediction of bladder cancer (BC). Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to screen and evaluate the expressions of eight candidate lncRNAs in a training set (208 urine samples) and a validation set (160 urine samples). A panel consisting of three differently expressed lncRNAs (MALAT1, PCAT-1 and SPRY4-IT1) was established for BC diagnosis in the training set, showing an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.854. Subsequently, the performance of the panel was further verified with an AUC of 0.813 in the validation set, which was significantly higher than that of urine cytology (0.619). In addition, Kaplan-Meier analysis suggested that the up-regulation of PCAT-1 and MALAT1 was associated with poor recurrence-free survival (RFS) of non-muscle-invasive BC (NMIBC) (p < 0.001 and p = 0.002, respectively), and multivariate Cox proportional hazards regression analysis revealed that exosomal PCAT-1 overexpression was an independent prognostic factor for the RFS of NMIBC (p = 0.018). Collectively, our findings indicated that UE-derived lncRNAs possessed considerable clinical value in the diagnosis and prognosis of BC.
https://ift.tt/2InEpxb
Cancers, Vol. 10, Pages 366: Bipolar Tumor-Associated Macrophages in Ovarian Cancer as Targets for Therapy
Cancers, Vol. 10, Pages 366: Bipolar Tumor-Associated Macrophages in Ovarian Cancer as Targets for Therapy
Cancers doi: 10.3390/cancers10100366
Authors: Vijayalaxmi Gupta Fiona Yull Dineo Khabele
Ovarian cancer, a rare but fatal disease, has been a challenging area in the field of gynecological cancer. Ovarian cancer is characterized by peritoneal metastasis, which is facilitated by a cross-talk between tumor cells and other cells in the tumor microenvironment (TME). In epithelial ovarian cancer, tumor-associated macrophages (TAMs) constitute over 50% of cells in the peritoneal TME and malignant ascites, and are potential targets for therapy. Here, we review the bipolar nature of TAMs and the evolving strategies to target TAMs in ovarian cancer.
https://ift.tt/2QfIrdK
Lymphovascular invasion and extranodal tumour extension are risk indicators of breast cancer related lymphoedema: an observational retrospective study with long-term follow-up
Abstract
Background
Breast cancer related lymphoedema (BCRL) occurs in a substantial proportion of breast cancer survivors and is a major contributor to patients' disability. Regrettably, there are no validated predictive biomarkers, diagnostic tools, and strong evidence-supported therapeutic strategies for BCRL. Here, we provide an integrative characterization of a large series of women with node-positive breast cancers and identify new bona fide predictors of BCRL occurrence.
Methods
Three hundred thirty-two cases of surgically-treated node-positive breast cancers were retrospectively collected (2–10.2 years of follow-up). Among them, 62 patients developed BCRL. To identify demographic and clinicopathologic features related to BCRL, Fisher's exact test or Chi-squared test were carried out for categorical variables; the Wilcoxon rank-sum was employed for continuous variables. Factors associated with BCRL occurrence were assessed using a Cox proportional hazards regression model.
Results
En-bloc dissection of the axillary lymph nodes but not the type of breast surgery impacted on BCRL development. Most of BCRL patients had a Luminal A-like neoplasm. The median number of lymph nodes involved by metastatic deposits was significantly higher in BCRL compared to the control group (p = 0.04). Both peritumoral lymphovascular invasion (LVI) and extranodal extension (ENE) of the metastasis had a negative impact on BCRL-free survival (p = 0.01). Specifically, patients with LVI and left side localization harboured 4-fold higher risk of developing BCRL, while right axillary nodes metastases with ENE increased the probability of BCRL compared to ENE-negative patients.
Conclusions
Assessment of LVI and ENE should be integrated with clinical and surgical data to improve BCRL risk stratification.
https://ift.tt/2OZqa4g
Diagnostic accuracy of the implant stability quotient in monitoring progressive peri‐implant bone loss: An experimental study in dogs
Clinical Oral Implants Research, EarlyView.
https://ift.tt/2xOzXDC
Clinical and radiographic outcomes of a surgical reconstructive approach in the treatment of peri‐implantitis lesions: A 5‐year prospective case series
Clinical Oral Implants Research, EarlyView.
https://ift.tt/2OYPBmG
Guided bone regeneration using beta‐tricalcium phosphate with and without fibronectin—An experimental study in rats
Clinical Oral Implants Research, EarlyView.
https://ift.tt/2xKVgWD
Effect of titanium surface functionalization with bioactive glass on osseointegration: an experimental study in dogs
Clinical Oral Implants Research, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OXxX2A
Losartan reverses impaired osseointegration in spontaneously hypertensive rats
Clinical Oral Implants Research, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xMs3Lc
Influence of the abutment height and connection timing in early peri‐implant marginal bone changes: A prospective randomized clinical trial
Clinical Oral Implants Research, Volume 29, Issue 9, Page 907-914, September 2018.
