Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience of Spanish primary care providers handling uncertainty and patients requests

Objectives

Identify the sources of overuse from the point of view of the Spanish primary care professionals, and analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals face these demands.

Design

A cross-sectional study.

Setting

Primary care in Spain.

Participants

A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was recruited during the survey.

Primary and secondary outcome measures

The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.

Results

In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments that patients could find on printed and digital media, contributed to the professional's inability to adequately counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x²=88.8, P<0.001, percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x²=175.7, P<0.001, PD=12.3).

Conclusion

Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.

https://ift.tt/2LUp9Ze

Socioeconomic status and cigarette expenditure among US households: results from 2010 to 2015 Consumer Expenditure Survey

Objectives

To examine (1) the association between household socioeconomic status (SES) and whether a household spends money on cigarettes and (2) socioeconomic variations in proportion of total household expenditure spent on cigarettes among smoking households.

Methods

We pooled data from six consecutive years, 2010–2015, of the Consumer Expenditure Interview Survey. The interviews involved a structured questionnaire about household income, demographics and expenditures including expenditure on cigarettes. Households that reported cigarette expenditure in the previous 3 months were distinguished as smoking households. SES indicators were household poverty status, education and occupation of the head of household. Logistic regression was used to assess the association of household smoking status with SES. Fractional logistic regression was used to assess the association of cigarette expenditure as a proportion of total household expenditure with SES. The analysis sample size was 39 218.

Results

The probability of spending money on cigarettes was higher among lower SES households. Households in poverty compared with those above 300% of poverty threshold had 1.86 (95% CI 1.61 to 2.16), households headed by a person with less than high school education compared with those headed by a person with at least a bachelor's degree had 3.37 (95% CI 2.92 to 3.89) and households headed by a blue-collar work compared with those headed by a person in a managerial occupation had 1.45 (95% CI 1.26 to 1.66) higher odds of spending money on cigarettes. Similarly, the proportion of total household expenditure spent on cigarettes was higher among lower SES smoking households.

Conclusion

Lower SES households are more likely to spend money on cigarettes and spend a larger proportion of their total expenditure on cigarettes. We recommend strategies effective in reducing smoking among low SES smokers.

https://ift.tt/2t3J94L

What insights do patients and caregivers have on acute kidney injury and posthospitalisation care? A single-centre qualitative study from Toronto, Canada

Objectives

Hospitalisation with acute kidney injury (AKI) is associated with short-term and long-term adverse events, but patient and caregiver experiences with AKI are not well described. We sought to better understand patient and caregiver perspectives after a hospitalisation with AKI to inform discharge strategies that may improve outcomes for this high-risk population.

Design

Qualitative study with semistructured interviews.

Setting

Tertiary care hospital in Toronto, Ontario, Canada.

Participants

Adult patients (n=15) who survived a hospitalisation with Kidney Disease Improving Global Outcomes stage 2 or 3 AKI from May to December 2016. We also interviewed five patient caregivers. We required patients to have no previous evidence of severe chronic kidney disease (ie, prior receipt of dialysis, previous kidney transplantation or pre-existing estimated glomerular filtration rate (eGFR) under 30 mL/min/1.73 m²).

Results

We identified three over-arching themes: (1) prioritisation of conditions other than AKI, reflected by the importance placed on other comorbidities and the omission of AKI as part of the ongoing medical history; (2) variability in comprehension of the significance of AKI, represented by minimal knowledge of the causes and symptoms associated with AKI, along with misinformation on the kidneys' ability to self-repair; and (3) anxiety from discharge planning and competing health demands, illustrated by complicated discharge plans involving multiple specialist appointments.

Conclusions

Patients and caregivers view AKI as a short-term and reversible condition, giving it little thought during the postdischarge period. As a result, reliance on patients and caregivers to report an episode of AKI to their outpatient physicians is unlikely to be successful. Patient-centred tools and decision aids are needed to bridge the gap between a hospitalisation with AKI and the safe transition to the outpatient setting.

https://ift.tt/2LSvQem

Changes in the rate of publicly financed knee arthroscopies: an analysis of data from the Norwegian patient registry from 2012 to 2016

Objective

To examine rates of publicly financed knee arthroscopic surgery in Norway between 2012 and 2016.

Design

Analysis of anonymised data from the National Patient Registry.

Interventions

Beginning in 2012, South-Eastern Norway Regional Health Authority implemented administrative measures to bring down rates of knee arthroscopy. Similar measures were not introduced in the other three Regional Health Authorities.

Main outcome measures

We analysed annual national rates of publicly financed knee arthroscopies in 2012 and 2016. We compared the rates in South-Eastern Norway Regional Health Authority with corresponding rates in the rest of the country. Variations by county, public hospital versus publicly reimbursed private hospital, gender and age were also assessed.

Results

The overall annual rate of arthroscopic procedures declined by 33% from 2012 to 2016, from 310 to 207 per 100 000 inhabitants, respectively. Hospitals in South-Eastern Norway Regional Health Authority reported a 48% reduction, compared with mean 13% in the other three Regional Health Authorities. In public hospitals, rates decreased nationally by 42%, while rates in publicly reimbursed private hospitals increased by 12%. Rates in publicly reimbursed private hospitals decreased by 30% in South-Eastern Norway Regional Health Authority but increased by 63% in the other Regional Health Authorities. The proportion of patients ≥50 years (excluding meniscal repairs) in Norway was 54% in 2012 and fell to 46% in 2016. Average rates per county varied by a factor of 3:1.

Conclusion

We report a marked overall reduction of knee arthroscopic procedures from 2012 to 2016 in publicly funded hospitals. The largest decrease was reported in South-Eastern Norway Regional Health Authority, and this coincides in time with implemented administrative measures. The results suggest that the trend of increasing rates of knee arthroscopies can be reversed through purposeful professional and administrative interventions.

https://ift.tt/2JJgtZ0

An international qualitative study exploring patients experiences of cutaneous leishmaniasis: study set-up and protocol

Introduction

Lack of investments in drug development, lack of standardisation of clinical trials and the complexity of disease presentations contribute to the current lack of effective, safe and adapted treatments for cutaneous leishmaniasis (CL). One aspect concerns outcomes affecting patients' quality of life (QoL): these are hardly assessed in trials, despite potential functional and/or aesthetic impairment caused by CL, which typically affects disadvantaged and vulnerable people living in rural areas. Here, we describe the approach used to bring perspectives of patients with CL into designing and assessing treatments.

Methods and analysis

This international qualitative study uses interviews with patients to explore their experiences with CL to (1) elicit outcomes and eligibility criteria for clinical trials important to them and (2) to better understand their needs and views about the disease and their requirements and expectations from treatment. Here, we describe the set-up of this collaborative study and the protocol. Data collection is ongoing.

The protocol includes study design, preparation, conduct and analysis of individual interviews with approximately 80 patients in seven countries (Burkina Faso, Brazil, two sites in Colombia, Iran, Morocco, Peru and Tunisia) where CL is prevalent. Principal investigators and sites were selected through an open call, and two workshops were organised for protocol development and training in conduct and analysis of qualitative health research. Patient recruitment aims at covering a maximum variation of experiences. Transcripts will be analysed to identify outcomes and eligibility criteria as well as further topics that are expected to emerge from the interviews, such as direct and indirect costs related to CL, its psychological impact, preferred modes of drug administration and traditional treatments.

Ethics and dissemination

The study received ethical approval by the responsible committees of each of the participating institutions. Findings will be disseminated through publication in peer-reviewed journals, scientific meetings and to participants and their communities.

https://ift.tt/2LWmCxU

The COMMAND trial of cognitive therapy for harmful compliance with command hallucinations (CTCH): a qualitative study of acceptability and tolerability in the UK

Objectives

To explore service user experiences of a 9-month cognitive behavioural therapy for command hallucinations in the context of a randomised controlled trial including their views on acceptability and tolerability of the intervention.

Design

Qualitative study using semistructured interviews.

Setting

The study took place across three sites: Birmingham, Manchester and London. Interviews were carried out at the sites where therapy took place which included service bases and participants' homes.

Participants

Of 197 patients who consented to the trial, 98 received the Cognitive Behavior Therapy for Command Hallucinations (CTCH) intervention; 25 (15 males) of whom were randomly selected and consented to the qualitative study. The mean age of the sample was 42 years, and 68% were white British.

Results

Two superordinate themes were identified: participants' views about the aspects of CTCH they found most helpful; and participants' concerns with therapy. Helpful aspects of the therapy included gaining control over the voices, challenging the power and omniscience of the voices, following a structured approach, normalisation and mainstreaming of the experience of voices, and having peer support alongside the therapy. Concerns with the therapy included anxiety about completing CTCH tasks, fear of talking back to voices, the need for follow-up and ongoing support and concerns with adaptability of the therapy.

Conclusions

Interpretation: CTCH was generally well received and the narratives validated the overall approach. Participants did not find it an easy therapy to undertake as they were challenging a persecutor they believed had great power to harm; many were concerned, anxious and occasionally disappointed that the voices did not disappear altogether. The trusting relationship with the therapist was crucial. The need for continued support was expressed.

Trial registration number

ISRCTN62304114, Pre-results.

https://ift.tt/2t2AbEN

Long weekly working hours and ischaemic heart disease: a follow-up study among 145 861 randomly selected workers in Denmark

Objectives

The aim of the present study was to test if incidences of ischaemic heart disease (IHD) and usage of antihypertensive drugs are independent of weekly working hours (WWH) among full-time employees in Denmark.

Design and participants

Data on WWH from participants of the Danish labour force surveys, 1999–2013, were linked on an individual level to national registers with data on socioeconomic status (SES), industry, emigrations, redeemed prescriptions, hospital contacts and deaths. Participants were followed until the end of 2014 (on average 7.7 years). Poisson regression was used to model incidence rates as a function of WWH. The analyses were controlled for calendar time, time passed since start of follow-up, employment in the healthcare industry, age, sex, SES and night work.

Results

In total, we found 3635 cases of IHD and 20 648 cases of antihypertensive drug usage. The rate ratio of IHD was 0.95 (95% CI 0.85 to 1.06) for 41–48 compared with 32–40 WWH and 1.07 (0.94 to 1.21) for >48 compared with 32–40 WWH. The corresponding rate ratios for antihypertensive drug usage were 0.99 (0.95 to 1.04) and 1.02 (0.97 to 1.08). No statistically significant interactions between WWH and sex, SES and night work, respectively, were found.

Conclusion

In this Danish sample, we did not find any statistically significant association between WWH and IHD or antihypertensive drug usage.

https://ift.tt/2LVGyRl

Histological changes of superficial esophageal squamous cell carcinoma after preoperative chemotherapy

Abstract

Introduction

We aimed to analyze the clinical and histological effects of chemotherapy in superficial esophageal squamous cell carcinoma (SESCC).

