Τρίτη, 8 Μαρτίου 2016

Autosomal recessive MFN2-related Charcot-Marie-Tooth disease with diaphragmatic weakness: Case report and literature review

Pathogenic variants in the mitofusin 2 gene (MFN2) are the most common cause of autosomal dominant Charcot-Marie-Tooth (CMT2) disease, which is typically characterized by axonal sensorimotor neuropathy. We report on a 7-month-old white female with hypotonia, motor delay, distal weakness, and motor/sensory axonal neuropathy in which next-generation sequencing analysis identified compound heterozygous pathogenic variants (c.2054_2069_1170del and c.392A>G) in MFN2. A review of the literature reveals that sporadic and familial cases of compound heterozygous or homozygous pathogenic MFN2 variants have been infrequently described, which indicates that MFN2 can also be inherited in a recessive manner. This case highlights several clinical findings not typically associated with MFN2 pathogenic variants, including young age of onset and rapidly progressing diaphragmatic paresis that necessitated tracheostomy and mechanical ventilation, and adds to the growing list of features identified in autosomal recessive MFN2-related CMT2. Our patient with MFN2-related CMT2 expands the clinical and mutational spectrum of individuals with autosomal recessive CMT2 and identifies a new clinical feature that warrants further observation. © 2016 Wiley Periodicals, Inc.



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Does medical intervention affect outcome in infants with trisomy 18 or trisomy 13?



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Abdominal tuberculosis: experience with RNTCP category III antitubercular therapy

2016-03-08T23-05-59Z
Source: International Journal of Medical Science and Public Health
Sunit K Shukla, Govind N Srivastava, Manoj Meena, Piyush Arora, Chetan B Patil, Ram N Meena.
Background: Abdominal tuberculosis as such has been put in seriously ill category III regimen because the therapy of abdominal tuberculosis throws up many challenges, especially those presenting with immune compromised and malnourished state. To accommodate all the accompanying challenges, it is prudent to keep the regimen flexible. Objective: To study the 30- and 60-day efficacy of daily versus alternate-day self-administered therapy of abdominal tuberculosis in young adults with ileocecal tuberculosis (IC) and mesenteric tubercular lymphadenitis (ML). Materials and Methods: This study was conducted for a duration of 2 years, starting June 2013, in an outpatient setting of a tertiary referral center in north India. Patients identified during a study of causes of functional abdominal pain syndrome (FAPS) or only pain presentation in gastroenterology (GI) outpatient and diagnosed as IC or ML on the basis of contrast-enhanced computerized tomography (CECT) and/or colonoscopy with ileoscopy were given daily (weight based) versus alternate-day revised national tuberculosis control program (RNTCP) category III regimen therapy in a nonrandom manner. Result: Twelve patients of abdominal tuberculosis were identified: eight cases had IC with varying degrees of gastrointestinal disturbances whereas four had ML with no other organic disease explaining the symptoms. Groups prescribed daily versus alternate-day therapy did not differ significantly because of the presentation as FAPS in young adults. All patients received clinically significant improvement with antitubercular therapy. Four patients prescribed RNTCP category III regimen showed excellent clinical relief. Dyspepsia occurred significantly more with alternate-day therapy. Conclusion: Self-administered DOTS alternate-day therapy according to RNTCP category III regimen is equally efficacious to daily-weight-based regimen in young adults with abdominal tuberculosis.


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Interneurons contribute to the hemodynamic/metabolic response to epileptiform discharges

Interpretation of hemodynamic responses in epilepsy is hampered by an incomplete understanding of the underlying neurovascular coupling, especially the contributions of excitation and inhibition. We made simultaneous multimodal recordings of local field potentials (LFPs), firing of individual neurons, blood flow, and oxygen level in the somatosensory cortex of anesthetized rats. Epileptiform discharges induced by bicuculline injections were used to trigger large local events. LFP and blood flow were robustly coupled, as were LFP and tissue oxygen. In a parametric linear model, LFP and the baseline activities of cerebral blood flow and tissue partial oxygen tension contributed significantly to blood flow and oxygen responses. In an analysis of recordings from 402 neurons, blood flow/tissue oxygen correlated with the discharge of putative interneurons but not of principal cells. Our results show that interneuron activity is important in the vascular and metabolic responses during epileptiform discharges.