https://ift.tt/2OYPqrw
Issue Information
Clinical Oral Implants Research, Volume 29, Issue 9, Page i-ii, September 2018.
https://ift.tt/2xOzBwM
Cytotoxicity and molecular activity of fenretinide and metabolites in T-cell lymphoid malignancy, neuroblastoma, and ovarian cancer cell lines in physiological hypoxia
Objective All-trans-N-(4-hydroxyphenyl)retinamide or fenretinide (4-HPR) acts by reactive oxygen species (ROS) and dihydroceramides (DHCers). In early-phase clinical trials 4-HPR has achieved complete responses in T-cell lymphomas (TCL) and neuroblastoma (NB) and signals of activity in ovarian cancer (OV). We defined the activity of 4-HPR metabolites in N-(4-methoxyphenyl)retinamide (MPR), 4-oxo-N-(4-hydroxyphenyl)retinamide (oxoHPR), and the 4-HPR isomer 13-cis-fenretinide (cis-HPR) in NB, OV, and TCL cell lines cultured in physiological hypoxia. Methods We compared the effect of 4-HPR, cis-HPR, oxoHPR, and MPR on cytotoxicity, ROS, and DHCers in a panel of TCL, NB, and OV cell lines cultured in bone marrow level physiological hypoxia (5% O2), utilizing a fluorescence-based cytotoxicity assay (DIMSCAN), flow cytometry, and quantitative mass spectrometry. Results 4-HPR (10 µmol/l) achieved more than three logs of cell kill in nine of 15 cell lines. Cytotoxicity of 4-HPR and oxoHPR was comparable; in some cell lines, cis-HPR cytotoxicity was lower than 4-HPR, but additive when combined with 4-HPR. MPR was not cytotoxic. ROS and DHCers were equivalently increased by 4-HPR and oxoHPR in all cell lines (P0.05). Mitochondrial membrane depolarization, caspase-3 cleavage, and apoptosis (TUNEL) were all significantly increased by 4-HPR and oxoHPR (P
https://ift.tt/2xZV9pG
https://ift.tt/2xZV9pG
Diagnostic accuracy of cone beam computed tomography used for assessment of apical periodontitis: an ex vivo histopathological study on human cadavers
International Endodontic Journal, Volume 0, Issue ja, -Not available-.
https://ift.tt/2DGw4Gt
Development of a cerebrovascular MRI biomarker for cognitive aging
Annals of Neurology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OgBQ5F
A case of uterine carcinosarcoma which was strongly suspected to have metastases to the psoas and gluteus muscles
Abstract
Metastasis to the skeletal muscles is uncommon. We report a case which was strongly suspected to have psoas and gluteus muscle metastases from uterine carcinosarcoma. A 68-year-old woman (gravida, 2; para, 0) underwent retroperitoneal endoscopic paraaortic lymphadenectomy, laparoscopic modified radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy for uterine carcinosarcoma, suspected to be stage IB. Metastasis to one right pelvic lymph node was observed. Ascites fluid cytology was negative. Postoperative pathological examination revealed stage IIIC1 (pT1bN1M0) disease. Five cycles of chemotherapy with paclitaxel + carboplatin were performed. 10 months after chemotherapy, serum cancer antigen-125 level was elevated. Computed tomography (CT) revealed a 3-cm tumor of the left psoas muscle and magnetic resonance imaging revealed a tumor of the left gluteus maximus muscle. These lesions showed fluorodeoxyglucose uptake in positron emission tomography-CT. Because we considered the tumors were metastases of uterine carcinosarcoma, we recommended her chemotherapy. However, after one cycle of chemotherapy, the patient underwent immunotherapy elsewhere with immune checkpoint inhibitors. 5 months after the recurrence, she was alive.
https://ift.tt/2N6gweh
GNA13 promotes tumor growth and angiogenesis by upregulating CXC chemokines via the NF‐κB signaling pathway in colorectal cancer cells
Cancer Medicine, EarlyView.
https://ift.tt/2R7svvr
Factors contributing to disparities in mortality among patients with non–small‐cell lung cancer
Cancer Medicine, EarlyView.
https://ift.tt/2InUnY8
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An international effort toward improved patient care—when the roots might be inspired by Leonardo da Vinci
Cancer Cytopathology, EarlyView.
