ESTIMATION OF SERUM ASCITIC ALBUMIN GRADIENT (SAAG) AND SERUM ASCITIC CHOLESTEROL GRADIENT (SACG) IN DIFFERENT CAUSES OF ASCITES

2016-09-02T16-45-30Z
Source: Journal of Contemporary Medicine
Vinod Porwal, Ashwin Porwal, Yogesh Ajnar, Anand Verma, Priyanka Pandey.
Background: The aim of present study was to differentiate the portal hypertension and non-portal hypertension as well as malignant causes of ascites by serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradient(SACG). Material and method: a total of 130 patients having ascites were included in the study. Serum and Ascitic albumin and cholesterol was measured. SAAG and SACG were calculated by subtracting ascitic values from the respective serum values. Results: There was significant difference in SAAG in portal hypertension cases of ascites as compared to non-portal hypertension cases of ascites. In malignant cases the SACG was found significantly lower than non-malignant cases. The efficacy of SAAG in the present study to classify portal hypertension and non-portal hypertension etiology was 98.4%. SACG was able to accurately differentiate the malignant and non-malignant cases in 99.2% of cases at cut off value of 53mg/dl Conclusion: In view of the good diagnostic efficacy, easy availability and cost-effectiveness, serum ascitic albumin and cholesterol gradient is an excellent parameter for the diagnosis of portal hypertension and malignant ascites respectively.


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Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the aospine north america and international prospective multicenter studies

It remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM).

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Early gastric cancer with a mixed-type Lauren classification is more aggressive and exhibits greater lymph node metastasis

Abstract

Background

The clinicopathological features of mixed-type (MT) early gastric cancer (EGC) according to Lauren's classification remain uninvestigated. This study aimed to clarify the clinicopathological features of MT EGC, particularly in relation to lymph node metastasis (LNM) and long-term survival.

Methods

This study included 5309 patients who underwent gastrectomy for EGC. The clinicopathological features, LNM, and long-term outcomes of patients with MT carcinomas were compared with those of patients with intestinal-type (IT) and diffuse-type (DT) cancers. Furthermore, we evaluated the predictors of LNM in each Lauren classification subgroup.

Results

Patients with MT carcinomas were likelier to have larger tumors, submucosal invasion, lymphovascular invasion, and LNM than those with IT or DT carcinomas. Multivariate logistic regression analysis revealed that the Lauren classification was a significant predictor of LNM (P < 0.001). The significant predictors of LNM in MT carcinomas were female sex, greater tumor size, presence of submucosal invasion, and lymphovascular invasion. However, the overall survival of patients with MT carcinoma was not significantly different from that of patients with IT or DT carcinomas (P = 0.104).

Conclusions

The presence of MT EGC carries a higher risk of LNM compared with the presence of IT or DT carcinomas. Therefore, MT carcinomas should be managed with gastrectomy that includes lymph node dissection instead of endoscopic resection.

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Cow’s milk protein allergy

Clinical Pediatrics

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Role of omentectomy as part of radical surgery for gastric cancer

British Journal of Surgery

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Perforated peptic ulcer repair: Factors predicting conversion in laparoscopy and postoperative septic complications

World Journal of Surgery

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A randomized clinical trial of preoperative administration of branched-chain amino acids to prevent postoperative ascites in patients with liver resection for hepatocellular carcinoma

Annals of Surgical Oncology

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Managing malignant colorectal obstruction with self-expanding stents. a closer look at bowel perforations and failed procedures

Journal of Gastrointestinal Surgery

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Impact of non-neoplastic vs intratumoural hepatitis B viral DNA and replication on hepatocellular carcinoma recurrence

British Journal of Cancer

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Predictors of emergency ventral hernia repair: Targets to improve patient access and guide patient selection for elective repair

Surgery

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A quantitative analysis of FDA adverse event reports with oral bisphosphonates and Clostridium difficile

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy

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An integrated device for coprecipitation and filtration of radiocesium in seawater

Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Jianhua He
To improve the pretreatment efficiency of radiocesium in seawater, a prototype machine based on a new design of an integrated device for coprecipitation and filtration was developed and tested in the laboratory for its possibility and efficiency, the results show the that the efficiency of pretreatment of radiocesium can be improved more than one orders of magnitude compared to traditional methods. And the results from experiments on effect of settle time show that immediately filtration of solution after reaction will not affect the absorption of AMP to radiocesium in seawater.



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Intractable Seizures and Rehabilitation in Ciguatera Poisoning.