Methods

We analyzed tumor samples from five patients with cT1bN1M0 who underwent subtotal esophagectomy following two courses of a new triplet chemotherapy regimen including docetaxel, cisplatin, and 5-fluorouracil (DCF). To assess the histological effects of chemotherapy, resected specimens were analyzed by macroscopic examination, hematoxylin & eosin (HE) staining, immunohistochemical (IHC) staining (p53, Ki-67 and cytokeratin) and periodic acid-Schiff (PAS) staining.

Results

All five patients had a pathological T stage of T0/1a-LPM/1a-MM/1b (1/2/1/1) and histological grade of grade1a/1b/2/3 (1/1/2/1). Endoscopic examination revealed substantial shrinkage of lugol-voiding lesions (LVLs) in all cases. One case showed complete LVL disappearance, and resected specimen examination confirmed pathological complete response (pCR). IHC and PAS staining revealed that most initial LVLs were PAS-negative. Obvious viable cells were confirmed in two cases. The other three cases exhibited nuclear atypia and strong expression of p53 and Ki-67 in the basal layer of mucosa or lamina propria mucosae, even though the superficial layer of mucosa showed no obvious LVLs with PAS-positive. p53-positive lesions were also observed in Ki-67-positive. This indicated discordance between the endoscopic findings and histopathological evaluation.

Conclusion

DCF chemotherapy alone had a substantial therapeutic effect on SESCC in all cases. However, despite the normal appearance of the mucosal surface, viable cancer cells remained below the basal layer of mucosa. Careful attention should be paid when diagnosing clinical CR, or securing a resection margin of SESCC after DCF chemotherapy.

https://ift.tt/2JOv5lT

Atypical chest pain in a patient with hydatid cyst of the interventricular septum

We report a 57-year-old man presenting with symptoms of sharp pricking, exertional retrosternal chest pain multiple times, each episode lasting for a few seconds. On evaluation, the ECG of the patient showed normal sinus rhythm with T wave inversions in leads V1–V3. Troponin T test was negative. Transthoracic echocardiography showed a globular mass in the interventricular septum. Cardiac MRI was suspicious of the lesion to be a hydatid cyst. Surgical excision of the lesion followed by histopathology was confirmatory of hydatid cyst.

https://ift.tt/2LTh4UI

Dengue fever with encephalitis: a rare phenomenon

The clinical profile and presentation of patients with dengue fever may differ from asymptomatic infection to the dreadful complications like dengue shock syndrome. However, neurological complications are very rare. Dengue encephalitis occurs by a direct involvement of central nervous system by the dengue virus which is an extremely rare complication. A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital. The diagnosis of dengue fever was confirmed by dengue serology (IgM) and (NS1) antigen assay. MRI brain was suggestive of encephalitis. Thus, the patient was treated symptomatically and discharged in stable condition with minimal neurological deficit.

https://ift.tt/2t1hfXb

Rotator cuff tear following long-standing axillary neuropathy in a female motocross racer

A 'terrible triad' of anterior shoulder dislocation, axillary nerve damage and rotator cuff tear has been previously described. However, we are unaware of any report of anterior shoulder dislocation, humeral fracture, axillary neuropathy and subsequent rotator cuff tear requiring surgery when the axillary neuropathy was deemed permanent. We report the case of a 20-year-old woman who fell in a motocross accident and had an anterior shoulder dislocation, humeral fracture and axillary neuropathy. The fracture was treated surgically with open reduction and internal fixation. The axillary nerve injury was ultimately permanent. Thirteen months after the motocross accident, the patient sustained a rotator cuff tear from seemingly minor trauma. However, several months of aggressive physical therapy preceded the rotator cuff tear. The tear was repaired and the patient was followed for 5 years after the initial injury. She returned to competing in motocross, even though the axillary neuropathy remained complete and permanent.

https://ift.tt/2LVOBxG

Thiazide diuretics-associated skin rash

Description 

A 50-year-old man with a history of hypertension and dyslipidaemia, both controlled with oral medications, was admitted to the emergency department due to a sudden onset of pruritus 2 days before, which would not improve with the application of topic antihistamines prescribed by his family doctor. A maculopapular, symmetric rash with plaques located on sun-exposed areas (hands, forearms, face and upper torso, sparing the abdomen, lower limbs and arm flexures) had appeared a few hours before coming to the emergency department (figures 1 and 2). The patient denied any sort of respiratory distress, as well as prolonged exposure to sunlight, history of drug allergies or having seen anyone in his family with the same problem before. The only recent change had been to his hypertension medication in the last 13 days, when hydrochlorothiazide was combined with his usual medication (losartan), which he had been taking for the...

https://ift.tt/2t0O0Uk

Transdermal rotigotine patch in Parkinsons disease with a history of intestinal operation

A 42-year-old Japanese man with a history of small intestine resection and familial Mediterranean fever was referred to our hospital for a second opinion on parkinsonism. At the age of 35, the patient attended a hospital due to impaired left-hand movement and resting tremor. He was previously diagnosed with multiple system atrophy based on the lack of effectiveness of levodopa treatment. With suspicion of malabsorption due to his history of ileostomy, a levodopa challenge test with levodopa intravenous infusion was conducted, and revealed a 65% improvement in Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part III. Therefore, diagnosis of Parkinson's disease was made and a transdermal rotigotine patch was selected as a treatment. This treatment dose-dependently improved the patient's symptoms. The transdermal drug delivery should be considered when patients show dose failure due to malabsorption.

https://ift.tt/2LUyuAf

Delayed presentation of iatrogenic splenic injury 21 days after laparoscopic donor left nephrectomy

We report the case of a 46-year-old woman who had presented with left-sided abdominal pain 21 days after undergoing a left-sided laparoscopic nephrectomy for donation. Initial haemoglobin and haematocrit levels were within normal range, and vital signs on admission were unremarkable. Significant intra-abdominal pathology was not suspected; however, inpatient CT scan of the abdomen showed a posterolateral subcapsular splenic haematoma with free abdominal fluid. Initial trial of conservative management was not successful as the patient became hypotensive on the third day of admission with a sudden decrease in haemoglobin and haematocrit. The patient was immediately taken to theatre for laparotomy and splenectomy. Recovery was uneventful and was discharged home on the fifth postoperative day. In this article, we aim to discuss several important clinical lessons involving iatrogenic injury of the spleen, its management, and diagnosis of acute and severe haemorrhage.

https://ift.tt/2JHrWbP

Paraneoplastic cerebellar degeneration in a patient with anaplastic non-Hodgkins lymphoma

A 31-year-old man presented with a subacute cerebellar syndrome of unknown aetiology. Investigations including a paraneoplastic antibody screen were negative and a working diagnosis of possible vasculitis was concluded. After 1 month, he re-presented with worsening of his symptoms and a neck lump. He was diagnosed with anaplastic lymphoma kinase, negative non-Hodgkin's lymphoma and paraneoplastic cerebellar syndrome. A more extensive paraneoplastic antibody screen found patient to be Tr (delta/notch-like epidermal growth factor-related receptor) antibody positive. After a period of chemotherapy and steroid treatments, his symptoms are now stable in terms of cerebellar function. This case report summarises a very rare diagnosis of paraneoplastic cerebellar degeneration with a positive onconeuronal antibody associated with anaplastic non-Hodgkin's lymphoma.

https://ift.tt/2LXgVjh

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

A newly diagnosed 53-year-old woman with cirrhosis has repeated gastrointestinal bleeding with resulting symptomatic anaemia. She underwent routine diagnostic endoscopic evaluation without localisation of the aetiology of her bleed. Ultimately, she was found to have ectopic varices in the small bowel as a result of underlying high portal pressures. She underwent transjugular intrahepatic portosystemic shunt for portal system decompression with resolution in her bleeding.

https://ift.tt/2JDRHcO

Lymphedema secondary to limited cutaneous systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterised by vascular abnormalities, immune system activation and fibrosis. Lymphatic involvement in SSc was described more recently and starts in early stages. This report describes a 46-year-old patient who developed over the last 2 years asymmetric lymphedema in lower extremities. Compromise in lymphatic drainage was confirmed by lymphoscintigraphy. She also presented Raynaud's phenomenon, a scleroderma pattern in nailfold capillaroscopy, cutaneous thickening and anticentromere antibodies, which together resulted in a new diagnosis of limited cutaneous SSc. Treatment with methotrexate, prednisolone and lymphatic drainage resulted in lymphedema improvement. To our knowledge, this is the first case of grade 2 lymphedema in the setting of anticentromere-positive limited cutaneous SSc. We highlight the importance of considering rheumatic diseases in the differential diagnosis of lymphedema.

https://ift.tt/2LRgXcj

Graves disease presenting as severe postpartum pruritus

A 39-year-old multigravida woman presented 3 weeks postpartum with worsening generalised pruritus without primary rash. Workup was significant for cholestasis and undiagnosed Graves' disease. She began to have symptomatic relief after starting methimazole, and liver function tests normalised as she became euthyroid.

https://ift.tt/2t0NOV6

Closed-loop small bowel obstruction from lateral trocar site hernia following robotic sigmoid resection

Description

A 67-year-old man with medical history significant for hypertension and hyperlipidaemia was found on screening colonoscopy to have a large, polypoid adenomatous polyp of the distal descending colon not amenable to colonoscopic resection. He underwent a robotic sigmoid colon resection with primary anastomosis. Postoperatively the patient developed persistent abdominal distention, nausea and had no passage of flatus or bowel movements after 7 days which was initially attributed to ileus. Cross-sectional CT revealed a closed-loop small bowel obstruction secondary to an incarcerated hernia at the right lateral 8 mm robotic trocar site with surrounding subcutaneous emphysema (figure 1). On physical examination, there was no palpable bulge or overlying erythema along the previous incision. The patient was brought back to the operating room and underwent a diagnostic laparoscopy utilising the prior robotic incisions. On exploration, the incarcerated small bowel loop was easily reduced with gentle traction and appeared...

https://ift.tt/2LWCqR0

Common femoral artery aneurysm repair using bifurcated graft

Common femoral artery aneurysms are rare, and surgical repair is indicated if they are significantly large, or if they are symptomatic (thrombosis causing limb ischaemia and compression of surrounding structures). Synthetic grafts are preferred, especially in cases involving large aneurysms, or the bifurcation of the common femoral artery. We present a case of bilateral common femoral artery aneurysms extending into the bifurcation repaired using a synthetic graft which is traditionally used for an axillobifemoral bypass. This technique was employed due to the specific anatomical relationship between the profunda femoris and the superficial femoral artery in our patient. We will also review the current literature on the operative approaches to repair of common femoral artery aneurysms.

https://ift.tt/2t0NHZG

CT Scan Is Still a Valuable Tool to Assess Hepatic Encephalopathy Pathophysiology in Both Acute and Chronic Liver Diseases