https://ift.tt/2R6iKO6
Adenoma mimicking hyponatremia of SIAD
Hyponatremia is a common electrolyte disorder, with prevalence as high as 20% in inpatient settings. It is classified based on volume status, urine sodium and osmolality results. While this approach might help narrow down the differential diagnoses, it can leave other diagnoses unentertained. In this case, we report recurrent and refractory hyponatremia secondary to hypocortisolism due to non-functioning pituitary macroadenoma. Interestingly, urine studies mimicked syndrome of inappropriate antidiuresis, but exclusively responded to hydrocortisone replacement. Hospital course was also complicated by hyponatremia-induced rhabdomyolysis, which is a rare complication of severe hyponatremia. We also discuss the role of anchoring heuristics and how they influence the physician's decision leading to possible diagnostic errors. One way to minimise the effect of anchoring bias on physicians is their cognitive awareness of such bias. In addition, discussing complicated cases with all members of medical team can highlight the clinician's thought processes, share uncertainty and help broaden differential diagnoses.
https://ift.tt/2xKftfw
Pneumatosis cystoides intestinalis (PCI) in a patient with undiagnosed systemic sclerosis
Pneumatosis cystoides intestinalis (PCI) refers to the presence of gas within the wall of the small or large intestine. The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. We present the case of a patient who was referred to gastroenterology clinic by her general practitioner for investigation of 8 months of weight loss, urgency, diarrhoea, bloating and crampy abdominal pain. Extensive investigations were performed to exclude infective, inflammatory or malignant aetiologies for these symptoms. She was diagnosed with PCI on her colonoscopy and was subsequently screened for secondary causes. Our patient was diagnosed with the limited cutaneous (CREST) variant of systemic scleroderma. This case report illustrates that PCI could be an uncommon presentation of systemic sclerosis, therefore clinicians should be aware of the association between these conditions.
https://ift.tt/2DDZfKb
Correction: Non-operative management, supported by self-monitoring using web-based patient reported outcome measures (PROMs), in knee osteoarthritis
Webb E, Parkes RJ, Gough AT, et al. Non-operative management, supported by self-monitoring using web-based patient reported outcome measures (PROMs), in knee osteoarthritis. BMJ Case Rep 2018. doi:10.1136/bcr-2017-223560.
This article was published with an error in the funding statement. The correct funding statement should read: 'the authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors'.
https://ift.tt/2xKCVJx
Perianeurysmal vasogenic oedema (PAVO) following aneurysm embolisation: a unique case of asymptomatic long-term progression and review of the literature
Perianeurysmal vasogenic oedema is a recognised although rare phenomenon following endovascular treatment of certain intracranial aneurysms. We present a unique case of asymptomatic perianeurysmal vasogenic oedema following bare platinum coil embolisation of an incidentally discovered right middle cerebral artery aneurysm that slowly increased over a period of 6 years before stabilising and regressing. During this time, the coiled aneurysm per se remained completely stable on serial magnetic resonance angiography.
https://ift.tt/2DGrjg1
Pneumopericardium due to bronchopericardial fistula in a patient with lung cancer
Description
Documented cases of pneumopericardium in patients with lung cancer are extremely rare.
We report the case of a 66-year-old man with a 45 pack-year smoking history and an Eastern Cooperative Oncology Group performance status 4. He presented with dyspnoea and chest pain in the last 2 hours. There were no signs of cardiac tamponade present.
CT angiography of the chest revealed a 78 mm right pulmonary mass containing small areas with gas density and a pneumopericardium of 28 mm in maximum thickness (figure 1). Transthoracic echocardiography showed the air gap sign, identified as the loss of signal during the systolic phase presented in patients with pneumopericardium. Bronchofibroscopy showed extensive infiltration and destruction of the carina bronchial wall and of the main bronchi by malignancy and endobronchial disease (figure 2). Endobronchial biopsies revealed an invasive squamous cell carcinoma.
Figure 1
CT angiography of the chest...
https://ift.tt/2xLV2yF
Unusual case of primary pulmonary Hodgkins lymphoma presenting with a continuous murmur
Systemic to pulmonary fistulas are an unusual entity, even more so in association with Hodgkin's lymphoma. We herein report a case of a 33-year-old woman that presented with an incidental lung lesion on a chest radiograph with an associated high-frequency continuous murmur over the lesion. The diagnosis of primary pulmonary Hodgkin's lymphoma, nodular sclerosis type, was obtained by a CT transthoracic biopsy. We achieved an excellent response after polychemotherapy with near-complete disappearance of the mass and a residual faint systolic murmur over the lesion.
https://ift.tt/2DHk4Er
Gardener-associated fibroma: an unusual cause of upper airway obstruction
We present the first case of upper airway obstruction secondary to a retropharyngeal Gardner-associated fibroma (GAF). A 16-month-old infant presented with a 3-month history of worsening dyspnoea and apnoeic episodes. Examination revealed stridor and left-sided retropharyngeal asymmetry. MRI demonstrated a mass in the retropharynx. Tracheostomy and pharyngeal biopsy under anaesthesia were performed, and histology confirmed a diagnosis of GAF. The mass was excised using a transcervical approach, and postoperative recovery was unremarkable. GAF is associated with Gardner's syndrome (GS) and familial adenomatous polyposis (FAP), both of which are associated with multiple colonic polyps and increased risk of colorectal malignancy. Subsequent testing for an APC mutation seen in GS and FAP was negative in our patient. The details of this unusual presentation of a rare disease are given in addition to a review of the literature.