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Quantifying the spatial extent of the corollary discharge benefit to transsaccadic visual perception

Extraretinal information, such as corollary discharge (CD), is hypothesized to help compensate for saccade-induced visual input disruptions. However, support for this hypothesis is largely for one-dimensional transsaccadic visual changes, with little comprehensive information on the spatial characteristics. Here we systematically mapped the two-dimensional extent of this compensation by quantifying the insensitivity to different displacement metrics. Human subjects made saccades to targets positioned at different amplitudes (4° or 8°) and directions (rightward, oblique, or upward). After the saccade the initial target disappeared and, after a blank period, reappeared at a shifted location—a collinear, diagonal, or orthogonal displacement. Subjects reported the perceived shift direction, and we determined the displacement detection based on the perceptual judgments. The two-dimensional insensitivity fields resulting from the perceptual thresholds had spatial features similar to the saccadic eye movement variability: 1) scaled with movement amplitude, 2) oriented (less sensitive to the change) along the saccade vector, and 3) approximately constant in shape when normalized by movement amplitude. In addition, comparing the postsaccadic perceptual estimate of the presaccadic target location to that based solely on the postsaccade visual error showed that overall the perceptual estimate was approximately 50% more accurate and 35% less variable than estimates based solely on this visual information. However, this relationship was not uniform: The benefit of extraretinal information was observed largely for displacements with a component parallel to the saccade vector. These results suggest a graded use of extraretinal information when forming the postsaccadic perceptual evaluation of transsaccadic environmental changes.



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Hyperpolarization-independent maturation and refinement of GABA/glycinergic connections in the auditory brain stem

During development GABA and glycine synapses are initially excitatory before they gradually become inhibitory. This transition is due to a developmental increase in the activity of neuronal potassium-chloride cotransporter 2 (KCC2), which shifts the chloride equilibrium potential (ECl) to values more negative than the resting membrane potential. While the role of early GABA and glycine depolarizations in neuronal development has become increasingly clear, the role of the transition to hyperpolarization in synapse maturation and circuit refinement has remained an open question. Here we investigated this question by examining the maturation and developmental refinement of GABA/glycinergic and glutamatergic synapses in the lateral superior olive (LSO), a binaural auditory brain stem nucleus, in KCC2-knockdown mice, in which GABA and glycine remain depolarizing. We found that many key events in the development of synaptic inputs to the LSO, such as changes in neurotransmitter phenotype, strengthening and elimination of GABA/glycinergic connection, and maturation of glutamatergic synapses, occur undisturbed in KCC2-knockdown mice compared with wild-type mice. These results indicate that maturation of inhibitory and excitatory synapses in the LSO is independent of the GABA and glycine depolarization-to-hyperpolarization transition.



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Modulation of impulsivity and reward sensitivity in intertemporal choice by striatal and midbrain dopamine synthesis in healthy adults

Converging evidence links individual differences in mesolimbic and mesocortical dopamine (DA) to variation in the tendency to choose immediate rewards ("Now") over larger, delayed rewards ("Later"), or "Now bias." However, to date, no study of healthy young adults has evaluated the relationship between Now bias and DA with positron emission tomography (PET). Sixteen healthy adults (ages 24–34 yr; 50% women) completed a delay-discounting task that quantified aspects of intertemporal reward choice, including Now bias and reward magnitude sensitivity. Participants also underwent PET scanning with 6-[18F]fluoro-l-m-tyrosine (FMT), a radiotracer that measures DA synthesis capacity. Lower putamen FMT signal predicted elevated Now bias, a more rapidly declining discount rate with increasing delay time, and reduced willingness to accept low-interest-rate delayed rewards. In contrast, lower FMT signal in the midbrain predicted greater sensitivity to increasing magnitude of the Later reward. These data demonstrate that intertemporal reward choice in healthy humans varies with region-specific measures of DA processing, with regionally distinct associations with sensitivity to delay and to reward magnitude.



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Neuroanesthesiology Update

imageWe provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. The following broad topics are covered: general neurosurgery, spine surgery, stroke, traumatic brain injury, anesthetic neurotoxicity, perioperative cognitive dysfunction, and monitoring.

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The Right Insular Cortex: A Critical Region for Modulating the Parasympathetic Activity?

No abstract available

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The Cerebrovascular Response to Ketamine: A Systematic Review of the Animal and Human Literature

imageBackground: The aim of the study was to perform a systematic review of the literature on the cerebrovascular/cerebral blood flow (CBF) effects of ketamine in both animal and human subjects. Materials and Methods: We searched MEDLINE, BIOSIS, EMBASE, Global Health, SCOPUS, and Cochrane Library from inception to December 2014. Two reviewers independently identified all manuscripts pertaining to the administration of ketamine in both human and animal subjects in which the impact on CBF/cerebral vasculature was recorded by means of functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, xenon computed tomography, transcranial Doppler velocities, arteriovenous difference in N2O method of CBF measurement, cerebral digital subtraction angiography, or any other objective means of CBF determination. Results: We identified 38 animal studies with various animal models studied. Overall there was a trend to a direct vasodilatory effect of ketamine on the cerebral vasculature, with a trend in most studies to an increase or regional CBF (rCBF) or global CBF. Twenty human studies were identified. The majority displayed an increase in rCBF and global CBF on imaging in patients without neurological illness. Conclusions: Animal models indicate an increase in global CBF and rCBF with ketamine administration, with a trend to vasodilation of medium-sized intracranial vessels through a calcium-dependent mechanism. Human studies display an Oxford 2b, Grading of Recommendation Assessment Development and Education C, level of evidence to support a trend to increased global CBF and rCBF with ketamine administration in both healthy volunteers and elective surgical patients without neurological illness.