No abstract available

https://ift.tt/2JKD0VH

Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials*

Objectives: To identify, appraise, and synthesize the most current evidence to determine whether early enteral nutrition alters patient outcomes from critical illness. Data Sources: Medline and Embase were searched. The close out date was November 20, 2017. Study Selection: Early enteral nutrition was defined as a standard formula commenced within 24 hours of ICU admission. Comparators included any form of nutrition support "except" early enteral nutrition. Only randomized controlled trials conducted in adult patients requiring treatment in an ICU were eligible for inclusion. Data Extraction: The primary outcome was mortality. Secondary outcomes included pneumonia, duration of mechanical ventilation, and ICU and hospital stay. Data Synthesis: Six-hundred ninety-nine full-text articles were retrieved and screened. Sixteen randomized controlled trials enrolling 3,225 critically ill participants were included. Compared with all other types of nutrition support, commencing enteral nutrition within 24 hours of ICU admission did not result in a reduction in mortality (odds ratio, 1.01; 95% CI, 0.86–1.18; p = 0.91; I2 = 32%). However, there was a differential treatment effect between a priori identified subgroups (p = 0.032): early enteral nutrition reduced mortality compared with delayed enteral intake (odds ratio, 0.45; 95% CI, 0.21–0.95; p = 0.038; I2 = 0%), whereas a mortality difference was not detected between early enteral nutrition and parenteral nutrition (odds ratio, 1.04; 95% CI, 0.89–1.22; p = 0.58; I2 = 30%). Overall, patients who were randomized to receive early enteral nutrition were less likely to develop pneumonia (odds ratio, 0.75; 95% CI, 0.60–0.94; p = 0.012; I2 = 48%). Conclusions: Overall, there was no difference between early enteral nutrition and all other forms of nutrition support. A priori planned subgroup analysis revealed early enteral nutrition reduced mortality and pneumonia compared with delayed enteral intake; however, there were no clear clinical advantages of early enteral nutrition over parenteral nutrition.

https://ift.tt/2LTaXzK

Optimization of Care for Adults With Moderate Traumatic Brain Injury: A Place for Transcranial Doppler

No abstract available

https://ift.tt/2t29AYE

What Faces Reveal: A Novel Method to Identify Patients at Risk of Deterioration Using Facial Expressions*

Objectives: To identify facial expressions occurring in patients at risk of deterioration in hospital wards. Design: Prospective observational feasibility study. Setting: General ward patients in a London Community Hospital, United Kingdom. Patients: Thirty-four patients at risk of clinical deterioration. Interventions: A 5-minute video (25 frames/s; 7,500 images) was recorded, encrypted, and subsequently analyzed for action units by a trained facial action coding system psychologist blinded to outcome. Measurements and Main Results: Action units of the upper face, head position, eyes position, lips and jaw position, and lower face were analyzed in conjunction with clinical measures collected within the National Early Warning Score. The most frequently detected action units were action unit 43 (73%) for upper face, action unit 51 (11.7%) for head position, action unit 62 (5.8%) for eyes position, action unit 25 (44.1%) for lips and jaw, and action unit 15 (67.6%) for lower face. The presence of certain combined face displays was increased in patients requiring admission to intensive care, namely, action units 43 + 15 + 25 (face display 1, p

https://ift.tt/2LUrWSb

Feasibility and Safety of Intravascular Temperature Management for Severe Heat Stroke: A Prospective Multicenter Pilot Study

Objectives: Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke. Design: Prospective multicenter study. Setting: Critical care and emergency medical centers at 10 tertiary hospitals. Patients: Patients with severe heat stroke hospitalized during two summers. Interventions: Conventional cooling with or without intravascular temperature management. Measurements and Main Results: Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p

https://ift.tt/2JIo7TF

Increasing the Number of Medical Emergency Calls Does Not Improve Hospital Mortality

Objectives: Medical emergency teams were established to rescue patients experiencing clinical deterioration thus preventing cardiac arrest and unexpected hospital mortality. Although hospitals are encouraged to increase emergency calling rates to improve in-hospital mortality, there are increasing concerns about the impact these calls have on the workload of the teams and the skill levels on the general wards. We set out to examine the relationship between emergency calling rates and adjusted in-hospital mortality. Design: Retrospective analysis of prospectively collected patient and emergency call data. Setting: Tertiary, metropolitan, and regional hospitals in the State of Victoria, Australia. Patients: Consecutive patients discharged from 1) St Vincent's Hospital Melbourne from January 2008 to June 2016 and 2) 15 Victorian hospitals from July 2010 to June 2015. Measurements and Main Results: We studied 441,029 patients from St Vincent's Hospital Melbourne. Median age was 61.0 years (interquartile range, 45–74 yr), 57.2% were men, and 0.70% died; monthly emergency calling rates varied between 9.21 and 30.69 (median 18.4) per 1,000 discharges. In-hospital mortality adjusted for age, gender, emergency status, same day admission, year of discharge, and Charlson Comorbidity Index was not reduced by higher calling rates in the month of discharge (odds ratio, 1.019; 95% CI, 1.008–1.031). We then examined 3,339,789 discharges from 15 Victorian hospitals with median age 61 years (interquartile range, 43–74 yr), 51.4% men, and hospital mortality 0.83% where yearly emergency calling rates varied from 18.46 to 33.40 (median, 25.75) per 1,000 discharges. Again, adjusted mortality was not reduced by higher calling rates in the year of discharge (odds ratio, 1.003; 95% CI, 1.001–1.006). Conclusions: With adjustment for patient factors, illness, and comorbidities, increased emergency calling rates were not associated with reduced in-hospital mortality. Efforts to increase calling rates do not seem warranted.

https://ift.tt/2LUfu4R

Deepening the Understanding of the Psychomotor Response to Critical Illness

No abstract available

https://ift.tt/2t0H5KD

The Development of a Machine Learning Inpatient Acute Kidney Injury Prediction Model*

Objectives: To develop an acute kidney injury risk prediction model using electronic health record data for longitudinal use in hospitalized patients. Design: Observational cohort study. Setting: Tertiary, urban, academic medical center from November 2008 to January 2016. Patients: All adult inpatients without pre-existing renal failure at admission, defined as first serum creatinine greater than or equal to 3.0 mg/dL, International Classification of Diseases, 9th Edition, code for chronic kidney disease stage 4 or higher or having received renal replacement therapy within 48 hours of first serum creatinine measurement. Interventions: None. Measurements and Main Results: Demographics, vital signs, diagnostics, and interventions were used in a Gradient Boosting Machine algorithm to predict serum creatinine–based Kidney Disease Improving Global Outcomes stage 2 acute kidney injury, with 60% of the data used for derivation and 40% for validation. Area under the receiver operator characteristic curve (AUC) was calculated in the validation cohort, and subgroup analyses were conducted across admission serum creatinine, acute kidney injury severity, and hospital location. Among the 121,158 included patients, 17,482 (14.4%) developed any Kidney Disease Improving Global Outcomes acute kidney injury, with 4,251 (3.5%) developing stage 2. The AUC (95% CI) was 0.90 (0.90–0.90) for predicting stage 2 acute kidney injury within 24 hours and 0.87 (0.87–0.87) within 48 hours. The AUC was 0.96 (0.96–0.96) for receipt of renal replacement therapy (n = 821) in the next 48 hours. Accuracy was similar across hospital settings (ICU, wards, and emergency department) and admitting serum creatinine groupings. At a probability threshold of greater than or equal to 0.022, the algorithm had a sensitivity of 84% and a specificity of 85% for stage 2 acute kidney injury and predicted the development of stage 2 a median of 41 hours (interquartile range, 12–141 hr) prior to the development of stage 2 acute kidney injury. Conclusions: Readily available electronic health record data can be used to predict impending acute kidney injury prior to changes in serum creatinine with excellent accuracy across different patient locations and admission serum creatinine. Real-time use of this model would allow early interventions for those at high risk of acute kidney injury.

https://ift.tt/2LUsiZ1

An Open-Loop, Physiologic Model–Based Decision Support System Can Provide Appropriate Ventilator Settings

Objectives: To evaluate the physiologic effects of applying advice on mechanical ventilation by an open-loop, physiologic model–based clinical decision support system. Design: Prospective, observational study. Setting: University and Regional Hospitals' ICUs. Patients: Varied adult ICU population. Interventions: Advice were applied if accepted by physicians for a period of up to 4–8 hours. Measurements and Main Results: Seventy-two patients were included for data analysis. Acceptance of advice was high with 95.7% of advice applied. In 41 patients in pressure support ventilation, following system advice led to significant decrease in PS, with PS reduced below 8 cm H2O in 15 patients (37%), a level not prohibiting extubation. Fraction of end-tidal CO2 values did not change, and increase in respiratory rate/VT was within clinical limits, indicating that in general, the system maintained appropriate patient breathing effort. In 31 patients in control mode ventilation, pressure control and tidal volume settings were decreased significantly, with tidal volume reduced below 8 mL/kg predicted body weight in nine patients (29%). Minute ventilation was maintained by a significant increase in respiratory rate. Significant reductions in FIO2 were seen on elevated baseline median values of 50% in both support and control mode–ventilated patients, causing clinically acceptable reductions in oxygen saturation. Conclusions: The results indicate that during a short period, the clinical decision support system provided appropriate suggestions of mechanical ventilation in a varied ICU population, significantly reducing ventilation to levels which might be considered safe and beneficial.

https://ift.tt/2sZxZOe

One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation

Objectives: Many survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome. Design: Long-term follow-up data from a previously published randomized controlled trial. Patients: Adults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial. Setting: Adult ICU. Intervention: None. Measurements and Main Results: The primary outcome was functional independence at 1 year after hospital discharge defined as independence in activities of daily living and ambulation. At 1 year, patients were surveyed to assess for functional independence, survival, and number of institution-free days, defined as days alive spent living at home. The presence of ICU-acquired weakness and functional independence was also assessed by a blinded therapist on hospital discharge. On hospital discharge, there was a greater prevalence of ICU-acquired weakness (79.5% vs 38.6%; p = 0.0002) and less functional independence (15.4% vs 50%; p = 0.001) in the facemask group. One-year follow-up data were collected for 81 of 83 patients (97.6%). One-year mortality was higher in the facemask group (69.2% vs 43.2%; p = 0.017). At 1 year, patients in the helmet group were more likely to be functionally independent (40.9% vs 15.4%; p = 0.015) and had more institution-free days (median, 268.5 [0–354] vs 0 [0–323]; p = 0.017). Conclusions: Poor functional recovery after invasive mechanical ventilation for acute respiratory distress syndrome is common. Helmet noninvasive ventilation may be the first intervention that mitigates the long-term complications that plague survivors of acute respiratory distress syndrome managed with noninvasive ventilation.

