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https://www.readbyqxmd.com/read/29345058/frontline-science-anti-pd-l1-protects-against-infection-with-common-bacterial-pathogens-after-burn-injury
#1
Naeem K Patil, Liming Luan, Julia K Bohannon, Antonio Hernandez, Yin Guo, Edward R Sherwood
Burn patients are susceptible to infections due, in part, to immune dysfunction. Upregulation of programmed death-1 (PD-1) receptor on T cells and programmed cell death ligand-1 (PD-L1) on myeloid cells contribute to immune dysfunction in nonburn-related sepsis. We hypothesized that PD-1/PDL1 interactions contribute to immune dysfunction after burn injury. To determine the impact of burn injury and infection on PD-L1, PD-1 and costimulatory receptor expression by leukocytes and its relationship to T cell functions...
January 2018: Journal of Leukocyte Biology
https://www.readbyqxmd.com/read/29343648/par1-agonists-stimulate-apc-like-endothelial-cytoprotection-and-confer-resistance-to-thromboinflammatory-injury
#2
Karen De Ceunynck, Christian G Peters, Abhishek Jain, Sarah J Higgins, Omozuanvbo Aisiku, Jennifer L Fitch-Tewfik, Sharjeel A Chaudhry, Chris Dockendorff, Samir M Parikh, Donald E Ingber, Robert Flaumenhaft
Stimulation of protease-activated receptor 1 (PAR1) on endothelium by activated protein C (APC) is protective in several animal models of disease, and APC has been used clinically in severe sepsis and wound healing. Clinical use of APC, however, is limited by its immunogenicity and its anticoagulant activity. We show that a class of small molecules termed "parmodulins" that act at the cytosolic face of PAR1 stimulates APC-like cytoprotective signaling in endothelium. Parmodulins block thrombin generation in response to inflammatory mediators and inhibit platelet accumulation on endothelium cultured under flow...
January 17, 2018: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/29343134/implementation-of-vaginal-cleansing-prior-to-cesarean-delivery-to-decrease-endometritis-rates
#3
Laura Felder, Amanda Paternostro, Johanna Quist-Nelson, Jason Baxter, Vincenzo Berghella
BACKGROUND: Endometritis is a postpartum complication that is more common after cesarean delivery. It frequently requires intravenous antibiotic administration, prolonged hospital stays, and carries a risk of sepsis or abscess formation. Precesarean vaginal preparation has been shown to decrease the risk of endometritis in patients who have labored or have ruptured membranes. OBJECTIVE: The objective of this study was to assess the practical implementation of a protocol for vaginal cleansing prior to cesarean delivery and the subsequent effect on endometritis rates in a clinical setting...
January 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29334018/pyoderma-gangrenosum-demographics-treatments-and-outcomes-an-analysis-of-2-273-cases
#4
Sarah E Sasor, Tahereh Soleimani, Michael W Chu, Julia A Cook, Peter J Nicksic, Sunil S Tholpady
OBJECTIVE: Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis. This condition has clinical features analogous to infectious processes and must be quickly diagnosed to be properly treated. The purpose of this study was to characterise relevant clinical features associated with pyoderma gangrenosum based on a large inpatient cohort. METHOD: The National Inpatient Sample (US) was used to identify patients with the diagnosis of pyoderma gangrenosum using ICD-9 diagnosis code 686...
January 1, 2018: Journal of Wound Care
https://www.readbyqxmd.com/read/29333081/innate-immunity-recovers-earlier-than-acquired-immunity-during-severe-postoperative-immunosuppression
#5
Gunnar Lachmann, Clarissa von Haefen, Johannes Kurth, Fatima Yuerek, Claudia Spies
Background: Postoperative immune suppression, particularly a loss of cell-mediated immunity, is commonly seen after surgery and is associated with worse outcome, i.e. delayed wound healing, infections, sepsis, multiple-organ failure and cancer recurrence. However, the recovery of immune cells focusing on differences between innate and acquired immunity during severe postoperative immunosuppression is not investigated. Methods: In this retrospective randomized controlled trial (RCT) subgroup analysis, 10 postoperatively immune suppressed patients after esophageal or pancreatic resection were analyzed...
2018: International Journal of Medical Sciences
https://www.readbyqxmd.com/read/29327977/status-and-challenges-of-predicting-and-diagnosing-sepsis-in-burn-patients
#6
Mile Stanojcic, Roohi Vinaik, Marc G Jeschke
Burns are a common form of trauma that account for more than 300,000 deaths each year worldwide. Survival rates have improved over the past decades because of improvements in nutritional and fluid support, burn wound care, and infection control practices. Death, however, remains unacceptably high. The primary cause of death has changed over the last decades from anoxic causes to now predominantly infections and sepsis. Sepsis and septic complications are not only major contributors to poor outcomes, but they further result in longer hospital stay and higher healthcare costs...
