Παρασκευή, 9 Δεκεμβρίου 2016

Unusual case of duodenobiliary fistula complicating Crohn’s disease successfully treated with Adalimumab

Publication date: Available online 9 December 2016
Source:Arab Journal of Gastroenterology
Author(s): Aya Hammami, Aida Ben Slama, Hanen Jaziri, Wafa Ben Ameur, Imed Ben Mansour, Ahlem Brahem, Salem Ajmi, Hela Jemni, Mehdi Ksiaa, Ali Jmaa
Crohn's disease (CD) is characterized by transmural inflammation of the gastrointestinal tract, which predisposes to the formation of fistula. Duodenal involvement occurs in less than 5% of cases and often leads to clinically relevant strictures. However, fistula formation in the duodenum is exceptional. Herein, we report an unusual case of duodenobiliary fistula due to CD occurring in a 65-year-old patient who was successfully treated by anti-tumor necrosis factor (TNF) agents. This case report highlights the efficacy of anti-TNF alpha agents in the treatment of a bilioenteric fistula because it increases the probability of clinical remission and mucosal healing and therefore reduces the need for surgical treatment which may be associated morbidity.



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NF-Y in cancer: Impact on cell transformation of a gene essential for proliferation

Publication date: Available online 9 December 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Aymone Gurtner, Isabella Manni, Giulia Piaggio
NF-Y is a ubiquitous heterotrimeric transcription factor with a binding affinity for the CCAAT consensus motif, one of the most common cis-acting element in the promoter and enhancer regions of eukaryote genes in direct (CCAAT) or reverse (ATTGG) orientation. NF-Y consists of three subunits, NF-YA, the regulatory subunit of the trimer, NF-YB, and NF-YC, all required for CCAAT binding. Growing evidence in cells and animal models support the notion that NF-Y, driving transcription of a plethora of cell cycle regulatory genes, is a key player in the regulation of proliferation. Proper control of cellular growth is critical for cancer prevention and uncontrolled proliferation is a hallmark of cancer cells. Indeed, during cell transformation aberrant molecular pathways disrupt mechanisms controlling proliferation and many growth regulatory genes are altered in tumors. Here, we review bioinformatics, molecular and functional evidence indicating the involvement of the cell cycle regulator NF-Y in cancer-associated pathways. This article is part of a Special Issue entitled: Nuclear Factor Y in Development and Disease, edited by Prof. Roberto Mantovani.



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Vestibular implants studied in animal models: clinical and scientific implications

Damage to the peripheral vestibular system can result in debilitating postural, perceptual, and visual symptoms. A potential new treatment for this clinical problem is to replace some aspects of peripheral vestibular function with an implant that senses head motion and provides this information to the brain by stimulating branches of the vestibular nerve. In this review I consider animal studies performed at our institution over the past 15 years, which have helped elucidate how the brain processes information provided by a vestibular (semicircular canal) implant and how this information could be used to improve the problems experienced by patients with peripheral vestibular damage.



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Driving After Adolescent Concussion: Advice From Nurse Practitioners in the Absence of Standardized Recommendations

Nurse practitioners (NPs) are authorized to manage concussion recovery. Common adolescent activities, like driving, are omitted from guidelines. We investigated NP driving guidance and its clinical basis for restriction or limitation following adolescent concussion.

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Asthma Home Management in the Inner-City: What can the Children Teach us?

Knowledge of asthma home management from the perspective of poor, minority children with asthma is limited.

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Rickets: Not Just a Disease Caused by Vitamin D Deficiency

A 2-year, 10-month-old White girl presented to a pediatric clinic with an abnormal wide gait and genu varum. She had been an established patient at the clinic since her 4-month well-child visit. Concerns regarding her motor development were noted at her 6-month well-child visit, when she presented with generalized muscle hypotonia, was unable to roll supine to prone or prone to supine, and was unable to sit unassisted. Additionally, the patient had dropped to the 5th to 10th percentile for weight at 6 months from the 25th percentile at her 4-month visit.