https://ift.tt/2LUsgjR

Extensive Myocardial Calcification in Critically Ill Patients

Objectives: To describe an unusual complication on extracorporeal membrane oxygenation. Data Sources: Clinical observation. Study Selection: Case report. Data Extraction: Relevant clinical information. Data Synthesis: We report the cases of three young patients who developed extensive myocardial calcifications on prolonged extracorporeal membrane oxygenation support for severe acute respiratory distress syndrome with septic cardiomyopathy, postresuscitation cardiogenic shock, and septic shock complicating severe acute respiratory distress syndrome, respectively. Extensive myocardial calcifications were confirmed by echocardiography, CT, and cardiac biopsy. The combination of multiple factors, for example, prolonged hemodynamic failure, profound acidosis, high vasopressor doses, and renal failure, may lead to this unusual and severe complication. Conclusions: Intensivists should be aware of this rare but rapid complication on extracorporeal membrane oxygenation support that may directly impact outcome. The precise role of extracorporeal membrane oxygenation support in the timing and frequency of new-onset diffuse myocardial calcification deserves further investigation.

https://ift.tt/2JHkEEH

Clinical Predictors of Survival and Functional Outcome of Stroke Patients Admitted to Critical Care*

Objectives: To determine the predictive value of commonly used clinical variables upon ICU admission for long-term all-cause mortality and functional outcome of adult stroke patients admitted to the ICU. Design: Retrospective observational cohort study. Setting: General and neurosurgical ICUs of the University College London Hospitals in North Central London. Patients: All adult ICU patients with a clinical diagnosis of acute stroke admitted between February 2010 and May 2012. Interventions: None. Measurements and Main Results: Demographic and clinical data concerning the first 24 hours after ICU admission were obtained. Patients were followed until February 2016 to assess long-term survival. Functional outcome was determined using the modified Rankin Scale. We evaluated 131 critically ill stroke patients, with a median (interquartile range) age of 70 years (55–78 yr). One-year mortality rate was 52.7%. Surviving patients were followed up over a median (interquartile range) period of 4.3 years (4.0–4.8 yr). The multivariable model that best predicted long-term all-cause mortality indicated that mortality of critically ill stroke patients was predicted by high Acute Physiology and Chronic Health Evaluation II score, impaired consciousness (Glasgow Coma Scale score ≤ 8) as reason for ICU admission, low Glasgow Coma Scale sum score after 24 hours, and absence of brainstem reflexes. Long-term independent functional status occurred in 30.9% of surviving patients and was predicted by low Acute Physiology and Chronic Health Evaluation II score, high Glasgow Coma Scale sum score at ICU admission, and absence of mass effect on CT scan. Conclusions: Mortality in critically ill stroke patients is high and occurs most often shortly after the event. Less than one in three surviving patients is able to function independently after 1 year. This study has identified several clinical variables that predict long-term all-cause mortality and functional outcome among critically ill stroke patients and found that mainly acute physiologic disturbance and absolute values of neurologic clinical assessment are predictive.

https://ift.tt/2LUrWl9

Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Needs More Focus on Left Ventricle Unloading

No abstract available

https://ift.tt/2sZd7qK

Estimation of Extra Length of Stay Attributable to Hospital-Acquired Infections in Adult ICUs Using a Time-Dependent Multistate Model*

Objectives: The objective of the study was to estimate the length of stay of patients with hospital-acquired infections hospitalized in ICUs using a multistate model. Design: Active prospective surveillance of hospital-acquired infection from January 1, 1995, to December 31, 2012. Setting: Twelve ICUs at the University of Lyon hospital (France). Patients: Adult patients age greater than or equal to 18 years old and hospitalized greater than or equal to 2 days were included in the surveillance. All hospital-acquired infections (pneumonia, bacteremia, and urinary tract infection) occurring during ICU stay were collected. Interventions: None. Measurements and Main Results: The competitive risks of in-hospital death, transfer, or discharge were considered in estimating the change in length of stay due to infection(s), using a multistate model, time of infection onset. Thirty-three thousand four-hundred forty-nine patients were involved, with an overall hospital-acquired infection attack rate of 15.5% (n = 5,176). Mean length of stay was 27.4 (± 18.3) days in patients with hospital-acquired infection and 7.3 (± 7.6) days in patients without hospital-acquired infection. A multistate model–estimated mean found an increase in length of stay by 5.0 days (95% CI, 4.6–5.4 d). The extra length of stay increased with the number of infected site and was higher for patients discharged alive from ICU. No increased length of stay was found for patients presenting late-onset hospital-acquired infection, more than the 25th day after admission. Conclusions: An increase length of stay of 5 days attributable to hospital-acquired infection in the ICU was estimated using a multistate model in a prospective surveillance study in France. The dose-response relationship between the number of hospitalacquired infection and length of stay and the impact of early-stage hospital-acquired infection may strengthen attention for clinicians to focus interventions on early preventions of hospital-acquired infection in ICU.

https://ift.tt/2LUs6cf

Piperacillin-Tazobactam: Extended Infusion Versus Continuous Infusion

No abstract available

https://ift.tt/2JF1K1r

Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*

Objectives: Occurrence of delirium in the ICU is associated with a longer stay in the ICU. To examine whether the use of ramelteon, a melatonin agonist, can prevent delirium and shorten the duration of ICU stay of critically ill patients. Design: A single-center, triple-blinded, randomized placebo-controlled trial. Setting: ICU of an academic hospital. Patients: Eligible patients were ICU patients who could take medicines orally or through a nasogastric tube during the first 48 hours of admission. Interventions: The intervention group received ramelteon (8 mg/d), and the control group received placebo (1 g/d of lactose powder) at 20:00 hours every day until discharge from the ICU. Measurements and Main Results: A total of 88 subjects were randomized to the ramelteon group (45 subjects) or the placebo group (43 subjects). As the primary endpoint, there was a trend toward decrease in the duration of ICU stay (4.56 d) in the ramelteon group compared with the placebo group (5.86 d) (p = 0.082 and p = 0.028 before and after adjustments). As the secondary endpoints, statistically significant decreases in the occurrence rate (24.4% vs 46.5%; p = 0.044) and duration (0.78 vs 1.40 d; p = 0.048) of delirium were observed in the ramelteon group. The nonintubated patients of the ramelteon group showed statistically significantly fewer awakenings per night and a higher proportion of nights without awakenings. Conclusions: Ramelteon tended to decrease the duration of ICU stay as well as decreased the occurrence rate and duration of delirium statistically significantly.

https://ift.tt/2LWc55I

Risk Stratifying the Critically Ill: Will More Acronyms and Definitions Lead to Misuses in Critical Care Literature and Patient Care?

No abstract available

https://ift.tt/2JIWfij

Combined Biomarkers Predict Acute Mortality Among Critically Ill Patients With Suspected Sepsis*

Objectives: Sepsis is associated with high early and total in-hospital mortality. Despite recent revisions in the diagnostic criteria for sepsis that sought to improve predictive validity for mortality, it remains difficult to identify patients at greatest risk of death. We compared the utility of nine biomarkers to predict mortality in subjects with clinically suspected bacterial sepsis. Design: Cohort study. Setting: The medical and surgical ICUs at an academic medical center. Subjects: We enrolled 139 subjects who met two or more systemic inflammatory response syndrome (systemic inflammatory response syndrome) criteria and received new broad-spectrum antibacterial therapy. Interventions: We assayed nine biomarkers (α-2 macroglobulin, C-reactive protein, ferritin, fibrinogen, haptoglobin, procalcitonin, serum amyloid A, serum amyloid P, and tissue plasminogen activator) at onset of suspected sepsis and 24, 48, and 72 hours thereafter. We compared biomarkers between groups based on both 14-day and total in-hospital mortality and evaluated the predictive validity of single and paired biomarkers via area under the receiver operating characteristic curve. Measurements and Main Results: Fourteen-day mortality was 12.9%, and total in-hospital mortality was 29.5%. Serum amyloid P was significantly lower (4/4 timepoints) and tissue plasminogen activator significantly higher (3/4 timepoints) in the 14-day mortality group, and the same pattern held for total in-hospital mortality (Wilcoxon p ≤ 0.046 for all timepoints). Serum amyloid P and tissue plasminogen activator demonstrated the best individual predictive performance for mortality, and combinations of biomarkers including serum amyloid P and tissue plasminogen activator achieved greater predictive performance (area under the receiver operating characteristic curve > 0.76 for 14-d and 0.74 for total mortality). Conclusions: Combined biomarkers predict risk for 14-day and total mortality among subjects with suspected sepsis. Serum amyloid P and tissue plasminogen activator demonstrated the best discriminatory ability in this cohort.

https://ift.tt/2LUrZ0j

Comparative Usefulness of Sepsis-3, Burn Sepsis, and Conventional Sepsis Criteria in Patients With Major Burns

Objectives: We evaluated the ability of new sepsis (S3) criteria (compared with previous definitions of sepsis [S1] and burn sepsis criteria) to accurately determine the mortality in severe burns patients with sepsis. Design: This was retrospective cohort study. Setting: The Burn ICU of Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea. Patients: A total of 1,185 adult patients (mean age, 49.1 yr) were admitted between January 2009 and December 2015. Interventions: The 1,185 patients enrolled in the present study and were then re-evaluated based on S1, burn sepsis, and S3 criteria, following which 565 patients, 812 patients, and 809 patients were diagnosed with sepsis based on S1, burn sepsis, S3 criteria, respectively. Measurements and Main Results: For diagnostic performance, sensitivity, specificity, predictive value, and likelihood ratio were calculated. The area under the curve of the receiver operating characteristic curve was calculated to determine the accuracy of mortality prediction. The optimal cutoff value of Sequential Organ Failure Assessment score was calculated by the decision tree method. Total body surface area burned was 33.4%. Patients were identified with sepsis using S1 (812), S3 (809), and burn sepsis (565) criteria. Overall mortality was 20.3%, highest (82.2%) and lowest (26.5%) occurred with new septic shock (SH3) and S3, respectively. The sensitivity and specificity for burn sepsis (84.6% and 61.8%) and SH3 (63.1% and 96.5%) were reported. Area under the curve values for Sequential Organ Failure Assessment scores were the highest in all sepsis categories. With Sequential Organ Failure Assessment score greater than or equal to 6 (with infection), the accuracy was 0.86 (95% CI, 0.82–0.89). Conclusions: The S3 criteria failed to show superior prognostic accuracy for mortality in severely burned patients. Sequential Organ Failure Assessment score greater than or equal to 6 may be a better criterion for the diagnosis of sepsis in burns patients.

https://ift.tt/2JIWji3

End-of-Life Care in ICUs in East Asia: A Comparison Among China, Korea, and Japan

Objectives: To compare physicians' perceptions and practice of end-of-life care in the ICU in three East Asian countries cultures similarly rooted in Confucianism. Design: A structured and scenario-based survey of physicians who managed ICU patients from May 2012 to December 2012. Setting: ICUs in China, Korea, and Japan. Subjects: Specialists who are either intensivists or nonintensivist primary attending physicians in charge of patients (195 in China, 186 in Korea, 224 in Japan). Interventions: None. Measurements and Main Results: Country was independently associated with differences in the practice of limiting multiple forms of life-sustaining treatments on multivariable generalized linear model analysis. Chinese respondents were least likely to apply do-not-resuscitate orders, even if they existed (p

https://ift.tt/2LXLzcn

Narrative medicine in metastatic prostate cancer reveals ways to improve patient awareness & quality of care

Future Oncology, Ahead of Print.


https://ift.tt/2LWD6WN

Is a Pathological Complete Response Following Neoadjuvant Chemoradiation Associated With Prolonged Survival in Patients With Pancreatic Cancer?