January 12, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29324599/risk-factors-incidence-and-morbidity-associated-with-obstetric-clostridium-difficile-infection
#7
Jacob Ruiter-Ligeti, Sophie Vincent, Nicholas Czuzoj-Shulman, Haim Arie Abenhaim
OBJECTIVE: To evaluate the risk factors, incidence, and morbidity associated with the diagnosis of obstetric Clostridium difficile infection. METHODS: We performed a retrospective cohort study on women admitted for delivery using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from the United States. The delivery admission records of pregnant women were reviewed between 1999 and 2013. After adjusting for demographic and clinical characteristics, we assessed risk factors for the diagnosis of C difficile infection using unconditional logistic regression...
January 9, 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29322631/cold-inducible-rna-binding-protein-in-cancer-and-inflammation
#8
REVIEW
Daniel A Lujan, Joey L Ochoa, Rebecca S Hartley
RNA binding proteins (RBPs) play key roles in RNA dynamics, including subcellular localization, translational efficiency and metabolism. Cold-inducible RNA binding protein (CIRP) is a stress-induced protein that was initially described as a DNA damage-induced transcript (A18 hnRNP), as well as a cold-shock domain containing cold-stress response protein (CIRBP) that alters the translational efficiency of its target messenger RNAs (mRNAs). This review summarizes recent work on the roles of CIRP in the context of inflammation and cancer...
January 11, 2018: Wiley Interdisciplinary Reviews. RNA
https://www.readbyqxmd.com/read/29312714/off-vs-on-pump-coronary-artery-bypass-graft-surgery-on-hospital-outcomes-in-134-117-octogenarians
#9
Umberto Benedetto, Gianni D Angelini, Massimo Caputo, Dmitriy N Feldman, Luke K Kim, Christopher Lau, Antonino Di Franco, Leonard N Girardi, Mario Gaudino
Background: In octogenarian patients there is a potential for more tangible clinical benefits from off-pump coronary artery bypass (OPCAB) compared to conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (COCAB). We aimed to investigate whether, compared to COCAB, OPCAB is associated with better operative outcomes in octogenarians by analyzing the Nationwide Inpatient Sample (NIS) databases 2003-2011. Methods: Of the 134,117 discharge records from 797 hospitals analyzed of patients aged ≥80 years undergoing first time isolated CABG from 2003 to 2011, 70...
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29306854/successful-management-of-a-24-year-old-pregnant-woman-with-necrotising-fasciitis-of-the-forearm
#10
Sam Nahas, Anne McKirdy, Arjuna Imbuldeniya
A 24-year-old woman who was 24 weeks pregnant presented to the emergency department with septic shock and an elbow wound that had become infected. She sustained an injury to the tip of the right elbow on a light switch 4 days prior. In the space of 1 day, she developed a necrotising soft tissue infection, which was rapidly spread to the forearm with florid sepsis. Her initial serum C reactive protein was 392 mg/L, and white cell count was 32×109/L. The patient was treated promptly with aggressive surgical debridement and broad-spectrum antibiotics...
January 6, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29301804/recurrent-hospitalisations-in-a-rare-case-of-hemicorporectomy-a-challenging-case-for-medical-management
#11
Ajit Thakur, Brittney Elliott, Rohan Naik, Nabeel Khan, Shayna McQuaid, Camelia Arsene
Hemicorporectomy, or translumbar amputation, is a radical surgery involving the dissection of the body at the waist and is usually reserved for complex medical conditions including locally invasive malignancy and terminal pelvic osteomyelitis. Only 71 cases have previously been reported. We present a rare case of hemicorporectomy in a 53-year-old patient with terminal pelvic osteomyelitis which occurred after he suffered a gunshot wound at T6 causing paraplegia at the age of 31. Unfortunately, this patient continued to suffer recurrent hospitalisations and sepsis events secondary to chronic, non-healing advanced pressure ulcers and complicated urinary tract infections despite repeated courses of broad-spectrum intravenous antibiotics and surgical debridements...
January 4, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29296271/epidemiologic-analysis-of-central-vein-catheter-infection-in-burn-patients
#12
Maryam Roham, Mahnoush Momeni, Mohsen Saberi, Rahil Kheirkhah, Ali Jafarian, Hossein Rahbar
Background and Objectives: Currently, there are no well-defined guidelines or criteria for catheter-site care in burn patients, and there is little information about the epidemiology of central vein catheter (CVC) infection in such patients. This study aimed at addressing the epidemiological aspect of CVC infection in a sample of Iranian burn patients admitted to the largest referral burn center in Iran, Motahari Burn Center. Materials and Methods: A total of 191 burn patients were eligible for the study...
October 2017: Iranian Journal of Microbiology
https://www.readbyqxmd.com/read/29280887/smoking-as-an-independent-risk-factor-for-postoperative-complications-in-plastic-surgical-procedures-a-propensity-score-matched-analysis-of-36-454-patients-from-the-nsqip-database-from-2005-to-2014
#13
Yoshiko Toyoda, Rose H Fu, Lu Li, David M Otterburn, Christine H Rohde
BACKGROUND: Smoking has been associated with wound healing complications and overall morbidity in multiple specialties, including plastic surgery. From 2005 to 2014, smoking prevalence among U.S. adults decreased from 20.9 percent to 16.8 percent. This study aims to investigate whether smoking prevalence among plastic surgery patients paralleled the national trend and whether smoking was an independent risk factor for postoperative complications. METHODS: The 2005 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking prevalence and 30-day postoperative complications in 36,454 patients who underwent common plastic surgical procedures with extensive planes of dissection...