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Authors’ Reply to Anoop Balachandran et al.: Comment on “Sub-Anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial”



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Comment on “Sub-anesthetic Xenon Increases Erythropoietin Levels in Humans: A Randomized Controlled Trial”



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Neural control and precision of flight muscle activation in Drosophila

Abstract

Precision of motor commands is highly relevant in a large context of various locomotor behaviors, including stabilization of body posture, heading control and directed escape responses. While posture stability and heading control in walking and swimming animals benefit from high friction via ground reaction forces and elevated viscosity of water, respectively, flying animals have to cope with comparatively little aerodynamic friction on body and wings. Although low frictional damping in flight is the key to the extraordinary aerial performance and agility of flying birds, bats and insects, it challenges these animals with extraordinary demands on sensory integration and motor precision. Our review focuses on the dynamic precision with which Drosophila activates its flight muscular system during maneuvering flight, considering relevant studies on neural and muscular mechanisms of thoracic propulsion. In particular, we tackle the precision with which flies adjust power output of asynchronous power muscles and synchronous flight control muscles by monitoring muscle calcium and spike timing within the stroke cycle. A substantial proportion of the review is engaged in the significance of visual and proprioceptive feedback loops for wing motion control including sensory integration at the cellular level. We highlight that sensory feedback is the basis for precise heading control and body stability in flies.



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Extradural Hematoma With Unanticipated Difficult Intubation Due to Rhinoscleromatosis

imageNo abstract available

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JNA Journal Club

No abstract available

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Equiosmolar Solutions of Hypertonic Saline and Mannitol Do Not Impair Blood Coagulation During Elective Intracranial Surgery

imageBackground: The authors investigated the effect of equiosmolar, equivolemic solutions of 3% hypertonic saline (HS) and 20% mannitol on blood coagulation assessed by rotational thromboelastometry (ROTEM) and standard coagulation tests during elective craniotomy. Methods: In a prospective, randomized, double-blind trial, 40 patients undergoing elective craniotomy were randomized to receive 5 mL/kg of either 20% mannitol or 3% HS for intraoperative brain relaxation. Fibrinogen, activated partial thromboplastin time, prothrombin time, hemoglobin, hematocrit, and platelet count were simultaneously measured intraoperatively with ROTEM for EXTEM, INTEM, and FIBTEM analysis. ROTEM parameters were: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and α-angle. Results: No significant differences between groups were found in ROTEM variables CT, CFT, MCF, α-angle (EXTEM and INTEM), and MCF (FIBTEM) nor standard coagulation tests. ROTEM parameters did not show changes after administration of hyperosmolar solutions relating to basal values, except for an increase of CFT EXTEM (118±28 vs. 128±26 s) and decrease of CT INTEM (160±18 vs. 148±15 s) with values within normal range. Significant decreases from baseline levels were observed for hematocrit (−7%), platelet count (−10%), and fibrinogen (−13%) after HS infusion, and hematocrit (−9%), platelet count (−13%), and fibrinogen (−9%) after mannitol infusion, but remaining normal. Conclusions: The use of 5 mL/kg of equiosmolar solutions of 3% HS and 20% mannitol applied to reach a brain relaxation during elective craniotomy does not induce coagulation impairment as evidenced by ROTEM and standard coagulation tests.

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Regional Anesthesia for Craniotomy

No abstract available

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Comparison of Intra-Abdominal Pressure Among 3 Prone Positional Apparatuses After Changing From the Supine to the Prone Position and Applying Positive End-Expiratory Pressure in Healthy Euvolemic Patients: A Prospective Observational Study

imageBackground: Positional apparatuses used for the prone position can affect intra-abdominal pressure (IAP). In this study, we compared the IAP after changing to the prone position and applying various positive end-expiratory pressure (PEEP) levels among 3 prone positional apparatuses. Methods: A total of 108 healthy euvolemic patients undergoing elective prone spinal surgery were divided into 3 groups based on the positional apparatus used: the Jackson spinal table was used in group J (n=36), the Wilson frame in group W (n=36), and chest rolls in group C (n=36). The IAP was measured 2 minutes after application of 0, 3, 6, and 9 cm H2O of PEEP. Results: The IAP in the supine position was 6.4±3.0, 5.9±2.8, and 7.1±2.5 mm Hg in groups J, C, and W, respectively. After the supine-to-prone positional change, the IAP in the prone position was significantly lower in group J than in groups C and W (2.7±2.9 vs. 8.9±4.0 and 12.9±4.3 mm Hg, P