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2015 Society for Neuroscience in Anesthesiology and Critical Care Annual Meeting Report

No abstract available

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Comparison of Dexmedetomidine Versus Midazolam-Fentanyl Combination for Monitored Anesthesia Care During Burr-Hole Surgery for Chronic Subdural Hematoma

imageBackground: Intraoperative movements are marker of inadequate level of sedation and are undesirable during burr-hole surgery under monitored anesthesia care (MAC). It distracts surgeon, hinders surgical procedure, and may lead to iatrogenic complication. Dexmedetomidine has shown to provide excellent analgesia, cooperative sedation with fewer fluctuations in sedation level during MAC. We compared the effect of dexmedetomidine on intraoperative patient movement, postoperative recovery time, and the surgeon and patient satisfaction scores with commonly used midazolam-fentanyl combination. Methods: Fifty-two patients undergoing burr-hole surgery for chronic subdural hematoma under MAC were randomly assigned to receive either IV dexmedetomidine 1 μg/kg over 10 minutes followed by continuous infusion 0.03 to 0.07 μg/kg/h (group D) or IV fentanyl 0.5 μg/kg and midazolam 0.03 mg/kg over 10 minutes followed by continuous infusion of 0.5 to 1.16 μg/kg/h fentanyl and 0.03 to 0.07 mg/kg/h midazolam (group M/F) titrated to maintain Ramsay sedation scale 3. Total number of intraoperative patient movements, postoperative recovery time, and patient and surgeon satisfaction scores were recorded. Results: Demographic and baseline characteristics were comparable between the 2 groups. Intraoperative patient movements were significantly less in group D than group M/F (median interquartile range, 1.00 [0.00 to 2.00] vs. 3.00 [1.00 to 3.25], P=0.007). Group D patients showed faster postoperative recovery (mean±SD, 7.00±6.96 vs. 13.69±6.18 min, P=0.000). Surgeon satisfaction scores were better in group D compared with group M/F (median interquartile range, 1.00 [1.00 to 1.25] vs. 2.00 [1.00 to 2.00], P=0.014). However, patient satisfaction score and hemodynamic parameters were comparable (P>0.05) between both the groups. Conclusions: Use of dexmedetomidine for MAC is associated with lesser number of intraoperative patient movements, faster postoperative recovery, better surgeon satisfaction score, and comparable patient's satisfaction compared with midazolam-fentanyl combination.

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Business card with a working mini EKG

A short demonstration of the ECG business card

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Business card with a working mini EKG

A short demonstration of the ECG business card

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Suspended For Saving A Life - Firefighters In Trouble For Driving Toddler

One of the suspended firefighters speaks out

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Business card with a working mini EKG

A short demonstration of the ECG business card

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Suspended For Saving A Life - Firefighters In Trouble For Driving Toddler

One of the suspended firefighters speaks out

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Fire engine transport had 3 possible patient outcomes

The suspension and reinstatement of two volunteer firefighters for transporting a possibly critically ill 18-month-old child in their fire engine brings up several issues that are not likely to be reported in the mainstream media. The child survived.

The incident points to the concept that out-of-hospital care is provided through a system of processes that work in conjunction with each other.

Whether the actions of the crew had anything to do with the child's outcome is debatable. Not working within the system can initiate a series of consequences and risks that can endanger the patient, the crew and the community at large.

First, rarely does the end justify the means. We have no idea what was happening with the patient, nor do we know what the outcome was. The crew's decision to transport using their engine may — or may not have — contributed to the patient's outcome in one of three ways:

1. No difference
The patient was not critically ill and saving a few minutes made no difference to the child's outcome.

2. Negative
Something was happening that was so significant, that early definitive intervention by EMS providers might have made a difference, but because of the transport, care was delayed and there was a negative result to the child's outcome.

3. Positive
Something was happening that was so significant to the child's life, such as an airway compromise or uncontrolled bleeding wound, that shortening on-scene and transport time made a positive difference to the child's outcome.

The third scenario, a positive outcome, is very rare.

The first scenario, no difference, is more likely. For example, Todd's paralysis after a seizure http://ift.tt/1pdwUyt is a transient problem after a seizure. It is an idiopathic problem that requires symptomatic treatment.

Transport is an intervention
Scenario 2, a negative impact on the patient's outcome is significant. Transporting in the cab of a fire engine with just one crew member to monitor and treat the patient would make it very difficult to manage any airway compromise, life-threatening hemorrhage or inadequate ventilation.

Could the core cyanosis be managed with positive-pressure ventilation" Were there secretions that needed suctioning" Either of these procedures could have been more easily managed at the scene, by the two EMT-trained firefighters, available BLS equipment and space to work.