https://ift.tt/2xKCQpd
Liver transplantation for inferior vena cava leiomyosarcoma: from a Maslows hammer to the Occams razor
Leiomyosarcoma (LMS) of primary vascular origin is a rare entity with only potentially curative option being complete surgical resection; despite which the prognosis remains dismal. Tumour recurrence is very common, and the benefits of adjuvant therapy are undefined. A 39-year-old woman presented with 6 months' history of abdominal pain, abdominal distension and pedal oedema. On evaluation, she was diagnosed to have chronic Budd-Chiari syndrome (BCS) secondary to a tumour arising from the inferior vena cava (IVC) on evaluation. Her liver decompensation included jaundice, gastrointestinal bleed and ascites. Following a detailed multidisciplinary team discussion, she underwent complete excision of the tumour along with a segment of the IVC with living donor liver transplantation. She remains disease-free 24 months following surgery. This is the first reported case of liver transplantation for IVC LMS causing chronic BCS.
https://ift.tt/2DCzrhC
Kiloh-Nevin syndrome associated with humeral shaft fracture
Fracture humerus may be associated with nerve injuries. However, among them median nerve is uncommonly involved and clinical affection of the anterior branch of median nerve is rare which can be easily missed and could be under-reported. A 42-year-old man presented with closed fracture of shaft of humerus right sided following fall. He had isolated weakness of flexor pollicis longus and flexor digitorum profundus of index finger without any other sensorimotor dysfunction. The findings were consistent with isolated palsy of anterior interosseous nerve (AIN). The patient was operated with fixation of humerus without exploring the AIN. At 6-month follow-up, the patient had complete recovery of both the muscles. This case highlights the classical clinical presentation of a rare injury associated with humerus fracture. Awareness and knowledge of this entity is of paramount importance for the practitioners.
https://ift.tt/2xKCKOn
Neuromyelitis optica with unilateral diaphragmatic paralysis
In this case report, we describe the course of a female patient who is known to have neuromyelitis optica (NMO) and developed left hemiparesis and unilateral diaphragmatic paralysis. She was initially treated with intravenous methylprednisolone 1 g daily for 5 days without improvement. Subsequently, she received five sessions of a plasmapheresis. Her hemiparesis had improved after few days. however, the phrenic nerve palsy remained.
https://ift.tt/2DNUuOm
Leptomeningeal dissemination of spinal pilocytic astrocytoma: a rare entity
Description
A currently 12-year-old boy presented at the age of 8 months with sleepiness, irritability and a tense fontanelle with upgaze palsy on a background of a 2-month history of vomiting, difficulty feeding and weight loss. Acute communicating hydrocephalus was diagnosed using ultrasonography and CT and treated with Ventriculo-Peritoneal shunt insertion. Further investigation with MRI (2006) found a thoracic intramedullary mass with further intracranial and spinal leptomeningeal dissemination (LD) (figures 1 and 2). A biopsy of the thoracic intramedullary mass showed pilocytic astrocytoma (PA) (figure 3).
Figure 1
Initial MRI whole spine (2006). (A) T2 sagittal, (B) T1 sagittal and (C) postcontrast T1 sagittal. Black arrows in (A) and (B) show upper thoracic intramedullary mass. The white arrow in (C) shows no significant enhancement. Thick white arrows in (C) show leptomeningeal enhancement.
Figure 2
Initial MRI brain...
https://ift.tt/2xKCDlV
Severe calcium pyrophosphate dihydrate deposition disease of the metacarpophalangeal joints
We report a case of calcium pyrophosphate deposition disease (CPPD) with an unusual presentation of severe chondrocalcinosis with atypical large burden deposited in the metacarpophalangeal joints as well as more typical deposition in wrists and knees as demonstrated on plain radiographs. A 77-year-old African-American woman 1-year status post parathyroidectomy for hyperparathyroidism initially presented to the rheumatology clinic to treat suspected rheumatoid arthritis given her pattern of joint involvement but was found to have CPPD. The patient's history is notable for end-stage renal disease which complicates medical management. This case illustrates radiographic findings of CPPD and explores the challenges of treating CPPD in the setting of comorbid conditions.
https://ift.tt/2DNUqhA
Health literacy and cancer self‐management behaviors: A scoping review
Cancer, EarlyView.
https://ift.tt/2xLmo82
Hospitalization by cytotoxic chemotherapy regimen among older women with stage IV breast cancer
Cancer, EarlyView.
https://ift.tt/2DNUo9s
Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis
Objective
Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services.
MethodWe conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication.
ResultsEleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences.