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Comparison of Continuous Noninvasive Blood Pressure Monitoring by TL-300 With Standard Invasive Blood Pressure Measurement in Patients Undergoing Elective Neurosurgery

imageBackground: Intraoperative blood pressure (BP) is one of the basic vital signs monitoring. Compared with standard invasive BP measurement, TL-300 allows for a continuous and beat-to-beat noninvasive intraoperative BP monitoring. The current retrospective study compared the accuracy and precision of this noninvasive technique for continuous BP monitoring with that of standard invasive BP measurement in patients undergoing elective neurosurgery. Materials and Methods: BP records of 23 patients undergoing elective neurosurgery, measured by both noninvasive TL-300 and invasive radial arterial catheter method, were retrospectively analyzed. Variability in BP data was analyzed by using linear regressions and Bland-Altman analysis. Results: Four thousand three hundred eighty-one pairs of BP measurements from a total of 23 patients were included. The coefficient of determination of systolic, diastolic, and mean BP were 0.908, 0.803, and 0.922, respectively. And their bias was found to be 1.3±5.87 mm Hg (95% limits of agreement: −10.2 to +12.8 mm Hg), 2.8±6.40 mm Hg (95% limits of agreement: −9.8 to +15.3 mm Hg), and 1.8±4.20 mm Hg (95% limits of agreement: −6.4 to +10.1 mm Hg), respectively. Conclusions: TL-300 system is a promising noninvasive alternative to the invasive arterial catheter method for intraoperative BP monitoring, with a high accuracy and precision. With the limitation of the current retrospective study, further prospective method comparison studies are needed.

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Association Between Perioperative Hyperglycemia and Survival in Patients With Glioblastoma

imageBackground: Several studies have examined the association between hyperglycemia in the first 10 to 12 weeks following surgery and postoperative survival in glioblastoma multiforme (GBM) patients. We hypothesize that episodes of hyperglycemia before, during and/or following surgery for primary GBM are independent predictors of disease progression and mortality. Materials and Methods: A total of 162 adult patients were included in the analysis. All patients received adjuvant temozolamide. The progression free survival (PFS) and overall survival (OS) rates at 1 and 5 years were analyzed using different glycemic cutoff values. Multivariate analyses were conducted to test the association between preoperative, intraoperative and postoperative hyperglycemia with PFS and OS. Results: Kaplan-Meier curves revealed a trend toward increased PFS and OS with lower glucose concentrations with the exception of glucose concentrations >180 mg/dL in the intraoperative/postoperative day 0 time period. Univariate analysis of blood glucose levels did not demonstrate a statistically significant effect on PFS in any time period, however hyperglycemia was statistically significant for OS in the preoperative time period. Although, multivariate analysis showed no statistically significant association with hyperglycemia on PFS, a statistically significant decrease in OS was seen for plasma glucose concentrations >112 mg/dL (P=0.01) and >180 mg/dL (P=0.01) in the preoperative period. There was a decreasing effect on OS with blood glucose concentrations greater than the median in multiple time periods (P=0.02). Conclusions: Preoperative hyperglycemia is associated with poor OS after GBM surgery.

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Comparing the Intubation Performance of Macintosh and Airtraq Laryngoscopes

No abstract available

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Intraoperative Monitoring of Diaphragm Neural Pathways During Cervical Surgery by Electrical Stimulation and Recordings of Ventilator Waveforms: Physiological Bases and Pilot Study

imageBackground: Surgery on the cervical spine entails the risk of damaging the neural structures responsible for diaphragmatic innervation, namely (C3)-C4-(C5) roots. In some "difficult" cases, anatomic identification of these structures may be hard to achieve. Therefore, monitoring of the diaphragm through the ventilation waveforms displayed on the anesthesia machine can be of practical help. According to literature review, very few publications have reported such monitoring. Methods: The present work aimed at investigating the feasibility and reliability of identifying cervical root(s) responsible for diaphragmatic innervation, by observing the changes on the recorded waveforms, indicating diaphragmatic responses to direct radicular electrical stimulation. In this study, the events not only on the capnography curve but also on pressure-time and flow-time waveforms were analyzed. Eight patients undergoing cervical Microsurgical DREZotomy (MDT) were enrolled in the study, as this surgical modality allows easy access to the C4 root, known to be prominent in diaphragmatic innervation. The technique did not require any harmful additional maneuver to the current anesthesia and surgical protocols. Results: Stimulation resulted in specific patterns of changes in the 3 waveforms in all 8 patients and proved "easy" to interpret, provided that close cooperation exists between the anesthesiologist and the surgeon. Conclusion: Intraoperative monitoring of the diaphragmatic responses to stimulation can be advocated in surgery at the cervical spine level, and also more widely in surgery in the supraclavicular region, when neural structures responsible for diaphragmatic function are at risk.