Ciguatera fish poisoning is the most frequently reported seafood toxin illness associated with the ingestion of contaminated tropical fish. Diagnosis relies on a history of recent tropical fish ingestion and subsequent development of gastrointestinal, cardiovascular, and neurological symptoms. Ciguatera poisoning usually has a self-limited time course, and its management involves symptomatic control and supportive care. This case report presents an uncommon case of ciguatera poisoning with prolonged intractable seizures refractory to standard antiseizure medications. The patient also had significant functional decline that responded to rigorous inpatient rehabilitation not previously described in literature. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Step Activity and 6-Minute Walk Test Outcomes When Wearing Low-Activity or High-Activity Prosthetic Feet.

Objective: To determine changes in average daily step count (ADSC) and 6-minute walk test (6MWT) due to use of low-activity feet (LA) and high-activity energy-storage-and-return (ESAR) feet, and examine the sensitivity of these measures to properly classify different prosthetic feet. Design: Individuals with transtibial amputations (n = 28) participated in a 6-week, randomized crossover study. During separate 3-week periods, participants wore either a LA foot (eg, solid-ankle-cushioned-heel) or an ESAR foot. Differences in 6MWT and ADSC at the end of the 3-week period were recorded. Results: Subjects performed similarly in the 6MWT with the LA and ESAR foot (P = 0.871) and ADSC (P = 0.076). The correct classification of ESAR is only 51.9% and 61.5% with 6MWT and ADSC, respectively. For the LA foot, correct classification is less than 50% for both tests. Conclusions: Neither ADSC or 6MWT are responsive to changes in prosthetic feet. The pitfalls and shortcomings of these instruments with regard to their ability to detect differences in prosthetic feet are outlined. Based on these results, it is not recommended that the 6MWT and ADSC are used as a means to assess outcomes for different prosthetic feet. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Electrical Stimulation Based on Chronaxie Increases Fibrosis and Modulates TWEAK/Fn14, TGF-[beta]/Myostatin, and MMP Pathways in Denervated Muscles.

Objective: The aim of this work was to investigate the effects of electrical stimulation (ES) of denervated muscles of rat in neuromuscular performance, muscle atrophy, and fibrosis formation. Design: Wistar rats were divided into normal (N), 7- or 15-day denervation (D7d and D15d), D7d or D15d plus ES (DES7d and DES15d, respectively). Sciatic nerves were crushed causing muscle denervation. Two hundred muscle contractions were electrically induced daily by surface electrodes, considering muscle chronaxie. Sciatic functional index was used to determine neuromuscular performance during walking. The muscle fiber cross-sectional area and percentage of connective tissue were assessed by light microscopy. Molecular markers of extracellular matrix production and remodeling were evaluated. Metalloproteinase (MMP) activity was assessed by zymography, and TWEAK, Fn14, myostatin, and transforming growth factor (TGF)-[beta] gene expressions were determined by real-time PCR. Results: Electrical stimulation impaired natural recovery of walking at 15 days. In addition, ES induced fibrosis and accentuated muscle atrophy in denervated muscles. Although ES reduced the accumulation of TWEAK and myostatin expressions, it up-regulated Fn14 and TGF-[beta] in a time-dependent manner. Electrical stimulation also increased the activity of MMP-2 compared to the other groups (P

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Home-Based Telemedicine in Patients with Chronic Neck Pain.

Objective: To investigate if a structured physician-directed, nurse-managed, home-based telemedicine (HBT) program, consisting of scheduled/unscheduled phone surveillance, can reduce pain in patients with chronic neck pain. Design: This is a prospective randomized controlled study conducted on outpatients. Following outpatient rehabilitation, patients (n = 100) were consecutively randomized to a 6-month HBT program (HBT group) or no HBT but only the recommendation to continue exercising at home (control group). At baseline and after 6 months, pain severity (visual analog scale) and disability (Neck Disability Index) were evaluated. Results: At 6 months, neck pain and disability declined in both groups (P

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Changes over Time and Responsiveness of the Cochin Hand Function Scale and Mouth Handicap in Systemic Sclerosis Scale in Patients with Systemic Sclerosis: A Prospective Observational Study.