Those definitive interventions for life-threatening emergencies, if needed, could have been applied 13 minutes sooner. We won't know if it would have made a difference until the investigation is complete.

But what if that was the scenario" Transport is an intervention in field care and it has to be delivered at the appropriate time, to the appropriate patient.

Another issue is the communications that occurred — or didn't occur — as the event unfolded. Stafford County is not small. Its fire and rescue department deploys numerous fire and EMS units out of 13 stations spread across 280 square miles, covering a population just under 137,000.

In other words, it's difficult to know where every unit is at any time — even for the dispatcher overseeing the system. GPS and automatic vehicle locators can be of assistance for real-time views, but there's no indication that the crew had access to that information.

In such circumstances crews have to rely on accurate information provided by other field units and the communication center to relay that information in order to best estimate arrival times of additional resources.

Here's one more issue. What if the patient was not 18-months-old, but a school-aged child, 25-year-old adult or a 75-year-old adult" At what point does the value of a life become so great that not using a properly prepared and authorized transport unit is justified"

That is a personal, moral decision that goes beyond the boundaries of a system designed to manage the majority of cases. How such a decision tips the risk-benefit scale is evaluated on a case-by-case basis. Nevertheless the dangers of such risk must be accepted by those who make such decisions.



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Business card with a working mini EKG

A short demonstration of the ECG business card

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Suspended For Saving A Life - Firefighters In Trouble For Driving Toddler

One of the suspended firefighters speaks out

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Suspended For Saving A Life - Firefighters In Trouble For Driving Toddler

One of the suspended firefighters speaks out

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Paramedic - Ambulance Services of Forrest City

The Paramedic is responsible for the pre-hospital care of patients. The Paramedic delivers care based on patient needs appropriate for the neonate, infant, child, adolescent, adult and geriatric patients. Demonstrates cooperation, flexibility and resourcefulness when dealing with patients, visitors, physicians, and other healthcare providers.

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Environmental determinants of life expectancy at birth in Turkey

2016-03-08T06-02-05Z
Source: International Journal of Research in Medical Sciences
Serap Taşkaya, Mustafa Demirkiran.
Background: Information on determinants of life expectancy has gained great importance due to the fact that life expectancy has been considered as the major health system outcome. Although social, economic and health-related factors of longevity have been investigated by some researchers, studies were undertaken on environmental determinants of lifespan are still inadequate. The aim of this study was to evaluate the environmental determinants of life expectancy at birth in Turkey. Methods: The research population constitutes 81 provinces in Turkey. Data were gathered from the Turkey statistical institute for the year of 2015. Air pollution, forest area, safe water and noise pollution were indicators of environmental health. OLS regression analysis was performed to investigate the relationship between dependent and independent variables by using Eviews 9 program. Results: At the end of analyses, it was found out that, the life expectancy at birth was affected by forest area per km2. Also, the results indicated that air pollution, access to safe water and noise pollution were not associated with life expectancy at birth. Conclusions: Forest area is one of the main issues for the healthy life of the country. These results are expected to provide evidence-based information to health policymakers to understand the environmental determinants of life expectancy at birth in Turkey.


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Code Green Campaign receives injury prevention award

Spokane, Wash. — The Code Green Campaign has been awarded the 2016 Nicholas Rosecrans Award for Excellence in Injury Prevention.

The award is presented by EPIC Medics in conjunction with JEMS, The RedFlash Group, the NHTSA's office of EMS and Laerdal Medical in recognition of emergency responders who demonstrate leadership, commitment and innovation in preventing injuries.

The Code Green Campaign works toward preventing suicides in first responders by raising awareness and providing education about the high rates of PTSD and suicide in the field. Since Code Green was founded in 2014, they have collected nearly 400 stories from first responders about their personal experiences with stress and trauma, have created a database of first responder-friendly mental health resources and have distributed over 22,000 resource cards, in addition to several other projects they are engaged in.

"We are honored to receive the award and humbled that after only being around for two years we are seen as being as worthy of the award as the previous winners," Anna Marie Farina, president of The Code Green Campaign, said. "Code Green's mission is quite a bit different than the winners in years past, but our ultimate goal is still prevention. Preventing suicide and preventing providers from leaving the field due to the trauma they've experienced."

In 1996, two-year old Nicholas Rosecrans wandered away from his daycare and drowned in an unsecured pool. After his death, the paramedics who treated Nicholas reached out to his mother and developed a close friendship with her. The paramedics later created EPIC Medics with the goal of integrating injury prevention and EMS. They created the Nicholas Rosecrans Award in 2002, which is presented by EPIC medics and Lynn Rosecrans-Artz at the EMS Today conference.

You can learn more about The Code Green Campaign here or by emailing admin@codegreencampaign.org.