ConclusionsThere is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
https://ift.tt/2R9jPVq
Functional genomics identifies AMPD2 as a new prognostic marker for undifferentiated pleomorphic sarcoma
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NQqsxY
Long‐term relationships between screening rates, breast cancer characteristics, and overdiagnosis in US counties, 1975‐2009
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QiXwv1
Somatic aberrations of BRCA1 gene are associated with ALDH1, EGFR and tumor progression in prostate cancer
International Journal of Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NNDEDD
A randomized, single-blind, single-dose study to assess the pharmacokinetic equivalence of the biosimilar ABP 215 and bevacizumab in healthy Japanese male subjects
Abstract
Purpose
Analytic, pharmacokinetic (PK), and clinical similarity between the biosimilar ABP 215 and bevacizumab has previously been demonstrated in global studies. Here we present a phase 1 study in healthy adult Japanese men.
Methods
This study was a randomized, single-blind, single-dose, parallel-group study comparing PK parameters of ABP 215 versus EU-authorized bevacizumab in healthy Japanese men. Primary endpoints were maximum observed serum concentration (Cmax) and area under the serum concentration—time curve from time 0 to infinity (AUCinf). Secondary endpoints included AUC from time 0 to time of last quantifiable concentration (AUClast), safety, tolerability, and immunogenicity.
Results
Baseline characteristics were similar among study subjects (n = 24/group). After a 3-mg/kg intravenous infusion, the geometric means (GMs) of Cmax, AUCinf, and AUClast were 71.2 µg/mL, 25,259 µg h/mL, and 22,499.3 µg h/mL, respectively, for ABP 215 and 70.16 µg/mL, 25,801 µg h/mL, and 22,604.6 µg h/mL, respectively, for bevacizumab. The GM ratios (90% confidence interval; CI) for Cmax, AUCinf, and AUClast were 1.015 (0.946–1.088), 0.979 (0.914–1.049), and 0.995 (0.941–1.053) for ABP 215 versus bevacizumab. All CIs fell within the prespecified bioequivalence margin (0.80–1.25). Adverse events (AEs) occurred in 2/24 subjects receiving ABP 215 and 1/24 receiving bevacizumab. There were no deaths or AEs leading to study discontinuation; no subject was positive for binding anti-drug antibodies (ADAs).
Conclusions
ABP 215 and bevacizumab showed PK similarity in Japanese men. Safety profiles were comparable between the two groups. The pharmacokinetics in Japanese subjects were consistent with those in a previous global PK equivalence study.
https://ift.tt/2xOuKf2
Filtered Out, but Not by Skill: The Gender Gap in Pursing Mathematics at a High-Stakes Exam
Abstract
The present paper concerns the gender gap in pursuing mathematics at high stakes matriculation exams in Poland. Results of the optional Extended Exam in Mathematics (EEM) serve as the main criterion in entering tertiary education in majority of technical and engineering majors and, therefore, the exam works as an important filter for future career paths. We investigate whether the wide, gross difference between men and women in the propensity to take EEM can be mostly explained by an underlying skill difference, school effects, or other non-cognitive factors. We also test a skill immunization hypothesis which predicts that the gender gap declines at higher levels of mathematical skill. For those purposes we use official data from the 2016 matriculation exams covering the complete cohort of a quarter of a million students in more than 5000 schools. The results show that with skill and school effects roughly held constant, women are still much less likely to take EEM and the gender gap does not narrow on the upper tail of performance in mathematics. Furthermore, higher verbal skill draws women away from pursuing mathematics more strongly than it draws away men. These combined results imply that non-cognitive factors play a key role in self-selection processes and that STEM majors are at higher risk of losing mathematically gifted women than mathematically gifted men.
https://ift.tt/2Itl65S
Acquiescing to the Script: A Panel Study of College Students’ Sexual Media Habits, Endorsement of Heteronormative Scripts, and Their Hesitance Toward Resisting Unwanted Hookups
Abstract
The present study set out to better understand how sexual entertainment media may be related to college students' heteronormative beliefs about sexuality and how these beliefs may be related to college students' hesitance toward resisting unwanted hookups. In a 2-month two-panel survey, cross-lagged models found 292 U.S. college women's sexual media habits were related to higher endorsement of heteronormative scripts, and their endorsement of heteronormative scripts were related to a hesitance toward resisting unwanted hookups. In addition, a half longitudinal mediation model found college women's sexual media habits were indirectly related to a greater hesitance toward resisting unwanted hookups through their endorsement of heteronormative scripts. The same analyses involving 88 U.S. college men were not significant, although the sample size for men did not reach the level needed for statistical power. These results provide some initial evidence that college women's, but not men's, hesitance toward resisting unwanted hookups could be related to beliefs reinforced by their habits regarding sexual entertainment media, which suggests the importance of educating young adult women about sexual agency, consent, and how to combat the role to which they are relegated within heteronormative scripts.
https://ift.tt/2zE6JbU
Bone marrow-stimulating techniques in arthroscopic rotator cuff repair: a systematic review protocol
Introduction
Bone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery.