Objective: To assess changes over time and responsiveness of the Cochin Hand Function Scale (CHFS) and Mouth Handicap In Systemic Sclerosis (MHISS) scale in patients with systemic sclerosis (SSc). Design: This was a prospective longitudinal study. Participants: Participants were drawn from a convenience sample of individuals with SSc, who were attending the annual Congress of the Association des Sclerodermiques de France, the French SSc patients' association. Methods: Participants were evaluated twice by the CHFS, MHISS scale, Health Assessment Questionnaire, McMaster-Toronto Arthritis Patient Preference Disability Questionnaire, and other outcome measures. Differences in measures over time were evaluated using the Wilcoxon signed rank test. Responsiveness was assessed by the effect size and standardized response mean. Nonparametric Spearman rank correlation (r) was used to assess correlation between outcome measures. Results: Forty-nine patients were assessed. The CHFS and MHISS scores worsened over time (mean [SD] differences 2.7 [10.7], P = 0.08, and 3.5 [9.8], P = 0.14, respectively). The CHFS effect size and standardized response mean values were -0.16 and -0.24, respectively, and MHISS values were -0.53 and -0.52, respectively. The correlation between change in the CHFS score and change in Health Assessment Questionnaire and McMaster-Toronto Arthritis Patient Preference Disability Questionnaire scores was fair to moderate, whereas changes in MHISS score were poorly or not correlated to other measures. For patients considering their state deteriorated, the MHISS scale was the most responsive instrument. Conclusions: The CHFS and MHISS scores may be useful in detecting changes in location-specific limitations in activity for SSc patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Responsiveness and Minimal Important Changes of the Western Ontario and McMaster Universities Osteoarthritis Index in Subjects Undergoing Rehabilitation Following Hip Fracture.

Objective: To evaluate the responsiveness and minimal important changes (MICs) for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and its subscales in subjects with hip fractures. Design: At the beginning and end of a 2-month rehabilitation program, 106 patients completed the WOMAC. After the program, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the WOMAC and its subscales were calculated by distribution (effect size; standardized response mean) and anchor-based methods (receiver operating characteristic curves; correlations between change scores of the WOMAC and its subscales and GPE). Receiver operating characteristic curves were also used in order to compute the best cutoff levels between improved and stable subjects (MICs). Results: The effect size ranged from 0.64 to 11.10 and the standardized response mean from 0.79 to 2.65. The receiver operating characteristic analyses revealed an MIC value (area under the curve, sensitivity, specificity) for the WOMAC of 29 (0.817, 92, 78); values of 35 (0.820, 77, 76) 44 (0.625, 25, 95), and 24 (0.707, 100, 76) were found for pain, stiffness, and physical function subscales, respectively. Correlations between change scores of the WOMAC and its subscales and GPE were low (0.240, for stiffness subscale) to moderate (0.438-0.570 for the other subscales and the WOMAC). Conclusions: The WOMAC and its subscales (all but stiffness) were sensitive in detecting clinical changes in subjects with hip fracture undergoing rehabilitation. We recommend taking the MICs provided into account when assessing patients' improvement or planning studies in this clinical context. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Benefits of Exercise on the Executive Functions in People with Parkinson Disease: A Controlled Clinical Trial.

Objective: We have made a 3-arm trial (group vs. individual exercise vs. no treatment) to test the effects of a 6-month exercise program upon the executive functions in participants with Parkinson disease. Methods: Twenty-four subjects were randomly allocated in 3 groups and undertook individualized exercises (G1, n = 8), group exercises (G2, n = 8), or monitoring (G3, n = 8). Executive functions were evaluated by means of the Wisconsin card sorting test and the Raven colored matrices, both assessed at the beginning of the program and after 6 months. The statistical analyses consisted of the application of repeated measurement tests, with a significant level of 5%. Results: The findings showed similar behavior of groups in terms of the Wisconsin card sorting test (P = 0.792), reporting no benefit of the program on such instrument. Differently, Raven colored matrices evidenced a significant benefit provided by the intervention (P = 0.032). Compared with the control group, individuals from G1 had a substantial improvement on executive functions (P = 0.031) and from G2 had a trend of significance (P = 0.072). Conclusion: Findings of this study show that 6 months of exercise improved some aspects of executive functions when compared with control peers. Individual therapy seems to have a more prominent improvement than group therapy. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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The Effectiveness of Technology-Supported Exercise Therapy for Low Back Pain: A Systematic Review.