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Sedate cardiac arrest patients who attain awareness from high-quality CPR

Researchers find a growing number of patients without a spontaneous heartbeat who regain consciousness while receiving CPR

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Activation of lysosomal P2×4 by ATP transported into lysosomes via VNUT/SLC17A9 using V-ATPase generated voltage gradient as the driving force

Abstract

The lysosome contains abundant ATP which plays important roles in lysosome functions as well as in cell signalling. Recently, solute carrier family 17 member 9 (SLC17A9, also known as VNUT for vesicular nucleotide transporter) proteins were suggested to function as a lysosomal ATP transporter responsible for lysosomal ATP accumulation, and P2×4 receptors were suggested to be lysosomal ion channels that are activated by luminal ATP. However, the molecular mechanism of SLC17A9 transporting ATP and the regulatory mechanism of lysosomal P2×4 are largely unknown. In this study, we report that SLC17A9-mediated ATP transport across lysosomal membranes is suppressed by Bafilomycin A1, the V-ATPase inhibitor. By measuring P2×4 activity, which is indicative of ATP transport across lysosomal membranes, we further demonstrated that SLC17A9 mainly uses voltage gradient but not pH gradient as the driving force to transport ATP into lysosomes. This study provides a molecular mechanism for lysosomal ATP transport mediated by SLC17A9. It also suggests a regulatory mechanism of lysosomal P2×4 by SLC17A9.

This article is protected by copyright. All rights reserved



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Concurrent chemoradiotherapy with elective lymph node irradiation for esophageal cancer: a systemic review and pooled analysis of the literature

Diseases of the Esophagus

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The vaginal microbiota, host defense and reproductive physiology

Abstract

The interaction between the human host and the vaginal microbiota is highly dynamic. Major changes in the vaginal physiology and microbiota over a woman's lifetime are largely shaped by transitional periods such as puberty, menopause, or pregnancy, while daily fluctuations in microbial composition observed through culture-independent studies are more likely the results of daily life activities and behaviours. The vaginal microbiota of reproductive-aged women is largely made up of at least five different community state types. Four of these community state types are dominated by lactic-acid producing Lactobacillus spp. while the fifth is commonly composed of anaerobes and strict anaerobes and is sometimes associated with vaginal symptoms. The production of lactic acid has been associated with contributing to the overall health of the vagina due to its direct and indirect effects on pathogens and host defense. Some species associated with non-Lactobacillus vaginal microbiota may trigger immune responses as well as degrade the host mucosa, processes that ultimately increase susceptibility to infections and contribute to negative reproductive outcomes such as infertility and preterm birth. Further studies are needed to better understand the functional underpinnings of how the vaginal microbiota affect host physiology but also how host physiology affects the vaginal microbiota. Understanding this fine-tuned interaction is key to maintaining women's reproductive health.

This article is protected by copyright. All rights reserved



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Incremental diagnostic utility of gastric distension FDG PET/CT

European Journal of Nuclear Medicine & Molecular Imaging

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Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders

Alimentary Pharmacology and Therapeutics

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Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition

Journal of Pediatric Surgery

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Infant and maternal risk factors related to necrotizing enterocolitis-associated infant death in the United States

Acta Pediatrica

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Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

The Journal of Nuclear Medicine

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Rising mortality associated with hepatitis C virus in the United States, 2003-2013

Clinical Infectious Diseases

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Preoperative functional status is not associated with postoperative surgical complications in low risk patients undergoing esophagectomty

Diseases of the Esophagus

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The prevalence and impact of thrombocytopenia, anaemia and leucopenia on sustained virological response in patients receiving hepatitis C therapy: evidence from a large ‘real world’ cohort

European Journal of Gastroenterology & Hepatology

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Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease following ileocolonic resection

Gastroenterology

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Risk factors for cholangiocarcinoma: Aspirin-use and the risk of cholangiocarcinoma

Hepatology

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Improvement of meal-related symptoms and epigastric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan

Neurogastroenterology & Motility

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Changes in the intestinal microbiome and alcoholic- and non-alcoholic liver diseases-causes or effects?

Gastroenterology

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Molecular fluorescence endoscopy targeting vascular endothelial growth factor a for improved colorectal polyp detection

The Journal of Nuclear Medicine

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Epidermal growth factor and prostaglandin E2 levels in Helicobacter pylori-positive gastric intraepithelial neoplasia

The Journal of International Medical Research

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Management and outcome of cervical versus intrathoracic manifestation of cervical anastomotic leakage after transthoracic esophagectomy for cancer

Diseases of the Esophagus

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Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy

Journal of Viral Hepatitis

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Multiresistente Erreger – Prävention und Diagnostik

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 112-120
DOI: 10.1055/s-0041-103142