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The Power of Raw Data

imageNo abstract available

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Sevoflurane Postconditioning Reduces Apoptosis by Activating the JAK-STAT Pathway After Transient Global Cerebral Ischemia in Rats

imageBackground: The antiapoptotic effects of sevoflurane postconditioning are responsible for neuroprotection against cerebral ischemia-reperfusion injury. Phosphorylation of the Janus family tyrosine kinases (JAK) 2-signal transducers and activators of transcription (STAT) 3 pathway is linked to antiapoptosis. Here, we determined whether the antiapoptotic effects of sevoflurane postconditioning are associated with activation of the JAK2-STAT3 pathway after global transient cerebral ischemia in rats. Materials and Methods: Forty-five rats were randomly assigned to 5 groups: sham (n=5), control (10 min of ischemia, n=10), sevoflurane postconditioning (2 periods of sevoflurane inhalation after ischemia for 10 min, n=10), AG490 (a JAK2 selective inhibitor, intraperitoneal administration of 40 mg/kg before ischemia, n=10), and sevoflurane postconditioning plus AG490 group (n=10). The number of apoptotic cells as well as the expression of JAK2, phosphorylated JAK2 (P-JAK2), STAT3, phosphorylated STAT3 (P-STAT3), Bcl-2 (antiapoptotic protein), and Bax (proapoptotic protein) were evaluated 3 days after ischemia. Results: The apoptotic cell count was significantly lower in the sevoflurane postconditioning group than in the control, AG490, and sevoflurane postconditioning plus AG490 groups. JAK2 and STAT3 levels were comparable among all 5 groups. P-JAK2, P-STAT3, and Bcl-2 levels were higher and Bax levels were lower in the sevoflurane postconditioning group relative to the control, AG490, and sevoflurane postconditioning plus AG490 groups. Conclusions: Sevoflurane postconditioning reduced apoptosis by increasing P-JAK and P-STAT expression after transient global ischemia in rats, and AG490 reversed the beneficial antiapoptotic effects of sevoflurane postconditioning, suggesting that the JAK-STAT pathway may be involved in the antiapoptotic mechanism of sevoflurane postconditioning.

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Handbook of Bleeding and Coagulation in Neurosurgery

No abstract available

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A Dexamethasone-regulated Gene Signature Is Prognostic for Poor Survival in Glioblastoma Patients

imageBackground: Dexamethasone is reported to induce both tumor-suppressive and tumor-promoting effects. The purpose of this study was to identify the genomic impact of dexamethasone in glioblastoma stem cell (GSC) lines and its prognostic value; furthermore, to identify drugs that can counter these side effects of dexamethasone exposure. Methods: We utilized 3 independent GSC lines with tumorigenic potential for this study. Whole-genome expression profiling and pathway analyses were done with dexamethasone-exposed and control cells. GSCs were also co-exposed to dexamethasone and temozolomide. Risk scores were calculated for most affected genes, and their associations with survival in The Cancer Genome Atlas and Repository of Molecular Brain Neoplasia Data databases. In silico Connectivity Map analysis identified camptothecin as antagonist to dexamethasone-induced negative effects. Results: Pathway analyses predicted an activation of dexamethasone network (z-score: 2.908). Top activated canonical pathways included "role of breast cancer 1 in DNA damage response" (P=1.07E–04). GSCs were protected against temozolomide-induced apoptosis when coincubated with dexamethasone. Altered cellular functions included cell movement, cell survival, and apoptosis with z-scores of 2.815, 5.137, and –3.122, respectively. CCAAT/enhancer binding protein beta (CEBPB) was activated in a dose dependent manner specifically in slow-dividing "stem-like" cells. CEBPB was activated in dexamethasone-treated orthotopic tumors. Patients with high risk scores had significantly shorter survival. Camptothecin was validated as potential partial neutralizer of dexamethasone-induced oncogenic effects. Conclusions: Dexamethasone exposure induces a genetic program and CEBPB expression in GSCs that adversely affects key cellular functions and response to therapeutics. High risk scores associated with these genes have negative prognostic value in patients. Our findings further suggest camptothecin as a potential neutralizer of adverse dexamethasone-mediated effects.