Various technological systems have been developed to assist exercise therapy for low back pain. The aim of this systematic review was to provide an overview and to assess the effectiveness of the available technology-supported exercise therapy (TSET) programs for low back pain. The electronic databases Pubmed, Embase, Cochrane Central Register of Controlled Trials, PEDro, IEEE, and ACM were searched until January 2016. Randomized controlled trials (RCTs) using electronic technological systems simultaneously with exercise therapy for patients with low back pain were included. Twenty-five RCTs met the inclusion criteria. Seventeen studies involved patients with chronic low back pain, and electromyography biofeedback was the most prevalent type of technological support. This review shows that TSET seems to improve pain, disability, and quality of life for patients with low back pain, and that a standard treatment combined with an additional TSET program might be superior to a standard treatment alone. However, TSET seems not more effective compared to other interventions or a placebo intervention for improving these outcomes, which may partially be explained by the analytical approach of the current TSET-programs. For most technologies, only a limited number of RCTs are available, making it difficult to draw firm conclusions about the effectiveness of individual technological systems. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Home-Based Compared with Hospital-Based Rehabilitation Program for Patients Undergoing Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objective: The aim of this study was to compare the effects of home-based with those of hospital-based rehabilitation on patients undergoing total knee arthroplasty (TKA). Design: PubMed, Web of Science, EMBASE, and Cochrane Library were systematically searched for randomized controlled trials; the studies were assessed with the modified Jadad scale. Ten trials involving 1240 patients were eligible for meta-analysis. Results: The results revealed that home-based rehabilitation is not inferior to hospital-based rehabilitation according to the total Western Ontario and McMaster Universities Osteoarthritis index score, physical function, stiffness, walk test, and Oxford Knee Score at 12 or 52 weeks after TKA (P > 0.05). Neither pain nor knee flexion range of motion differed between the groups in the first 12 weeks. Unexpectedly, the pain score in the hospital-based group was better than that in the home-based group (P 0.05). Conclusion: Home-based rehabilitation after primary TKA was comparable to hospital-based rehabilitation and thus is a significant alternative for patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A Comprehensive Rehabilitation Program and Follow-up Assessment for Acute Intermittent Porphyria.

Acute intermittent porphyria (AIP) is an infrequent metabolic disease that can cause severe disability or death without timely treatment. A porphyric attack occurs when genetic factors combine with trigger factors, and diagnosis may be delayed owing to nonspecific symptoms. Recovery from AIP can be nearly or fully complete with proper treatment, which includes intravenous hematin administration, the control of trigger factors, and a comprehensive rehabilitation program. The aim of this case report was to describe the clinical evolution of a 43-year-old woman with AIP and a polyneuropathy. The patient was treated through a comprehensive rehabilitation program, with outcomes evaluated by the Functional Independence Measure and the Berg scales during rehabilitation and postdischarge follow-up. After completing the comprehensive rehabilitation program, the patient achieved a satisfactory level of functional independence, allowing for social and work reintegration. We conclude that an early and multidisciplinary approach is essential for regaining optimal functionality after AIP. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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SEER Sonorheometry Versus Rotational Thromboelastometry in Large Volume Blood Loss Spine Surgery.

BACKGROUND: Sonic estimation of elasticity via resonance (SEER) sonorheometry is a novel technology that uses acoustic deformation of the developing clot to measure its viscoelastic properties and extract functional measures of coagulation. Multilevel spine surgery is associated with significant perioperative blood loss, and coagulopathy occurs frequently. The aim of this study was to correlate SEER sonorheometry results with those of equivalent rotation thromboelastometry (ROTEM) and laboratory parameters obtained during deformity correction spine surgery. METHODS: Four independent SEER sonorheometry hemostatic indices (clot time, clot stiffness, fibrinogen, and platelet contribution) were measured. SEER sonorheometry clot time, using kaolin as an activator, was correlated with ROTEM intrinsic temogram clotting time and the activated partial thromboplastin time. For clot stiffness, thromboplastin was the primary activator, and this was correlated against ROTEM external temogram amplitude at 10 minutes (A10). The assay for the fibrinogen contribution was similar to clot stiffness, but abciximab was added to inhibit platelet function. The fibrinogen contribution assay was correlated with the ROTEM fibrinogen temogram A10. Finally, the SEER sonorheometry platelet contribution was calculated by subtracting the fibrinogen contribution from the clot stiffness. This variable was correlated with both absolute platelet counts, and ROTEM determined clot elasticity attributable to platelets. RESULTS: Fifty-one patients were enrolled in this prospective observational study. SEER sonorheometry clot stiffness, fibrinogen, and platelet contribution had a very strong correlation with ROTEM external temogram A10 (rs = .92; 99% confidence interval, .85-.96), fibrinogen temogram A10 (rs = .90; 99% confidence interval, .83-.93), and ROTEM-determined clot elasticity attributable to platelets (rs = .89; 99% confidence interval, .80-.95). SEER sonorheometry clot time exhibited moderate correlation with ROTEM intrinsic temogram clotting time (rs = .62; 99% confidence interval, .44-.77) and very weak correlation with activated partial thromboplastin time (rs = .33; 99% confidence interval, .10-.51). CONCLUSIONS: SEER sonorheometry demonstrates very strong correlation with ROTEM for determining clot stiffness and assessing fibrinogen and platelet contribution to clot strength in major spine surgery. An advantage of SEER sonorheometry is direct measurement of clot elasticity with no need to transform amplitude oscillation to elasticity. (C) 2016 International Anesthesia Research Society