Multiresistente Keime spielen im klinischen Alltag eine zunehmend bedeutsame Rolle. Dieses besonders auf Intensivstationen bzw. in Risikobereichen. Oftmals herrschen Unklarheiten bezüglich diagnostischer Screening-Indikationen und Strategien zur Vermeidung von Übertragungen mittels Hygiene- und Isolierungsmaßnahmen. Wir geben einen orientierenden Überblick über die zur Zeit gängigen Empfehlungen und bewerten diese für Methicillin-resistente Staphylococcusaureus-Stämme (MRSA) und multiresistente gramnegative Bakterien (MRGN).
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  CME online  |  Full text



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Internet, Recht, Personalia & Co

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 138-139
DOI: 10.1055/s-0042-101051

Kurz & bündig - was gibt es Neues rund ums Fachgebiet AINS? Die wichtigsten Meldungen auf einen Blick finden Sie hier. In dieser Ausgabe mit den folgenden Themen:
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Nachrichten aus der internationalen Fachliteratur

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 81-83
DOI: 10.1055/s-0042-101052

In dieser Rubrik werden Nachrichten aus der Wissenschaft kurz und prägnant für Sie zusammengefasst. In dieser Ausgabe mit folgenden Themen:
[...]

© Georg Thieme Verlag Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text



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Multiresistente Erreger – Therapiestrategien

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 126-134
DOI: 10.1055/s-0041-103158

Infektionen durch multiresistente Erreger sind weltweit ein zunehmendes Problem. Bei schweren Infektionen durch MRSA kommen Glykopeptide, Linezolid, Daptomycin oder Cephalosporine der 5. Generation („MRSA-Cephalosporine") zum Einsatz, mögliche Kombinationspartner sind Fosfomycin und Rifampicin. Therapieoptionen für VRE-Infektionen sind beschränkt auf Linezolid, Tedizolid, Daptomycin und Tigecyclin. Neue Substanzen mit Wirksamkeit gegen MRSA und VRE sind Tedizolid, Dalbvancin und Oritavancin. Als Monotherapie bei schweren Infektionen durch 3MRGN stehen insbesondere die Carbapeneme zur Verfügung. Ceftolozan/Tazobactam wurde rezent auch in Europa zugelassen und zeigt gute Wirksamkeit gegen einen Großteil der ESBL-Bildner. Bei unkompliziertem Harnwegsinfekt können orale Substanzen wie Nitrofurantoin oder Fosfomycin eingesetzt werden. Gegenüber Carbapenem-resistenten Enterobacteriaceae zeigt Colistin die beste in vitro Empfindlichkeit, gefolgt von Fosfomycin und Tigecyclin. Bei schweren Infektionen durch 4MRGN wird eine Colistin-basierte Kombinationstherapie mit zwei bis drei Substanzen empfohlen, wobei hier als Kombinationspartner auch Carbapeneme sinnvoll sein können.
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Prähospitale Analgesie beim Erwachsenen – Schmerzerfassung und Therapieoptionen

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 84-96
DOI: 10.1055/s-0042-101466

Nach der Sicherung der Vitalfunktionen ist die Schmerztherapie ein wichtiger Faktor der notfallmedizinischen Versorgung. Unabhängig von der zugrunde liegenden Erkrankung oder Verletzung ist Schmerz ein wichtiges Warnsymptom des Körpers und der häufigste Grund für eine Notarztalarmierung. Als Maß der Versorgungsqualität und Erfolgskriterium für die prähospitale Versorgung beurteilt der Patient das Ausmaß der Schmerzlinderung. Da leichte Schmerzen in der Regel nicht zur Notarztalarmierung führen, gilt es im Wesentlichen, starke und sehr starke Schmerzen zu therapieren. Schmerzwahrnehmung ist interindividuell unterschiedlich. Entsprechend steht am Beginn jeder Schmerztherapie zunächst die Erfassung der Schmerzintensität. Für erwachsene Notfallpatienten eignet sich hierzu die Numeric Rating Scale (NRS) mit dem Beurteilungsbereich 0 (kein Schmerz) bis 10 (stärkster vorstellbarer Schmerz). Ab einem Grading von 4 sollte therapeutisch interveniert werden mit dem Ziel, einen Wert < 4 oder zumindest eine Schmerzreduktion um 3 Punkte zu erreichen. Die Auswahl der in der prähospitalen Notfallmedizin sinnvoll einzusetzenden Analgetika ist begrenzt. Der Notarzt soll die möglichen Medikamente und Applikationswege kennen.
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Strukturierte Patientenübergaben im Aufwachraum

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 77-78
DOI: 10.1055/s-0042-102208



© Georg Thieme Verlag Stuttgart · New York

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Pssst ... AINS-Secrets! – Heute aus der Allgemein- und Gefäßchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 98-100
DOI: 10.1055/s-0041-110164



© Georg Thieme Verlag Stuttgart · New York

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Multiresistente Erreger – Antibiotic Stewardship

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 122-125
DOI: 10.1055/s-0041-103159