Objectives: To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation. Background: Patients with BR/LA-PDAC are often treated with neoadjuvant chemoradiation in an attempt to downstage the tumor. Uncommonly, a pCR may result. Methods: A retrospective review of a prospectively maintained database was performed at a single institution. pCR was defined as no viable tumor identified in the pancreas or lymph nodes by pathology. A near complete response (nCR) was defined as a primary tumor less than 1 cm, without nodal metastasis. Overall survival (OS) and disease-free survival (DFS) were reported. Results: One hundred eighty-six patients with BR/LA-PDAC underwent neoadjuvant chemoradiation and subsequent pancreatectomy. Nineteen patients (10%) had a pCR, 29 (16%) had an nCR, and the remaining 138 (74%) had a limited response. Median DFS was 26 months in patients with pCR, which was superior to nCR (12 months, P = 0.019) and limited response (12 months, P

https://ift.tt/2y4TDpn

Neurologic Consequences of Preterm Birth

Abstract

Purpose of Review

Preterm birth is the leading cause of death worldwide in children < 5 years of age; however, technology and advances in medical knowledge are increasing the survival of children born even at the fringes of viability. With increased survival comes increased risk of long-term neurologic impairments. This paper aims to review recent findings related to changes in brain development associated with prematurity and its impact on neurodevelopmental disabilities.

Recent Findings

Advanced imaging techniques, longitudinal follow-up of individuals born extremely preterm into adulthood and improved understanding of risk factors associated with neurologic impairment contribute to recent discoveries. Sensory impairments are often associated with later cognitive and social impairments and therefore represent targets for therapy.

Summary

All aspects of neurologic development can be affected by preterm delivery. Future research is needed to further elucidate targets for prenatal and postnatal interventions for neuroprotection and to improve outcomes of prematurity.

https://ift.tt/2lfI45A

Wireless localization for mmWave networks in urban environments

Millimeter wave (mmWave) technology is expected to be a major component of 5G wireless networks. Ultra-wide bandwidths of mmWave signals and the possibility of utilizing large number of antennas at the transmi...

https://ift.tt/2yfGSbT

A weighted likelihood criteria for learning importance densities in particle filtering

Selecting an optimal importance density and ensuring optimal particle weights are central challenges in particle-based filtering. In this paper, we provide a two-step procedure to learn importance densities fo...

https://ift.tt/2JFX6QS

Feasibility of analysis of the SCN5A gene in paraffin embedded samples in sudden infant death cases at the Pretoria Medico-Legal Laboratory, South Africa

Abstract

To determine variations in the SCN5A gene linked to inherited cardiac arrhythmogenic disorders in sudden, unexplained infant death (SUID) cases examined at the Pretoria Medico-Legal Laboratory, South Africa. A retrospective study was conducted on SUID cases and controls, analyzing DNA extracted from archived formalin-fixed, paraffin-embedded (FFPE) myocardial tissue samples as well as blood samples. A total of 48 FFPE tissue samples (cases), 10 control FFPE tissue samples and nine control blood samples were included. DNA extracted from all samples was used to test for variations in the SCN5A gene by using high resolution melt (HRM) real-time PCR and sequencing. Genetic analysis showed 31 different single nucleotide variants in the entire study population (n = 67). Five previously reported variants of known pathogenic significance, and 14 variants of benign clinical significance, were identified. The study found 12 different variants in the cases that were not published in any database or literature and were considered novel. Of these novel variants, two were predicted as "probably damaging" with a high level of certainty (found in four case samples), one (identified in another case sample) was predicted to be "possibly damaging" with a 50% chance of being disease-causing, and nine were predicted to be benign. This study shows the significant added value of using genetic testing in determining the cause of death in South African SUID cases. Considering the high heritability of these arrhythmic disorders, post mortem genetic testing could play an important role in the understanding of the pathogenesis thereof and could also aid in the diagnosis and treatment of family members at risk, ultimately preventing similar future cases.

https://ift.tt/2JJPUTu

Autologous T Cells Targeting Four Neoantigens Induce Tumor Regression [Research Watch]

Autologous T-cell transfer achieves a durable regression in a patient with metastatic breast cancer.

https://ift.tt/2LSNezS

IL1 Blockade May Ameliorate Cytokine Release Syndrome [Research Watch]

Targeting IL1 attenuates cytokine release syndrome (CRS) without affecting CAR T-cell antitumor activity.

https://ift.tt/2JH8vj5

BAI1 Stabilizes p53 to Suppress Medulloblastoma Tumorigenesis [Research Watch]

Epigenetic silencing of BAI1 results in p53 degradation and accelerated medulloblastoma tumorigenesis.

https://ift.tt/2LSNcrK

Antibiotics Protect Against Liver Tumors in Mice [News in Brief]

An altered gut microbiome leads to the accumulation of hepatic natural killer T cells.

https://ift.tt/2JKGNlB

Precision Prevention and Early Detection of Cancer: Fundamental Principles [Prospective]

Prevention and early detection is critical for reducing the population cancer burden. Two approaches have been used: Population approaches change social norms (e.g., smoking bans) or impose incentives (e.g., cigarette taxes); high-risk strategies intervene upon individuals with elevated cancer risk (e.g., smoking cessation). Knowledge about carcinogenesis mechanisms, extreme exposures, and inherited susceptibility provides opportunities to develop precision prevention and early-detection (PPED) strategies. PPED aims to understand the basis of risk, identify groups that optimally benefit from interventions, characterize heterogeneity in intervention responses, optimize intervention timing, and minimize toxicities. We propose a framework around which PPED strategies can be developed. Currently available cancer prevention and early-detection approaches have the potential to reduce a large proportion of the cancer burden in the population. However, even if fully implemented, existing methods cannot fully eliminate the cancer burden. New PPED approaches that exploit the growing knowledge of molecular and biological cancer mechanisms should be developed and implemented. Cancer Discov; 8(7); 1–9. ©2018 AACR.

https://ift.tt/2LSNajC

YAP is essential for Treg mediated suppression of anti-tumor immunity [Research Articles]

Regulatory T cells (Tregs) are critical for maintaining self-tolerance and immune homeostasis, but their suppressive function can impede effective anti-tumor immune responses. Foxp3 is a transcription factor expressed in Tregs that is required for their function. However, the pathways and microenvironmental cues governing Foxp3 expression and Treg function are not completely understood. Herein, we report that Yes-associated protein (YAP), a co-activator of the Hippo pathway, is highly expressed in Tregs and bolsters Foxp3 expression and Treg function in vitro and in vivo. This potentiation stemmed from YAP-dependent upregulation of Activin signaling which amplifies TGFβ/SMAD activation in Tregs. YAP-deficiency resulted in dysfunctional Tregs unable to suppress anti-tumor immunity or promote tumor growth in mice. Chemical YAP antagonism and knockout or blockade of the YAP-regulated Activin Receptor similarly improved anti-tumor immunity. Thus we identify YAP as an unexpected amplifier of a Treg-reinforcing pathway with significant potential as an anti-cancer immunotherapeutic target.

https://ift.tt/2t1qqXs

Water fluoridation confirmed to prevent dental decay in US children and adolescents

The fluoridation of America's drinking water was a great public health achievement in the twentieth century but there are few studies from the last three decades investigating the impact of water fluoridation on US dental health. A recent study evaluated associations between the availability of community water fluoridation and dental decay experience in US child and adolescent populations.

https://ift.tt/2t0miXO

Correction to: Long noncoding RNA TUG1 facilitates osteogenic differentiation of periodontal ligament stem cells via interacting with Lin28A

Correction to: Long noncoding RNA TUG1 facilitates osteogenic differentiation of periodontal ligament stem cells via interacting with Lin28A

Correction to: Long noncoding RNA TUG1 facilitates osteogenic differentiation of periodontal ligament stem cells via interacting with Lin28A, Published online: 15 June 2018; doi:10.1038/s41419-018-0750-3

Correction to: Long noncoding RNA TUG1 facilitates osteogenic differentiation of periodontal ligament stem cells via interacting with Lin28A

https://ift.tt/2JWc9Fe

Long non-coding RNA HOTAIR promotes osteoarthritis progression via miR-17-5p/FUT2/β-catenin axis

Long non-coding RNA HOTAIR promotes osteoarthritis progression via miR-17-5p/FUT2/β-catenin axis

Long non-coding RNA HOTAIR promotes osteoarthritis progression via miR-17-5p/FUT2/β-catenin axis, Published online: 15 June 2018; doi:10.1038/s41419-018-0746-z

Long non-coding RNA HOTAIR promotes osteoarthritis progression via miR-17-5p/FUT2/β-catenin axis

https://ift.tt/2HSSHUJ

Mechanism of neuroprotection by trehalose: controversy surrounding autophagy induction

Mechanism of neuroprotection by trehalose: controversy surrounding autophagy induction

Mechanism of neuroprotection by trehalose: controversy surrounding autophagy induction, Published online: 15 June 2018; doi:10.1038/s41419-018-0749-9

Mechanism of neuroprotection by trehalose: controversy surrounding autophagy induction

https://ift.tt/2JWc3NS

Unexpected benefits of aging for favorable responses to PD-1 blockade in melanoma?