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The Effect of Increased Intracranial Pressure on Pulmonary Compliance in a Neonate

imageNo abstract available

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The Effects of Handed Bias of Physicians and the Laterality of Recumbent Position of Patients on the Success Rate of Lumbar Puncture

imageNo abstract available

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Reply

No abstract available

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ILMA as an Alternative to Face Mask Ventilation in a Case of Nasal Chondrosarcoma

imageNo abstract available

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Intubation Difficulty Scale Score and Videolaryngoscopes

No abstract available

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Hyperventilation, Sympathetic and Metabolic Derangements After Endoscopic Third Ventriculostomy

No abstract available

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Regional Anesthesia to the Scalp for Craniotomy: Innovation With Innervation

No abstract available

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Identifying Drug-Induced Liver Illness (DILI) with Computerized Information Extraction: No More Dilly-Dallying



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Carcinoembryonic Antigen Level in Primary Sclerosing Cholangitis Is Not Influenced by Dominant Strictures or Bacterial Cholangitis

Abstract

Background

Carcinoembryonic antigen (CEA) can be used to screen for biliary tract cancer in patients with primary sclerosing cholangitis (PSC).

Aim

To study the influence of benign dominant strictures (DS), superimposed bacterial cholangitis (SBC), smoking status, and inflammatory bowel disease on CEA serum levels.

Methods

A retrospective analysis of CEA values in cancer-free PSC patients was performed. We included the maximal CEA value obtained during follow-up and information on the presence of DS and SBC at that time, and we analyzed the CEA values in the presence and absence of DS and SBC. Results are reported as medians with the interquartile range (IQR).

Results

The median maximal CEA level, which was 1.8 ng/mL (IQR 1.2–2.9) in the final 270 PSC patients included in the study, was not influenced by the presence of either DS or SBC (P = 0.320). Moreover, in 49 patients, the first CEA value available at the time of DS (1.5 ng/mL; IQR 1.2–2.1) and that at a time without DS (1.6 ng/mL; IQR 1.1–2.3) did not differ significantly (P = 0.397). Lastly, in 24 patients, the median CEA values at a time without SBC (1.8 ng/mL; IQR 1.2–2.5) and at the time of SBC (1.8 ng/mL; IQR 1.0–3.0) were comparable (P = 0.305). Smoking did not influence CEA-based cancer screening.

Conclusions

Serum CEA level is not influenced by the presence of DS or SBC and might therefore serve as a favorable parameter for improving cancer screening in PSC patients.



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From Breast Cancer to Antimicrobial: Combating Extremely Resistant Gram-Negative “Superbugs” Using Novel Combinations of Polymyxin B with Selective Estrogen Receptor Modulators

Microbial Drug Resistance , Vol. 0, No. 0.


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Effect of tempol and tempol plus catalase on intra-renal haemodynamics in spontaneously hypertensive stroke-prone (SHSP) and Wistar rats

Abstract

Vasoconstriction within the renal medulla contributes to the development of hypertension. This study investigated the role of reactive oxygen species (ROS) in regulating renal medullary and cortical blood perfusion (MBP and CBP respectively) in both stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar rats. CBP and MBP were measured using a laser-Doppler flow meter before and after intra-renal infusion of tempol, the superoxide dismutase (SOD) mimetic or tempol plus catalase, the hydrogen peroxide-degrading enzyme. Tempol infusion significantly elevated blood perfusion within the renal medulla (MBP) in both SHRSP (by 43 ± 7%, P < 0.001) and Wistar rats (by 17 ± 2%, P < 0.05) but the magnitude of the increase was significantly greater in the SHRSP (P < 0.01). When the enzyme catalase and tempol were co-infused, MBP was again significantly increased in SHRSP (by 57 ± 6%, P < 0.001) and Wistar rats (by 33 ± 6%, P < 0.001), with a significantly greater increase in perfusion being induced in the SHRSP relative to the Wistar rats (P < 0.01). Notably, this increase was significantly greater than in those animals infused with tempol alone (P < 0.01). These results suggest that ROS plays a proportionally greater role in reducing renal vascular compliance, particularly within the renal medulla, in normotensive and hypertensive animals, with effects being greater in the hypertensive animals. This supports the hypothesis that SHRSP renal vasculature might be subjected to elevated level of oxidative stress relative to normotensive animals.