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The Need to Apply Medical Device Informatics in Developing Standards for Safe Interoperable Medical Systems.

Medical device and health information technology systems are increasingly interdependent with users demanding increased interoperability. Related safety standards must be developed taking into account these systems' perspective. In this article, we describe the current development of medical device standards and the need for these standards to address medical device informatics. Medical device information should be gathered from a broad range of clinical scenarios to lay the foundation for safe medical device interoperability. Five clinical examples show how medical device informatics principles, if applied in the development of medical device standards, could help facilitate the development of safe interoperable medical device systems. These examples illustrate the clinical implications of the failure to capture important signals and device attributes. We provide recommendations relating to the coordination between historically separate standards development groups, some of which focus on safety and effectiveness and others focus on health informatics. We identify the need for a shared understanding among stakeholders and describe organizational structures to promote cooperation such that device-to-device interactions and related safety information are considered during standards development. (C) 2016 International Anesthesia Research Society

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Mitochondrial DNA and TLR9 Signaling Is Not Involved in Mechanical Ventilation-Induced Inflammation.

Exogenous administration of mitochondrial DNA (mtDNA) causes inflammatory lung injury in a toll-like receptor (TLR) 9-dependent manner. We investigated whether mechanical ventilation results in endogenous release of mtDNA and whether TLR9 plays a role in the pulmonary inflammatory response induced by mechanical ventilation. Wild-type and TLR9-/- C57bl/6 mice were ventilated with low (8 mL/kg) and high (32 mL/kg) tidal volumes for 4 hours. Levels of nuclear DNA and mtDNA in bronchoalveolar lavage fluid, as well as pulmonary concentrations of keratinocyte-derived chemokine, interleukin-1[beta], and interleukin-6, were determined. Cytokine and nuclear DNA, but not mtDNA, levels were increased after mechanical ventilation with both tidal volumes. Cytokine concentrations were similar between wild-type and TLR9-/- mice. Mechanical ventilation does not result in the release of mtDNA, and TLR9 is not involved in mechanical ventilation-induced inflammation. (C) 2016 International Anesthesia Research Society

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Thoracic Paravertebral Nerve Blocks in Pediatric Patients: Safety and Clinical Experience.

Thoracic paravertebral nerve blocks (PVNBs) provide excellent analgesia for many surgeries. The primary aim was to estimate the complication rate, and secondary aims were to provide information on the potential clinical application of PVNBs. Data on 2390 PVNBs were collected. A total of 625 catheters were performed on 468 patients, and 1765 single-injection PVNBs were performed on 403 patients. There was 1 case of local anesthetic systemic toxicity for a major complication rate of 1 per 2390 PVNBs. The minor complication rate was 13.2%. We demonstrate a low risk of complications in pediatric patients receiving PVNBs for various surgeries. (C) 2016 International Anesthesia Research Society

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Blood Bupivacaine Concentrations After a Combined Single-Shot Sciatic Block and a Continuous Femoral Nerve Block in Pediatric Patients: A Prospective Observational Study.

BACKGROUND: We evaluated blood bupivacaine concentrations in children having a single-shot sciatic and continuous femoral blocks after anterior cruciate ligament repair. METHODS: Dried blood spot samples were analyzed for bupivacaine levels at 0, 5, 15, 30, 60, and 120 minutes and 4, 24, and 48 hours. RESULTS: The highest 99% upper confidence interval limit was 135 ng/mL at the 4-hour evaluation point. The 99% upper confidence interval was below potentially toxic levels (1500 ng/mL) across all sampling times. CONCLUSIONS: The risk of local anesthetic toxicity in pediatric patients receiving single-shot sciatic and continuous femoral nerve blocks is very low. (C) 2016 International Anesthesia Research Society

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