Immunosenescence might be expected to reduce the efficacy of checkpoint blockade, which depends on a functionally intact immune system. However, it seems that older melanoma patients may respond better to anti-PD1 treatment than younger patients, possibly due to their having fewer regulatory T-cells relative to CD8+ T-cells within tumour deposits.

https://ift.tt/2laFs93

Detecting de Novo Homoeologous Recombination Events in Cultivated Brassica napus Using a Genome-Wide SNP Array

The heavy selection pressure due to intensive breeding of Brassica napus has created a narrow gene pool, limiting the ability to produce improved varieties through crosses between B. napus cultivars. One mechanism that has contributed to the adaptation of important agronomic traits in the allotetraploid B. napus has been chromosomal rearrangements resulting from homoeologous recombination between the constituent A and C diploid genomes. Determining the rate and distribution of such events in natural B. napus will assist efforts to understand and potentially manipulate this phenomenon. The Brassica high-density 60K SNP array, which provides genome-wide coverage for assessment of recombination events, was used to assay 254 individuals derived from 11 diverse cultivated spring type B. napus. These analyses identified reciprocal allele gain and loss between the A and C genomes and allowed visualization of de novo homoeologous recombination events across the B. napus genome. The events ranged from loss/gain of 0.09 Mb to entire chromosomes, with almost 5% aneuploidy observed across all gametes. There was a bias towards sub-telomeric exchanges leading to genome homogenisation at chromosome termini. The A genome replaced the C genome in 66% of events, and also featured more dominantly in gain of whole chromosomes. These analyses indicate de novo homoeologous recombination is a continuous source of variation in established Brassica napus and the rate of observed events appears to vary with genetic background. The Brassica 60K SNP array will be a useful tool in further study and manipulation of this phenomenon.

https://ift.tt/2JH5Vtp

Anal Achalasia: The Rat Tail Gas Sign

A 29-year-old woman presented with 7 years of abdominal pain, distension, bloating, incomplete rectal evacuation, and food intolerance. Prior gastrointestinal endoscopies, abdominal ultrasound, and computerized tomography (CT) scans were nondiagnostic. Abdominal examination showed distension, tympanic percussion note, and general tenderness, but no guarding or rebound. Rectal examination showed high anal sphincter tone, levator muscle tenderness, no perineal descent, and anal contraction while straining to evacuate the examining finger.

https://ift.tt/2JNLqqV

Portable Music Player Use Linked to Hearing Loss in Children

FRIDAY, June 15, 2018 -- Portable music player (PMP) use may be associated with high-frequency hearing loss in children, according to a study published online June 14 in JAMA Otolaryngology-Head & Neck Surgery. Carlijn M.P. le Clercq, M.D., from...

https://ift.tt/2LVQTN0

Doctors Want Substantial Improvements in EHRs

FRIDAY, June 15, 2018 -- Although primary care physicians (PCPs) see value in electronic health records (EHRs), they want substantial improvements, and generally agree on what these improvements should be, according to research from Stanford...

https://ift.tt/2JL5bnq

Kellogg's Honey Smacks Cereal Recalled Due to Salmonella Risk

FRIDAY, June 15, 2018 -- The Kellogg Company has announced it is recalling certain boxes of Honey Smacks cereal due to the possibility of contamination with Salmonella. According to the U.S. Centers for Disease Control and Prevention, 73 illnesses...

https://ift.tt/2LSHfLq

Resistant A. Baumannii Rose in Children From 1999 to 2012

FRIDAY, June 15, 2018 -- Between 1999 and 2012, Acinetobacter baumannii (A. baumannii) antibiotic resistance increased in children, though there was a decreasing trend after 2008, according to a study published in the Journal of the Pediatric...

https://ift.tt/2sYVyai

FDA Approves First Generic Under-the-Tongue Suboxone

FRIDAY, June 15, 2018 -- The first generic version of an under-the-tongue film to treat opioid addiction has been approved by the U.S. Food and Drug Administration. The generic version of Suboxone (buprenorphine and naloxone) film from Mylan...

https://ift.tt/2LSHdmM

Self-assessment differences between genders in a low-stakes objective structured clinical examination (OSCE)

Physicians and medical students are generally poor-self assessors. Research suggests that this inaccuracy in self-assessment differs by gender among medical students whereby females underestimate their perform...

https://ift.tt/2JEzig9

Confirmation of covalently-linked structure and cell-death inducing activity in site-specific chemical conjugates of human Fas ligand extracellular domain

In this study, we aimed to identify the structural components and to clarify the biological activity in the site-specific conjugates of human Fas ligand extracellular domain (hFasLECD) with either fluorescein ...

https://ift.tt/2LUAqc9

Acceptability and feasibility of magnetic femoral nerve stimulation in older, functionally impaired patients

Magnetic femoral nerve stimulation to test muscle function has been largely unexplored in older people. We assessed acceptability, feasibility, along with reproducibility and correlation with other physical fu...

https://ift.tt/2JKuuFV

Is Granulocyte Colony Stimulating Factor a New Treatment for Alcoholic Hepatitis?

https://ift.tt/2yhJPZm

Patient-Reported Outcomes and Endoscopic Appearance of Ulcerative Colitis—a Systematic Review and Meta-Analysis

We aimed to evaluate the association of the patient-reported outcomes for rectal bleeding and stool frequency among patients with ulcerative colitis (UC) in endoscopic remission.

https://ift.tt/2Mw16kA

Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders

As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring.

https://ift.tt/2JQ6htK

Low Rates of Screening for Celiac Disease Among Family Members

Given the increased morbidity and potential mortality of celiac disease, guidelines recommend screening high-risk individuals, including first-degree relatives of patients. We assessed how commonly celiac disease testing occurs in these individuals and identified factors that influence testing.

https://ift.tt/2MwzQST

Mimicking Abdominal Tuberculosis: Abdominal Abscess Caused by Lawsonella Clevelandensis in IBD

https://ift.tt/2JS0ynr

Sweetened Beverage Consumption and Risk of Crohn’s Disease and Ulcerative Colitis

https://ift.tt/2Mu31WE

Emricasan Improves Liver Function in Patients With Cirrhosis and High Model for End-stage Liver Disease Scores Compared With Placebo

Caspase-mediated apoptosis and inflammation contribute to progression of liver disease. Emricasan is a pan-caspase inhibitor that reduced serum markers of apoptosis and liver inflammation in patients with hepatitis C and non-alcoholic steatohepatitis (NASH).

https://ift.tt/2JNDaav

Credentialing for Endoscopic Practice: The Mayo Clinic Model

https://ift.tt/2JFqOoN

Rates and Factors Associated With Placebo Response in Trials of Pharmacotherapies for Nonalcoholic Steatohepatitis: Systematic Review and Meta-analysis

Understanding the extent of the placebo effect in randomized controlled trials of studying nonalcoholic steatohepatitis (NASH) is important for optimal trial design, including sample size calculations and treatment endpoint definition.

https://ift.tt/2JTOoKU

C11 Methionine PET (MET-PET) Imaging of Glioblastoma for Detecting Post-operative Residual Disease and Response to Chemoradiation Therapy

C11 Methionine PET may be a useful tool for delineation of radiation targets and assessment of response in glioblastoma. C11 Methionine PET scanning can show a significant decrease in extent of MET-avid glioblastoma at 1 month after completion of chemoradiation compared to the immediate post-operative period, even when T2/FLAIR changes little. MGMT promoter methylation status further predicts differential metabolic responses.

https://ift.tt/2MvQ0vW

Patient reported outcomes in NRG Oncology RTOG 0938, evaluating two ultrahypofractionated regimens for prostate cancer

The urinary and rectal quality of life outcomes reported by prostate cancer patients undergoing 5 & 12 prostate radiotherapy treatments are comparable to current standard 38-44 radiotherapy treatments. These shorter radiotherapy treatments need to be compared to the current standard radiotherapy treatments in a larger study.

https://ift.tt/2taB2Tl

Quantitative Imaging for Radiation Oncology

https://ift.tt/2JMApX3

Decreased alpha2 connectivity in EEG is correlated with the cognitive and psychiatric manifestations of Parkinson’s disease

Parkinson's disease (PD) was traditionally thought of as a motor disorder induced by selective apoptosis of unknown cause affecting dopaminergic neurons in the pars compacta of the substantia nigra (SNpc), leading, in turn, to basal ganglionic dysfunction that manifests itself as bradykinesia, rigidity, and rest tremor. These features remain important elements of the current diagnostic criteria for PD, which, however, also give a prominent role to non-motor manifestations of the disease (Postuma et al.

https://ift.tt/2yfqS9x

Quantitative EEG and functional outcome following acute ischemic stroke

Stroke is a leading cause of disability and mortality worldwide, and despite advances in disease prevention, acute treatment and rehabilitation, global stroke burden is expected to rise in the future (Feigin et al. 2017). Early post-stroke prognostication is essential both in the short-term (f. ex. in guiding treatment strategies) and in the long-term (to aid in rehabilitation management, in order to improve recovery and minimize disability). Predictors of stroke disability and associate death consistently include age and clinical / imaging related stroke severity (Adams et al.

https://ift.tt/2ldhYQN

Impaired Consciousness through a Focal Lesion under the left Posteromedial Cortex

Consciousness is made up of arousal (i.e. wakefulness) and awareness (i.e. awareness of the environment and self) (Laurey et al., 1999; Laurey et al., 2004). A series of imaging studies have potently suggested that awareness processing is associated with the posteromedial cortex (PMC, Laurey et al., 1999; Laurey et al., 2004; Cavanna et al., 2006), an area composed of multiple association cortices in the interhemispheric fissure, including the precuneus (BA 7), posterior cingulate area (BA 23), and retrosplenial area (BA 29 and 30) (Cavanna et al., 2006).

https://ift.tt/2yfqEiH

Treatment of ulnar neuropathy at the elbow – an ongoing conundrum

Ulnar neuropathy at the elbow (UNE) is the second most common mechanical mononeuropathy after carpal tunnel syndrome (CTS). Despite the frequency with which it is seen in the neurophysiology clinic, UNE still poses clinical and diagnostic challenges. The clinical diagnosis of ulnar neuropathy is generally easy to determine, but UNE may be difficult to localize on nerve conduction studies. Diagnostic localization is improved when the ulnar nerve is examined by ultrasound (Simon et al., 2015) and best with magnetic resonance neurography (Keen et al., 2012).

https://ift.tt/2len92Q

Hepatic vein stenting in a 7 week/old infant with Budd–Chiari syndrome using an anterograde approach from the inferior accessory hepatic vein

https://ift.tt/2lfjCRQ

Efficacy and safety of acupuncture for functional constipation: a randomised, sham-controlled pilot trial

The prevalence of functional constipation (FC) is 3–27%, and FC has been reported to cause discomfort in daily life and various complications. The treatment for FC depends on laxatives, and thus, effective and...

https://ift.tt/2tcSt5w

Demand for integrative medicine among women in pregnancy and childbed: a German survey on patients’ needs

Although integrative medicine is gaining increasing attention and is claiming more and more its place in modern health care, it still plays a marginal role in conventional maternity care. The present study aim...

https://ift.tt/2t1Nzch

The study of formulated Zoush ointment against wound infection and gene expression of virulence factors Pseudomonas aeruginosa

The outbreak of MDR and XDR strains of Pseudomonas aeruginosa and increased resistance to infection in burn patients recommend the issue of infection control. In this research, we study ZOUSH herbal ointment for ...

https://ift.tt/2JTuOOU

Immunomodulatory properties of quercetin-3-O-α-L-rhamnopyranoside from Rapanea melanophloeos against influenza a virus