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Safe Life Defense Body Armor (Bulletproof vest)

Visit Safe Life Defense and The Guardian Angel Program on Indiegogo at http://ift.tt/2hdrEdI Sales, rewards, discounts and more! For every $400 collectively contributed we will donate a vest through the Guardian Angel Program! Together we make a difference.

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1 hurt in San Diego ambulance, trolley collision

The ambulance was responding to a call and had its lights and sirens activated when the crash occurred

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Calif. off-duty paramedic, nurse aid man hit by car

By EMS1 Staff

SAN DIEGO — An off-duty and paramedic came to the aid of a man who was struck by a car Thursday.

The man was walking on a busy freeway when he was struck by a vehicle, who was then rear-ended by a second vehicle. Officials said it is unclear why the man was in the road.

A nurse and his wife, a paramedic, pulled over to render aid.

"My wife saw a body in the road, so we pulled up a little closer. We saw a guy sitting up and he had a bunch of injuries going on, bleeding," Biran San Miguel, a nurse, told FOX5

The man suffered moderate injuries and was transported to the hospital. There were no other reported injuries.

Nurse, paramedic stop to help man hit by car on freeway https://t.co/Xl8y8zxu0R http://pic.twitter.com/OetBmTDeQZ

— Gaby's Trump (@gabyramirez078) December 9, 2016


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Safe Life Defense Body Armor (Bulletproof vest)

Visit Safe Life Defense and The Guardian Angel Program on Indiegogo at http://ift.tt/2hdrEdI Sales, rewards, discounts and more! For every $400 collectively contributed we will donate a vest through the Guardian Angel Program! Together we make a difference.

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Safe Life Defense Body Armor President Getting Hit with a Baseball Bat!

Bullets and knives aren't the only threats. Thats why we've integrated strike resistance into our body armor! Strike Resistance, only by Safe Life Defense.

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Safe Life Defense Body Armor (Bulletproof vest)

Visit Safe Life Defense and The Guardian Angel Program on Indiegogo at http://ift.tt/2hdrEdI Sales, rewards, discounts and more! For every $400 collectively contributed we will donate a vest through the Guardian Angel Program! Together we make a difference.

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Safe Life Defense Body Armor President Getting Hit with a Baseball Bat!

Bullets and knives aren't the only threats. Thats why we've integrated strike resistance into our body armor! Strike Resistance, only by Safe Life Defense.

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Safe Life Defense Body Armor (Bulletproof vest)

Visit Safe Life Defense and The Guardian Angel Program on Indiegogo at http://ift.tt/2hdrEdI Sales, rewards, discounts and more! For every $400 collectively contributed we will donate a vest through the Guardian Angel Program! Together we make a difference.

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Safe Life Defense Body Armor President Getting Hit with a Baseball Bat!

Bullets and knives aren't the only threats. Thats why we've integrated strike resistance into our body armor! Strike Resistance, only by Safe Life Defense.

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Quality of nurse patient therapeutic communication and overall patient satisfaction during their hospitalization stay

2016-12-09T08-55-28Z
Source: International Journal of Medical Science and Public Health
Sandhya Negi, Harleen Kaur, Grace M Singh.
Background: Effective communication is very important aspect in a nursing career. When patient admitted in the ward then therapeutic nurse patient relationship developed and if person is not mentally disturbed so that is very important nurses will properly communicate or needs to show a greater amount of interest to the information-giving process and decision making regarding the care of the patient. Objectives: The main aim of the research is to find the quality of nurse patient therapeutic communication and overall patient satisfaction during their hospitalization stay. Material and Method: An exploratory descriptive design was followed. A total of 110 patients were recruited by convenient sampling technique. Self developed Likert scale is used to assess the quality of nurse patient therapeutic communication and patient satisfaction. Result: Finding suggests that the most (81.8%) of the patient agreed that nurse was helpful and should concern on them, and 81% of the patient agreed that privacy and confidentiality was maintained. Only a few patients (4.5%) agreed that nurses were prompt in decision-making regarding their care.