Die adäquate Behandlung von Infektionen ist eine wichtige Aufgabe in der Intensivmedizin, die für das Überleben der Patienten oft ausschlaggebend ist. Typischerweise finden sich auf Intensivstationen daher in der Regel hohe Anwendungsdichten von Antibiotika. In Anbetracht einer besorgniserregenden Resistenzentwicklung ist es dringend geboten, den Einsatz von Antiinfektiva zu optimieren, um den Resistenzdruck zu verringern. AntibioticStewardship versucht, das Infektionsmanagement durch interdisziplinäre Zusammenarbeit auf mehreren Ebenen zu verbessern. Übergeordnetes Ziel von ABS ist eine Verlangsamung der Resistenzentwicklung zur Schonung der wertvollen Ressource „Antibiotikum". Insbesondere die Intensivstation ist ein wichtiges Betätigungsfeld für AntibioticStewardship. Der vorliegende Artikel diskutiert praktische Aspekte sowie die verfügbare Evidenz für AntibioticStewardship.
[...]

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Multiresistente Erreger – Ein zunehmendes Problem in der Intensivmedizin – Time to act!

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 102-103
DOI: 10.1055/s-0042-101493

In den letzten Jahren hat das Problem der Infektionen mit multiresistenten Erregern auch in Deutschland zunehmend an Bedeutung gewonnen. Viele Jahre war dies ein Phänomen, welches sich hauptsächlich außerhalb Zentraleuropas ereignete. Waren in den letzten Jahrzenten in der Regel Methicillin-resistente Staphylokokken (MRSA) das Hauptproblem, so haben in den letzten Jahren zunehmend Vancomycin-resistente Enterokokken (VRE) und multiresistente gramnegative Erreger (MRGN) an Relevanz gewonnen. Teilweise sind auch panresistente Erreger bei den kritisch kranken Intensivpatienten anzutreffen, z. B. Acinobacter-baumanii-Stämme. Immuninkompetente und ältere Patienten mit hoher Komorbidität kombiniert mit der Notwendigkeit einer längeren Behandlung auf Intensivstationen sind hier eine besondere Risikogruppe.
[...]

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Empfehlung der DGAI zur strukturierten Patientenübergabe in der perioperativen Phase – Das SBAR-Konzept

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 136-137
DOI: 10.1055/s-0042-101190

Teamarbeit im OP-Saal und auf der Intensivstation erfordert eine klare und konsistente Kommunikation. Gerade in der unmittelbar prä-, intra- und postoperativen Phase kommt es jedoch – u. a. wegen der zu diesem Zeitpunkt hohen Arbeitsbelastung von Ärzten und Pflegepersonal– immer wieder zu Kommunikationsunterbrechungen.Ein möglicher Lösungsansatz für eine verbesserte Kommunikation bei einer Patientenübergabe liegt in der Verwendung eines strukturierten Übergabeprotokolls im Sinne einer „Standard Operating Procedure" (SOP). Die Verwendung eines geeigneten Protokolls kann die Häufigkeit von Behandlungsfehlern senken.Die DGAI hat nun eine Empfehlung zur strukturierten Patientenübergabe in der perioperativen Phase herausgegeben, in der sie das sog. SBAR-Konzept vorstellt (SBAR= Akronym für Situation, Background,Assessment, Recommendation).
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Multiresistente Erreger – Epidemiologie, Surveillance und Bedeutung

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 104-111
DOI: 10.1055/s-0041-103348

Epidemiologie Die Epidemiologie multiresistenter Erreger (MRE) ist für die einzelnen MRE Arten unterschiedlich und variiert zwischen ambulantem und stationärem Bereich sowie im zeitlichen Verlauf. Allgemein sind Antibiotikaresistenzraten für MRE (MRSA, VRE, MRGN) im ambulanten Bereich niedriger als in Krankenhäusern. Innerhalb des Krankenhauses ist der Anteil von MRE-Patienten auf Intensivstationen höher als auf Normalstationen. Während MRSA über die letzten Jahre immer mehr zurückgehen, hat der Anteil der Patienten mit MRGN kontinuierlich zugenommen. Aktuell ist bereits jeder 60. Patient auf einer ITS ein MRGN-Patient. Surveillance Krankenhäuser sind gesetzlich zu einer Surveillance von MRE verpflichtet. Um die Aussagekraft der Surveillance zu erhöhen besteht die Möglichkeit sich an einem der 3 Surveillance-Systeme (ARS, SARI, KISS) zu beteiligen, die sich in Aufwand und Aussagemöglichkeiten unterscheiden. Bedeutung MRE können zu vermehrten Kosten und einer Erhöhung der Morbidität und Mortalität führen.Abstract
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Buchtipps

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 140-140
DOI: 10.1055/s-0042-101377

Für Sie gelesen: In dieser Rubrik stellen wir Ihnen Neuerscheinungen aus Ihrem Fachbereich vor. In dieser Ausgabe:
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© Georg Thieme Verlag Stuttgart · New York

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Forum der Industrie

Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51: 142-142
DOI: 10.1055/s-0042-100646

Im Forum der Industrie lesen Sie über Marktneuheiten von A wie Analgetika bis Z wie zentraler Venenkatheter. Sie erhalten nützliche Informationen über Wirkungsweise, Anwendung und technische Ausstattung von Produkten – nach Angaben der Hersteller.In dieser Ausgabe:
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Role of Procalcitonin and C-Reactive Protein as Biomarkers of Infection in Children with Liver Disease.