Methods and analysisWe will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities.
Ethics and disseminationWe will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals.
PROSPERO registration numberCRD42018087161.
https://ift.tt/2IoBswz
Temporal and spatial associations between influenza and asthma hospitalisations in New York City from 2002 to 2012: a longitudinal ecological study
Objectives
To determine whether asthma hospitalisations of children and adults in the five boroughs of New York City are correlated with influenza hospitalisations temporally and spatially.
DesignA longitudinal ecological study.
Inclusion criteriaWe reviewed the Statewide Planning and Research Cooperative System's records of hospitalisations in Manhattan, Bronx, Queens, Brooklyn and Staten Island from 2002 to 2012. All hospitalisations with a primary diagnosis of either asthma or influenza were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.
MethodsA time-series regression analysis was performed using aggregate monthly counts of influenza hospitalisations as predictors of asthma hospitalisations. Time-series regression models were also applied to different age groups and boroughs to examine the magnitude of influenza and asthma correlations across strata. The per cent excess risk was also calculated across age groups and boroughs.
ResultsTime-series analysis of the overall population revealed a significant positive correlation between influenza and asthma hospitalisations (p=0.011). When stratifying by age, there was a significant positive correlation between asthma and influenza hospitalisations for individuals 18 and older (p<0.01), and no significant correlation found for age groups younger than 18. Percentages of excess risk of influenza-related asthma hospitalisations also increased with increasing age with adults 18–44, 45–64 and 65+ having excess risk percentages of 2.9%, 3.4% and 4%, respectively. Time-series analysis by location revealed positive significant correlations between asthma and influenza hospitalisations in Brooklyn (p=0.03) and Manhattan (p<0.01). Manhattan and Brooklyn had a 2.5% and 1.6%, respectively, percentage of excess risk of influenza-related asthma hospitalisations.
ConclusionInfluenza and asthma hospitalisations are significantly associated at the population level among adults. These associations vary by age and geographical location. Influenza prevention strategies targeting adult populations, particularly individuals living in Manhattan and Brooklyn, have the potential for meaningful reduction of influenza-related asthma hospitalisations.
https://ift.tt/2Ip7Sah
Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Womens Cohort Study (UKWCS)
Objectives
Breast cancer is associated with overweight and obesity after menopause. However, clothing size as a proxy of adiposity in predicting postmenopausal breast cancer is not widely studied. We aimed to explore the relationships between postmenopausal breast cancer risk with adipose indicators (including clothing sizes) and weight change over adulthood.
DesignProspective cohort study.
SettingEngland, Wales and Scotland.
Participants17 781 postmenopausal women from the UK Women's Cohort Study.
Primary outcome measureIncident cases of malignant breast cancers (International Classification of Diseases (ICD) 9 code 174 and ICD 10 code C50).
ResultsFrom 282 277 person-years follow-up, there were 946 incident breast cancer cases with an incidence rate of 3.35 per 1000 women. Body mass index (HR: 1.04; 95% CI: 1.02 to 1.07), blouse size (HR: 1.10; 1.03 to 1.18), waist circumference (HR: 1.07; 1.01 to 1.14) and skirt size (HR: 1.14;1.06 to 1.22) had positive associations with postmenopausal breast cancer after adjustment for potential confounders. Increased weight over adulthood (HR: 1.02; 1.01 to 1.03) was also associated with increased risk for postmenopausal breast cancer.
ConclusionsBlouse and skirt sizes can be used as adipose indicators in predicting postmenopausal breast cancer. Maintaining healthy body weight over adulthood is an effective measure in the prevention of postmenopausal breast cancer.
https://ift.tt/2RaxZ8W
Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: a nationwide cohort study in Korea
Objective
To evaluate whether oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin increase the risk of ventricular arrhythmia in Korea's general population.
DesignPopulation-based cohort study using administrative claims data on a national scale in Korea.
SettingAll primary, secondary and tertiary care settings from 1 January 2015 to 31 December 2015.
ParticipantsPatients who were prescribed the relevant study medications at outpatient visits.
Primary outcome measuresEach patient group that was prescribed ciprofloxacin, levofloxacin, ofloxacin or moxifloxacin was compared with the group that was prescribed cefixime to assess the risk of serious ventricular arrhythmia (ventricular tachycardia, fibrillation, flutter and cardiac arrest). Using logistic regression analysis with inverse probability of treatment weighting using the propensity score, OR and 95% CI for serious ventricular arrhythmia were calculated for days 1–7 and 8–14 after the patients commenced antibiotic use.