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Safe Life Defense Body Armor President Getting Hit with a Baseball Bat!

Bullets and knives aren't the only threats. Thats why we've integrated strike resistance into our body armor! Strike Resistance, only by Safe Life Defense.

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New KIMTEK Website Targets Brush Truck Market

ORLEANS, Vt. — KIMTEK Corporation, the world leader in off-road fire rescue skid units for UTV side-by-sides and pick-up and flatbed trucks, has announced the launch of its new website dedicated to the needs of firefighting agencies using pick-ups and flatbed trucks for off-road wildland firefighting. The new website, http://ift.tt/2hbTDHC, can be accessed directly or linked via the company's ...

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NAPNAP Position Statement on the Doctor of Nursing Practice (DNP)

The National Association of Pediatric Nurse Practitioners (NAPNAP) endorses the Doctor of Nursing Practice (DNP) degree as the appropriate credential and a terminal level of education for advanced practice nurses. NAPNAP has consistently led the way in advancing the role of the pediatric nurse practitioner (PNP) by advocating for high-quality education.

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A Novel Approach for the Control of Inflammatory Pain: Prostaglandin E2 Complexation by Randomly Methylated [beta]-Cyclodextrins.

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BACKGROUND: Inhibitors of cyclooxygenase, which block the formation of prostaglandin (PG) E2, are the standard treatment of inflammatory pain. These drugs, however, have serious gastrointestinal, renal, and cardiovascular side effects that limit their clinical use. Cyclodextrins are neutral glucose oligomers that form a hydrophilic outer and a hydrophobic interior cavity used to carry hydrophilic substances. Methyl-[beta]-cyclodextrins are used currently in several drugs as enhancers and also to deliver PGs. We therefore hypothesized that randomly methylated [beta]-cyclodextrins (RAMEB) could be used for pain treatment. METHODS: An in silico screening for important inflammatory mediators (eg, PGE2, substance P, bradykinin, and calcitonin gene-related peptide) was performed to predict the probability of these molecules binding to RAMEB. Thereafter, a comprehensive in vitro study investigated the complexation affinity of the best target toward RAMEB or its RAMEB-fraction L (FL) using capillary electrophoresis. Wistar rats were injected intraplantarly with complete Freund's adjuvant (CFA) for 96 hours to induce inflammatory hyperalgesia. Subsequently, rats were treated intraplantarly or intravenously either with RAMEB or RAMEB FL and compared with the respective controls. Parecoxib was used as positive control. Mechanical (paw pressure threshold, PPT) and thermal (paw withdrawal latency) nociceptive thresholds were determined before injection and at the indicated time points thereafter. Paw tissue was collected after treatments, and PGE2 and PGD2 contents were measured. Analysis of variance was used for data analysis followed by appropriate post hoc comparisons. RESULTS: In silico screening indicated that PGE2, with the highest affinity, was the best candidate for RAMEB binding. Likewise, in capillary electrophoresis experiments, RAMEB had a high affinity to form inclusion complexes with the PGE2 (stability constant [K], 360 1/M; 95% confidence interval [C]: 347.58-372.42 M-1). Local treatment with RAMEB alleviated CFA-induced mechanical (PPT: 76.25 g; 95% CI: 56.24-96.25 g) and thermal hyperalgesia (PPT: 8.50 seconds; 95% CI: 6.76-10.23 seconds). Moreover, a systemic administration of RAMEB decreased CFA-induced mechanical (PPT: 126.66 g; 95% CI: 114.54-138.77 g) and thermal hyperalgesia (paw withdrawal latency: 11.47 seconds; 95% CI: 9.26-13.68 seconds). RAMEB FL resulted in greater in vitro PGE2-binding capacity and decreased PG content as well as hyperalgesia in vivo to a similar extent. Motor activity of the rats was not altered by RAMEB or RAMEB FL. CONCLUSIONS: Capture of PGs by cyclodextrins could be a novel and innovative tool for the treatment of inflammatory pain and bypassing some unwanted side effects of cyclooxygenase inhibitors. (C) 2016 International Anesthesia Research Society

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