Influenza infection is a major public health threat. The role of influenza A virus-induced inflammatory response in severe cases of this disease is widely recognized. Drug resistance and side effects of chemic...

https://ift.tt/2Mwyc3Q

Wilson’s disease combined with systemic lupus erythematosus: a case report and literature review

Wilson's disease (WD) is an inherited disorder in which defective biliary excretion of copper leads to its accumulation, particularly in the liver and brain. Systemic lupus erythematosus (SLE) is a multi-syste...

https://ift.tt/2ylveMG

In Vivo Nanovector Delivery of a Heart-specific MicroRNA-sponge

Tissue-specific microRNA inhibition is a technology that is underdeveloped in the microRNA field. Herein, we describe a protocol to successfully inhibit the miR-181 microRNA family in myoblast cells from the heart. Nanovector technology is used to deliver a microRNA sponge that demonstrates significant in vivo cardio-specific miR-181 family inhibition.

https://ift.tt/2MxoXjY

Determination of Plasma Membrane Partitioning for Peripherally-associated Proteins

Here, we present a protocol to perform a quantitative analysis of the level of plasma-membrane association for fluorescently-tagged peripherally-associated protein. The method is based on the computational decomposition of membrane and cytoplasmic component of signal observed in cells labeled with plasma membrane fluorescent marker.

https://ift.tt/2JPmj7i

In Vivo Electrophysiological Measurement of Compound Muscle Action Potential from the Forelimbs in Mouse Models of Motor Neuron Degeneration

The measurement of nerve conduction is a useful tool to assess mouse models of neurodegeneration but it is frequently only applied to stimulate the sciatic nerve in hindlimbs. Here, we describe a technique to measure compound muscle action potential (CMAP) in vivo in the mouse forelimb muscles innervated by the brachial plexus.

https://ift.tt/2MsTmzK

Anaerobic coverage as definitive therapy does not affect clinical outcomes in community-onset bacteremic biliary tract infection without anaerobic bacteremia

Antibiotics with anaerobic coverage are widely used for the treatment of biliary tract infection (BTI), even in the absence of isolated anaerobes. The current study aimed to investigate the differences in clin...

https://ift.tt/2LPhkE4

Potential risk factors and prevalence of Helicobacter pylori infection among adult patients with dyspepsia symptoms in Cameroon

Helicobacter pylori is a Gram negative bacterium that colonizes the stomach of approximately two-thirds of the human population and it is involved in the pathogenesis of gastroduodenal diseases. This study sought...

https://ift.tt/2t6GQ11

A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection

This article describes a simple protein microarray method for profiling humoral immune responses to a 7-plex panel of highly purified Clostridium difficile antigens in human sera. The protocol can be extended for the determination of specific antibody responses in preparations of polyclonal intravenous immunoglobulin.

https://ift.tt/2ldE9X2

Dissecting Multi-protein Signaling Complexes by Bimolecular Complementation Affinity Purification (BiCAP)

This manuscript describes the protocol for Bimolecular Complementation Affinity Purification (BiCAP). This novel method facilitates the specific isolation and downstream proteomic characterization of any two interacting proteins, while excluding un-complexed individual proteins as well as complexes formed with competing binding partners.

https://ift.tt/2ydWPz9

Macrodiscs Comprising SMALPs for Oriented Sample Solid-State NMR Spectroscopy of Membrane Proteins

Macrodiscs, which are magnetically alignable lipid bilayer discs with diameters of >30 nm, were obtained by solubilizing protein-containing liposomes with styrene-maleic acid copolymers. Macrodiscs provide a detergent-free phospholipid bilayer environment for biophysical and functional studies of membrane proteins under physiological conditions. The narrow resonance linewidths observed from membrane proteins in styrene-maleic acid macrodiscs advance structure determination by oriented sample solid-state NMR spectroscopy.

https://ift.tt/2JBQsLc

Risk factors for poor outcome in community-onset Clostridium difficile infection

A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the ...

https://ift.tt/2HTm5dz

Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis

Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is...

https://ift.tt/2LUOB0W

Cochlear Implantation in the Guinea Pig

The goal of this protocol is to provide an animal model of cochlear implantation, which can be used to address a multitude of research questions. Potential applications include the evaluation of pharmaceutical interventions or electrical stimulation for beneficial effects on hearing thresholds or electrode impedances.

https://ift.tt/2lcOjqV

Microstate and Omega Complexity Analyses of the Resting-state Electroencephalography

This article describes the protocol underlying electroencephalography (EEG) microstate analysis and omega complexity analysis, which are two reference-free EEG measures and highly valuable to explore the neural mechanisms of brain disorders.

https://ift.tt/2yeIXop

Pediatric Kidney Recipients Often Have Subclinical Inflammation

FRIDAY, June 15, 2018 -- For pediatric kidney recipients, subclinical inflammation is associated with increased risk for acute rejection and allograft failure, according to a study published online May 15 in the American Journal of...

https://ift.tt/2JDXD5H

Screen Does Not Cut Abdominal Aortic Aneurysm Mortality in Men

FRIDAY, June 15, 2018 -- Screening men for abdominal aortic aneurysm (AAA) does not reduce AAA-related mortality, according to a study published in the June 16 issue of The Lancet. Minna Johansson, M.D., from the University of Gothenburg in Sweden,...

https://ift.tt/2JLMqMw

Higher Vitamin D Levels Tied to Lower Risk of Colorectal Cancer

FRIDAY, June 15, 2018 -- Higher circulating levels of vitamin D are tied to significantly lower colorectal cancer risk, particularly in women, according to a study published online June 14 in the Journal of the National Cancer Institute. Marjorie L....

https://ift.tt/2JJ3qqR

Good Sleep Tied to Better Cardiometabolic Health in Youths

FRIDAY, June 15, 2018 -- Longer sleep duration and higher sleep efficiency are associated with a more favorable cardiometabolic profile in early adolescence, according to a study published online June 15 in Pediatrics. Elizabeth M. Cespedes...

https://ift.tt/2yfP5fT

Amblyopia, Strabismus May Slow Test Performance in Children

THURSDAY, June 14, 2018 -- Children with certain eye conditions -- amblyopia or strabismus -- require more time to fill out multiple-choice answer forms, according to a study published online June 14 in JAMA Ophthalmology. Krista R. Kelly, Ph.D.,...

https://ift.tt/2MtofUN

Elevated NT-proBNP Found to Up Cardiovascular Risk in T2DM

FRIDAY, June 15, 2018 -- Elevated baseline N-terminal B-type natriuretic peptide (NT-proBNP) is independently associated with development of major cardiovascular (CV) events, in particular hospitalization for heart failure, according to a study...

https://ift.tt/2JNUlbU

VTE Linked to Acute Decline in Physical Function in Women

FRIDAY, June 15, 2018 -- For women, venous thromboembolism (VTE) is associated with acute decline in physical function, according to a study published online June 8 in the Journal of Thrombosis and Haemostasis. Kaitlin A. Hagan, Sc.D., from Brigham...

https://ift.tt/2JIKWX6

Walk Test IDs Risk of Cognitive Dysfunction Post Cardiac Surgery

FRIDAY, June 15, 2018 -- The six-minute walk distance (6MWD) test is useful in identifying patients with a higher likelihood of developing postoperative cognitive dysfunction (POCD) following cardiac surgery, according to a study published online...

https://ift.tt/2yhhhPE

Binge Drinking Tied to Poorer Bone Health in Young Females

FRIDAY, June 15, 2018 -- Binge drinking in adolescence may prevent girls from reaching their peak bone mass (PBM), according to a study published online June 13 in the Journal of Studies on Alcohol and Drugs. Joseph W. Labrie, Ph.D., from Loyola...

https://ift.tt/2JG1jDR

High-Quality Diet May Decrease Mortality Risk in Cancer Survivors

FRIDAY, June 15, 2018 -- High-quality diets are associated with decreased risks of overall and cancer-specific mortality among cancer survivors, according to a study published online June 5 in JNCI Cancer Spectrum. Ashish A. Deshmukh, Ph.D., M.P.H.,...

https://ift.tt/2yoddNN

Reclassifying Acute Respiratory Distress Syndrome

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1586-1595, June 15, 2018.


https://ift.tt/2JJEbEQ

Early Intravascular Events Are Associated with Development of Acute Respiratory Distress Syndrome. A Substudy of the LIPS-A Clinical Trial

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1575-1585, June 15, 2018.


https://ift.tt/2ye9t1f

Assessing Asthma Medication Responses in U.S. Minority Children by Whole-Genome Sequencing

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1513-1514, June 15, 2018.


https://ift.tt/2MuV6sr

Respiratory Symptoms in Young Adults and Future Lung Disease. The CARDIA Lung Study

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1616-1624, June 15, 2018.


https://ift.tt/2JPsZT1

The Functional Correlate of the Loss of Terminal Bronchioles in Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1633-1635, June 15, 2018.


https://ift.tt/2MuPbDK

Impact of T2R38 Receptor Polymorphisms on Pseudomonas aeruginosa Infection in Cystic Fibrosis

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1635-1638, June 15, 2018.


https://ift.tt/2JKzExE

Reply to Fernández Pérez: Diagnostic Decision-Making in Hypersensitivity Pneumonitis: Toward a Consensus Statement

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1648-1648, June 15, 2018.


https://ift.tt/2MuP4YQ

Reply to Sohal: Airway Basal Cell Reprogramming and Epithelial–Mesenchymal Transition: A Potential Key to Understanding Early Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1645-1646, June 15, 2018.


https://ift.tt/2ygDugM

Reply to Fernández Pérez: Diagnostic Decision-Making in Hypersensitivity Pneumonitis: Toward a Consensus Statement

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1647-1648, June 15, 2018.


https://ift.tt/2JHqxlg

Cardioventilatory Control in Preterm-born Children and the Risk of Obstructive Sleep Apnea

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1596-1603, June 15, 2018.


https://ift.tt/2ynYna3

Update in Chronic Obstructive Pulmonary Disease 2017

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1534-1539, June 15, 2018.


https://ift.tt/2MsXXSE

At the Root: Defining and Halting Progression of Early Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1540-1551, June 15, 2018.


https://ift.tt/2ycPwHX

The Clinical Impact of Different Adherence Behaviors in Patients with Severe Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1630-1633, June 15, 2018.


https://ift.tt/2MwW2fA

Control of Breathing in Preterm Infants. Neonatal ICU and Beyond

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1518-1520, June 15, 2018.


https://ift.tt/2yevTiI

Disease Management plus Recommended Care versus Recommended Care Alone for Ambulatory Patients with Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1565-1574, June 15, 2018.


https://ift.tt/2MuQUc4

H2 Receptor Antagonist Use and Mortality in Pulmonary Hypertension: Insight from the VA-CART Program

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1638-1641, June 15, 2018.