Background and aim: Early and accurate identification of infection in patients with liver disease is challenging. This study evaluated the role of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers of bacterial infection in children with liver disease. Methods: Demographic and clinical data of consecutive children admitted with acute liver failure (ALF) or decompensated chronic liver disease (DCLD) were collected. PCT and CRP were measured within 24 hours of admission. Blood and urine culture, chest x-ray and ascitic fluid analysis was done. Results: 164 children (113 boys, age 76 (0.5-204) months, ALF -69, DCLD-95) were enrolled. 77 (47%) had infection. Most common site was ascitic fluid (n-35), followed by urinary tract (n-26), pneumonia (n-22) and blood stream infection (n- 16). 21 children had multiple site infections, 18 had severe sepsis and 36 had systemic inflammatory response syndrome (SIRS). PCT and CRP correlated with infection severity, highest in severe sepsis [(8.3 (3.5-38)ng/mL and 4.1 (0.3-13.8) mg/dL] than only infection [0.89 (0.1- 8) ng/mL and 1.7 (0.32-24) mg/dL] than no infection [0.3 (0.1-6.75) ng/mL and 0.3 (0.1-4.16 mg/dL). SIRS was commoner in patients with infection (31/77 vs. 5/87, p = 0.00). PCT (> 0.5 ng/ml) and CRP (>0.6 mg/dL) performed better in DCLD (AUC of 0.90 and 0.83) as compared to ALF patients (AUC of 0.73 and 0.69). Conclusion: : PCT and CRP are reliable markers of infection and correlate with infection severity in children with liver disease. Their diagnostic accuracy is better in DCLD than ALF cases. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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ESPGHAN Distinguished Service Award 2015 to Professor C. Olle E. Hernell.

No abstract available

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Novel pathogenic SLC25A46 splice-site mutation causes an optic atrophy spectrum disorder

ABSTRACT

The inherited optic neuropathies comprise a group of genetically heterogeneous disorders causing optic nerve dysfunction. In some cases, optic neuropathies are associated with cerebellar atrophy which mainly affects the vermis. Here, we describe a Moroccan girl of consanguineous parents with optic atrophy and cerebellar atrophy. Exome sequencing revealed a novel homozygous mutation (c.283+3G>T) in the donor splice site for exon 1 of SLC25A46. RNA analysis revealed that an alternative splice site within exon 1 was used leading to a premature termination codon within exon 2. SLC25A46 mRNA expression showed there is no wild-type transcript present in the patient and the mutant transcript does not undergo nonsense mediated mRNA decay. Futhermore, we observed c.283+3G>T SLC25A46 mutation induces mitochondrial fragmentation. An additional 10 patients with optic atrophy and cerebellar atrophy, which were negative for mtDNA and OPA1 variants, were tested for pathogenic mutations in the SLC25A46 gene. However, no additional variants were identified. Our findings confirm the recent report of pathogenic SLC25A46 mutations as a novel cause for optic atrophy spectrum disorder.



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A de novo frameshift in HNRNPK causing a Kabuki-like syndrome with nodular heterotopia

Abstract

Kabuki syndrome is a heterogeneous condition characterized by distinctive facial features, intellectual disability, growth retardation, skeletal abnormalities and a range of organ malformations. Although at least two major causative genes have been identified, these do not explain all cases. Here we describe a patient with a complex Kabuki-like syndrome that included nodular heterotopia, in whom testing for several single gene disorders had proved negative. Exome sequencing uncovered a de novo c.931_932insTT variant in HNRNPK (heterogeneous nuclear ribonucleoprotein K). Although this variant was identified in March 2012, its clinical relevance could only be confirmed following the August 2015 publication of two cases with HNRNPK mutations and an overlapping phenotype that included intellectual disability, distinctive facial dysmorphism and skeletal/connective tissue abnormalities. Whilst we had attempted (unsuccessfully) to identify additional cases through existing collaborators, the two published cases were "matched" using GeneMatcher, a web-based tool for connecting researchers and clinicians working on identical genes. Our report therefore exemplifies the importance of such online tools in clinical genetics research and the benefits of periodically reviewing cases with variants of unproven significance. Our study also suggests that loss of function variants in HNRNPK should be considered as a molecular basis for patients with Kabuki-like syndrome.



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