ResultsDuring the study period, 4 888 890 patients were prescribed the study medications. They included 1 466 133 ciprofloxacin users, 1 141 961 levofloxacin users, 1 830 786 ofloxacin users, 47 080 moxifloxacin users and 402 930 cefixime users. Between 1 and 7 days after index date, there was no evidence of increased serious ventricular arrhythmia related to the prescription of ciprofloxacin (OR 0.72; 95% CI 0.49 to 1.06) and levofloxacin (OR 0.92; 95% CI 0.66 to 1.29). Ofloxacin had a 59% reduced risk of serious ventricular arrhythmia compared with cefixime during 1–7 days after prescription. Whereas the OR of serious ventricular arrhythmia after the prescription of moxifloxacin was 1.87 (95% CI 1.15 to 3.11) compared with cefixime during 1–7 days after prescription.
ConclusionsDuring 1–7 days after prescription, ciprofloxacin and levofloxacin were not associated with increased risk and ofloxacin showed reduced risk of serious ventricular arrhythmia. Moxifloxacin increased the risk of serious ventricular arrhythmia.
https://ift.tt/2IpcgWA
Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study
Aim
The aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).
Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort's demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients' discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.
ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients' self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.
https://ift.tt/2R3BmOR
Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study
Objectives
To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.
DesignQualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.
SettingIn North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.
Participants181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.
ResultsFive main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.
ConclusionsImplementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.
https://ift.tt/2IozcW1
Impact of bariatric surgery on neural food processing and cognition: an fMRI study
Introduction
The Roux-en-Y gastric bypass (RYGB) is one of the most widely used techniques for bariatric surgery. After RYGB, weight loss up to 50%–70% of excess body weight, improvement of insulin-resistance, changes in food preferences and improvements in cognitive performance have been reported. This protocol describes a longitudinal study of the neural correlates associated with food-processing and cognitive performance in patients with morbid obesity before and after RYGB relative to lean controls.
Methods and analysisThis study is a pre–post case–control experiment. Using functional MRI, the neural responses to food stimuli and a working memory task will be compared between 25 patients with obesity, pre and post RYGB, and a matched, lean control group. Resting state fMRI will be measured to investigate functional brain connectivity. Baseline measurements for both groups will take place 4 weeks prior to RYGB and 12 months after RYGB. The effects of RYGB on peptide tyrosine tyrosine and glucagon-like polypeptide-1 will also be determined.
Ethics and disseminationThe project has received ethical approval by the local medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-073). Results will be published in a peer-reviewed journal as original research and on international conferences.
Trial registration numberDRKS00012495; Pre-results.
https://ift.tt/2R4gVRI
Association of body mass index and age with incident diabetes in Chinese adults: a population-based cohort study
Objective
Type 2 diabetes mellitus is increasing in young adults, and greater adiposity is considered a major risk factor. However, whether there is an association between obesity and diabetes and how this might be impacted by age is not clear. Therefore, we investigated the association between body mass index (BMI) and diabetes across a wide range of age groups (20–30, 30–40, 40–50, 50–60, 60–70 and ≥70 years old).
DesignWe performed a retrospective cohort study using healthy screening programme data.
SettingA total of 211 833 adult Chinese persons >20 years old across 32 sites and 11 cities in China (Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong) were selected for the study; these persons were free of diabetes at baseline.
Primary and secondary outcome measuresFasting plasma glucose levels were measured and information regarding the history of diabetes was collected at each visit. Diabetes was diagnosed as fasting plasma glucose ≥7.00 mmol/L and/or self-reported diabetes. Patients were censored at the date of diagnosis or the final visit, whichever came first.
ResultsWith a median follow-up of 3.1 years, 4174 of the 211 833 participants developed diabetes, with an age-adjusted incidence rate of 7.35 per 1000 persons. The risk of incident diabetes increased proportionally with increasing baseline BMI values, with a 23% increased risk of incident diabetes with each kg/m2 increase in BMI (95% CI 1.22 to 1.24). Across all age groups, there was a linear association between BMI and the risk of incident diabetes, although there was a stronger association between BMI and incident diabetes in the younger age groups (agexBMI interaction, p<0.0001).
ConclusionsAn increased BMI is also independently associated with a higher risk of developing diabetes in young adults and the effects of BMI on incident diabetes were accentuated in younger adults.
https://ift.tt/2Ipc61q
Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance specialist access to care: a scoping review protocol
Introduction
Electronic consultations (eConsult), asynchronous exchanges of patient health information at a distance, are increasingly used as an option to facilitate patient care and collaboration between primary care providers and specialists. Although eConsult has demonstrated success in increasing efficiency in the referral process and enhancing access to care, little is known about the factors influencing its wider adoption and implementation by end users. In this paper, we describe a protocol to conduct a scoping review of the literature on the barriers and facilitators to a wider adoption and implementation of eConsult service.