https://ift.tt/2yevKvG

Endotracheal and Endobronchial Metastases of Small Cell Lung Cancer

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1628-1629, June 15, 2018.


https://ift.tt/2JGsJJV

Volcanic Eruptions and Threats to Respiratory Health

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page P21-P22, June 15, 2018.


https://ift.tt/2JLxeyR

Airway Basal Cell Reprogramming and Epithelial–Mesenchymal Transition: A Potential Key to Understanding Early Chronic Obstructive Pulmonary Disease

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1644-1645, June 15, 2018.


https://ift.tt/2MuQBOs

Early Returns in Vascular Inflammation in ARDS

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1514-1516, June 15, 2018.


https://ift.tt/2JLwZUt

Reply to the Letter to the Editor: "The hard road to patient-centered care: 3 or 6 months of adjuvant chemotherapy for patients with stage III colon cancer?" By P. Trendsz et al.

https://ift.tt/2JCZ1pb

Shared variance of oculomotor phenotypes in a large sample of healthy young men

Abstract

This study used canonical correlation analysis to investigate patterns of shared variance between parameters measured in seven different occulomotor function tasks, namely the visually guided saccade task, the antisaccade task, the closed-loop smooth-pursuit task, the open-loop smooth-pursuit task, and three active visual fixation tasks. These tasks were performed by 2130 young army recruits. Only a small percentage (1–10%) of shared variance existed between sets of parameters for all oculomotor function tasks measured. The most correlated tasks were the visually guided saccade and the antisaccade. The first common factor correlated with speed of performance between these tasks (latency), while the second and third correlated with accuracy of performance. Better performance in active visual fixation tasks correlated with better performance accuracy (lower error rate) and increased speed (lower latency) in the antisaccade and saccade tasks as well as better performance in the closed-loop smooth-pursuit task (increase in gain and decrease in the rate of unwanted saccades during pursuit). Better performance in the closed-loop smooth-pursuit task (increased gain and decreased number of unwanted saccades) also correlated with increased accuracy and increased speed of performing saccades and antisaccades. Finally, the open-loop fixation task had no correlation with all other oculomotor tasks except for a very weak negative correlation with the closed-loop pursuit task where better performance (increased gain) in one correlated with worse performance (decreased gain) in the other. The results of this analysis showed that a small percentage of variance is shared among different oculomotor function tasks. The structure of this shared variance could be used to derive common oculomotor function indices to study their relation to genetic and other sources of inter-subject variation.

https://ift.tt/2ta0s3i

Enhanced anticancer effect of MAP30–S3 by cyclosproin A through endosomal escape

Cyclosporin A (CsA) is a calcium antagonist and can enhance the efficacy of some protein drugs, but its mechanism remains unknown. In this study, MAP30, a ribosome-inactivating protein reported to have apoptotic effects on cancer cells, was fused with S3, an epidermal growth factor receptor (EGFR)-targeting peptide. In addition, CsA was used to investigate whether it can further promote the apoptotic effects of S3 fused MAP30 (MAP30–S3). Our result showed that the internalization of FITC-labeled MAP30–S3 was increased significantly by S3 in HeLa cells. Unexpectedly, MAP30–S3 only showed a minor decrease in the viability of EGFR-overexpressing cancer cells, including HeLa, SMMC-7721, and MGC803 (IC50>5 μmol/l). However, 2 μmol/l CsA significantly increased the cytotoxicity of MAP30–S3, especially for HeLa cells (IC50=40.3 nmol/l). In comparison, CsA did not further decrease the cytotoxicity of MAP30–S3 on MRC-5, an EGFR low-expressing cell line from normal lung tissue, indicating that CsA did not affect the cancer-targeting specificity of MAP30–S3. Our results also showed that CsA further increased the apoptotic activity of MAP30–S3 in HeLa cells. CsA could promote the endosomal escape of FITC-MAP30–S3 with a diffused pattern in the cytoplasm. Five endocytic inhibitors were used to investigate the cellular uptake mechanism of MAP30–S3, and the results showed that the endosomal escape-enhancing effect of CsA on MAP30–S3 may be associated with the clathrin-dependent endocytic pathways. Our study suggested that CsA could be a novel endosomal escape enhancer to potentiate the intracellular release of anticancer protein drugs, resulting in their improved therapeutic efficacy. Correspondence to Jian Zhao, PhD, Department of Applied Biology, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China Tel: +86 216 425 2256; fax: +86 216 425 2255; e-mail: zhaojian@ecust.edu.cn or Correspondence to Fu-Jun Wang, MSc, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China Tel: +86 215 132 2515; fax: +86 215 132 2508; e-mail: wfj@shutcm.edu.cn Received January 10, 2018 Accepted April 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2yb5IcU

Compounded Products Containing Triamcinolone-Moxifloxacin by Guardian Pharmacy Services (Dallas, Texas): Alert to Health Professionals - Adverse Events After Receiving Eye Injections

[Posted 06/14/2018] AUDIENCE: Patient, Health Professional, Eye Care, Risk Manager ISSUE:  At least 43 patients reported adverse events after receiving eye injections of Guardian's Pharmacy Services compounded triamcinolone-moxifloxacin...

https://ift.tt/2JLAV7v

Argus II retinal prosthesis system: a review of patient selection criteria, surgical considerations, and post-operative outcomes

https://ift.tt/2HS7nDr

Changes in programmed death ligand 1 expression in non-small cell lung cancer patients who received anticancer treatments

Abstract

Background

The expression of programmed death ligand 1 (PD-L1) is considered a predictive biomarker of anti-programmed death 1 (PD-1)/PD-L1 cancer therapies. However, changes in PD-L1 expression of tumor cells during clinical courses have not been fully evaluated. We evaluated changes in PD-L1 expression for non-small cell lung cancer (NSCLC) patients who received anticancer treatments during clinical courses.

Methods

In 76 NSCLC patients, PD-L1 expression was evaluated before and after anticancer treatment by immunohistochemical (IHC) analysis using an anti-PD-L1 antibody. We defined two cut-off points of PD-L1 expression (1 and 50%) and three corresponding IHC groups (A: 0%, B: 1–49%, and C: ≥50%). IHC group B and C were considered to be positive expression, and we defined the difference of IHC group between pre- and post-treatment as 'major change' in PD-L1 expression.

Results

Before anticancer treatment, PD-L1 expression was observed in 38/76 (50%) patients, and was significantly less common in patients harboring mutations in the epidermal growth factor receptor gene (EGFR) than in those without (P = 0.039). After anticancer treatment, PD-L1 expression was observed in 36/76 (47%) patients. Major increases in PD-L1 expression were seen in 11 (14%), and major decreases in 18 (24%) patients. Among 13 patients harboring EGFR mutations treated with EGFR tyrosine-kinase inhibitor (EGFR-TKI), five (38%) showed major increases.

Conclusion

Major changes of PD-L1 expression in tumor cells were observed in 38% of NSCLC patients who received anticancer treatments. And, treatments with EGFR-TKI may increase PD-L1 expression in NSCLC patients harboring EGFR mutations.

https://ift.tt/2l9eRZQ

Colorectal obstruction is a potential prognostic factor for stage II colorectal cancer

Abstract

Background

Obstructive colorectal cancer (CRC) is an emergency situation with high morbidity and mortality, but long-term outcomes of stage II/III obstructive CRC remain unclear. The aim of this study was to evaluate prognostic factors, including colorectal obstruction.

Methods

Data were retrospectively reviewed from consecutive patients with stage II/III CRC who underwent curative surgery between January 2007 and December 2011 at two Japanese institutions. We analyzed overall survival (OS) and relapse-free survival (RFS), according to various prognostic factors including colorectal obstruction.

Results

In total, 979 patients with stage II/III CRC were identified for this study. Among these 979 patients, 94 patients showed colorectal obstruction (9.6%). In both stage II and stage III CRCs, colorectal obstruction showed significantly poorer OS and RFS compared to non-obstruction (5-year OS, obstruction vs. non-obstruction, stage II: 65.9 vs. 86.5%, P = 0.002; stage III: 55.9 vs. 73.6%, P = 0.007) (5-year RFS, obstruction vs. non-obstruction, stage II: 59.2 vs. 77.8%, P = 0.008; stage III 31.3 vs. 56.3%, P = 0.001). Multivariate analysis demonstrated colorectal obstruction as a significant independent and poor prognostic factor in terms of both OS (hazard ratio (HR) 2.469; 95% CI 1.339–4.545; P = 0.004) and RFS (HR 1.992; 95% CI 1.160–3.425; P = 0.012) for stage II CRC, as well as pT4 stage. On multivariate analysis for stage III CRC, colorectal obstruction was a significant predictor of poor RFS (HR 1.626; 95% CI 1.070–2.469; P = 0.023), but not poor OS.

Conclusions

Colorectal obstruction is an independent poor prognostic factor for stage II CRC. Adjuvant chemotherapy might be feasible for stage II CRC with colorectal obstruction.

https://ift.tt/2tcrqqY

Compounded Products Containing Triamcinolone-Moxifloxacin by Guardian Pharmacy Services (Dallas, Texas): Alert to Health Professionals - Adverse Events After Receiving Eye Injections

[Posted 06/14/2018] AUDIENCE: Patient, Health Professional, Eye Care, Risk Manager ISSUE:  At least 43 patients reported adverse events after receiving eye injections of Guardian's Pharmacy Services compounded triamcinolone-moxifloxacin...

https://ift.tt/2JLAV7v

Changes in utilization and discard of HCV-antibody positive deceased-donor kidneys in the era of direct-acting antiviral therapy

Abstract Background The availability of direct-acting antiviral (DAA) therapy might have impacted use of HCV-infected (HCV+) deceased-donor kidneys for transplantation. Methods We used 2005-2018 SRTR data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (Interferon [IFN] era: 1/1/2005-12/5/2013 versus DAA era: 12/6/2013-8/2/2018). Models were adjusted for candidate, recipient, and donor factors where appropriate. Results In the DAA era, candidates were 2.2-times more likely to list as willing to accept HCV+ kidneys (aOR: 2.072.232.41, P

https://ift.tt/2tbmhPR

Long-term outcomes and risk factors after adult living donor liver transplantation

Background Although risk factors for the long-term mortality of liver transplantation are well described, there is a lack of detailed study regarding these factors for adult living donor liver transplantation (LDLT). Methods We retrospectively analyzed 528 adult LDLT recipients in our hospital. The risk factors were analyzed for overall deaths >5 years post-LDLT. Results Over the 20-year follow-up, 137 patients died. Patient survival at 1, 3, 5, and 10 years post-LDLT was 87.8%, 81.8%, 79.4%, and 72.8%, respectively. The independent risk factors for >5 years post-LDLT overall death were hepatocellular carcinoma recurrence (hazard ratio [HR] = 38.9, P

https://ift.tt/2lfp3jT