Methods and analysisThis scoping review will be based on the framework pioneered by Arksey and O'Malley and later developed by Levac et al. We will use the guidance for scoping reviews developed by the Joanna Briggs Institute to report our findings. In addition to several electronic databases (Medline, Embase, Cochrane Library, CINAHL, EBSCOhost and PsycINFO) studies will be identified by including relevant grey literature. Two reviewers will independently screen titles and full texts for inclusion. Studies reporting on barriers and/or facilitators in settings similar to eConsult will be included. Data on study characteristics and key barriers and facilitators will be extracted. Data will be analysed thematically and classified using the Quadruple Aim framework.
Ethics and disseminationApproval by research ethics board is not required since the review will only include published and publicly accessible data. Review findings will be used to inform future studies and the development of practice tools to support the wider adoption and success of eConsult implementation. We plan to publish our findings in a peer-reviewed journal and develop a useful and accessible summary of the results.
https://ift.tt/2R7EuZQ
Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study
Objectives
The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group.
DesignA descriptive study using nationwide mortality rates.
SettingData on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea.
ParticipantsPeople living in South Korea.
InterventionsImplementation of national suicide prevention policies (first: year 2004, second: year 2009).
Primary outcome measuresSuicide was defined as 'X60-X84' code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate.
ResultsFrom 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI –10.3% to –0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI –9.1% to –3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends.
ConclusionOur results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
https://ift.tt/2IoF6qe
Nurse-led medicines monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines
Introduction
Improved medicines' management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes.
Methods and analysisThis process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method.
Ethics and disseminationEthical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators.
Trial registration numberhttps://ift.tt/2R7kgj3
What is the evolution of stroke units accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases.
Objectives
We aimed to study trends in stroke unit (SU) admission during a period of their deployment in France and to assess whether this led to better and more equitable access to this specialised care.
DesignAnalysis of records from the national hospital database.
SettingAll acute care hospitals in metropolitan France for the period 2009–2014.
ParticipantsOver 600 000 patients admitted in acute care with a main diagnosis of stroke.
Main outcome measuresAdmission to a SU.
ResultsBetween 2009 and 2014, the number of stroke admissions rose from 93 728 to 109 456, and the proportion of SU admission from 23% to 44%. Overall, characteristics associated with higher probability of SU admission were: male gender, younger age, ischaemic stroke type, medium level of comorbidity and larger size of town of residence. Although likelihood of SU admission increased in all patients' categories during the study period, we identified steeper positive temporal trends among older patients, those with more comorbidities and those residing in medium or small towns (all p values <0.001), suggesting a 'catching up' phenomena. Temporal trends of men and women did not differ however.
ConclusionsAdmission to SU nearly doubled in France between 2009 and 2014. Faster trends observed for patients with lower admission to SU suggest that equity in access has improved over the period.
https://ift.tt/2IoF3uy
How do general practitioners and pharmacists experience antibiotic use in out-of-hours primary care? An exploratory qualitative interview study to inform a participatory action research project
Rationale
Antibiotics (ABs) are one of the most prescribed medications in out-of-hours (OOH) care in Belgium. Developing a better understanding of why ABs are prescribed in this setting is essential to improve prescribing habits.
ObjectivesTo assess AB prescribing and dispensing challenges for general practitioners (GPs) and pharmacists in OOH primary care, and to identify context-specific elements that can help the implementation of behaviour change interventions to improve AB prescribing in this setting.
DesignThis is an exploratory qualitative study using semistructured interviews. This study is part of a participatory action research project.
Setting and participantsParticipants include 17 GPs and 1 manager, who work in a Belgian OOH general practitioners cooperative (GPC), and 5 pharmacists of the area covered by the GPC. The GPC serves a population of more than 187 000 people.
ResultsGPs feel the threshold to prescribe AB in OOH care is lower in comparion to office hours. GPs and pharmacists talk about the difference in their professional identity in OOH (they define their task differently, they feel more isolated, insecure, have the need to please and so on), type of patients (unknown patients, vulnerable patients, other ethnicities, demanding patients and so on), workload (they feel time-pressured) and lack of diagnostic tools or follow-up. They are aware of the problem of AB overprescribing, but they do not feel ownership of the problem.
ConclusionThe implementation of behaviour change interventions to improve AB prescribing in OOH primary care has to take these context specifics into account and could involve interprofessional collaboration between GPs and pharmacists.
Trial registration numberhttps://ift.tt/2R7EusO
Small RNA sequencing of sessile serrated polyps identifies microRNA profile associated with colon cancer
Genes, Chromosomes and Cancer, Volume 0, Issue ja, -Not available-.
https://ift.tt/2DFS83S
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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Alimentary Pharmacology &Therapeutics, EarlyView. https://ift.tt/2qECBIJ
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heory of COVID-19 pathogenesis Publication date: November 2020Source: Medical Hypotheses, Volume 144Author(s): Yuichiro J. Suzuki ScienceD...