January 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29260243/-perioperative-handling-of-antidiabetic-drugs
#14
REVIEW
J Wagner, V Luber, J F Lock, U A Dietz, S Lichthardt, N Matthes, K Krajinovic, C-T Germer, S Knop, A Wiegering
Diabetes mellitus is the most frequent metabolic disorder in the western world with a prevalence of 3% in adults under 65 years of age and 14.3% in adults over 65 years of age. Due to the increasing age of our population, the number of patients taking oral antidiabetic drugs has increased. Thus, operating physicians must make a risk-adapted decision whether the medication can be continued perioperatively or if certain drugs must be paused, and if so, with what risks. Operative interventions can lead to a number of metabolic shifts, which change the normal glucose metabolism...
December 19, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/29243368/a-2000-patient-retrospective-assessment-of-a-new-strategy-for-burn-wound-management-in-view-of-infection-prevention-and-treatment
#15
Justyna Glik, Wojciech Łabuś, Diana Kitala, Karolina Mikuś-Zagórska, Christopher D Roberts, Mariusz Nowak, Aleksandra Kasperczyk, Marek Kawecki
Infections in burn patients are still the principal cause of complications in burn injuries. The aim of this study is to assess a new strategy for burn wound management in view of infection prevention and treatment in the experience of the Burn Treatment Center in Siemianowice Śląskie. The applied methodology involved the analysis of patient records describing the hospital's epidemiological situation between 2014 and 2016. The analysis also included the use and cost of antibiotics, silver-containing dressings, and other antiseptics relative to the number of sepsis cases, including those caused by Pseudomonas aeruginosa, as well as the mortality ratio...
December 15, 2017: International Wound Journal
https://www.readbyqxmd.com/read/29239852/management-specificities-for-abdominal-pelvic-and-vascular-penetrating-trauma
#16
E Hornez, F Béranger, T Monchal, Y Baudouin, G Boddaert, H De Lesquen, S Bourgouin, Y Goudard, B Malgras, G Pauleau, V Reslinger, N Mocellin, C Natale, L Meyrat, J-P Avaro, P Balandraud, S Gaujoux, S Bonnet
Management of patients with penetrating trauma of the abdomen, pelvis and their surrounding compartments as well as vascular injuries depends on the patient's hemodynamic status. Multiple associated lesions are the rule. Their severity is directly correlated with initial bleeding, the risk of secondary sepsis, and lastly to sequelae. In patients who are hemodynamically unstable, the goal of management is to rapidly obtain hemostasis. This mandates initial laparotomy for abdominal wounds, extra-peritoneal packing (EPP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) in the emergency room for pelvic wounds, insertion of temporary vascular shunts (TVS) for proximal limb injuries, ligation for distal vascular injuries, and control of exteriorized extremity bleeding with a tourniquet, compressive or hemostatic dressings for bleeding at the junction or borderline between two compartments, as appropriate...
November 24, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29238640/high-risk-subgroup-membership-is-a-predictor-of-30-day-morbidity-following-anterior-lumbar-fusion
#17
Rachel S Bronheim, Jun S Kim, John Di Capua, Nathan J Lee, Parth Kothari, Sulaiman Somani, Kevin Phan, Samuel K Cho
Study Design: Retrospective cohort study. Objective: To determine if membership in a high-risk subgroup is predictive of morbidity and mortality following anterior lumbar fusion (ALF). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify patients undergoing ALF between 2010 and 2014. Multivariate analysis was utilized to identify high-risk subgroup membership as an independent predictor of postoperative complications...
December 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29238639/the-use-of-vacuum-dressings-for-dead-space-management-in-deep-surgical-site-infections-allows-implant-and-bone-graft-retention
#18
James P Watt, Robert N Dunn
Study Design: Retrospective, descriptive study. Objectives: Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective...
December 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29238635/anesthesia-duration-as-an-independent-risk-factor-for-early-postoperative-complications-in-adults-undergoing-elective-acdf
#19
Kevin Phan, Jun S Kim, Joung Heon Kim, Sulaiman Somani, John Di'Capua, James E Dowdell, Samuel K Cho
Study Design: Retrospective study. Objective: To determine the presence of any potential associations between anesthesia time with postoperative outcome and complications following elective anterior cervical discectomy and fusion (ACDF). Methods: Patients who underwent elective ACDF were identified in the American College of Surgeons National Quality Improvement Program database. Patient demographics, medical comorbidities, and perioperative and postoperative complications up to 30 days were analyzed by univariate and multivariate analysis...
December 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29238634/asa-classification-as-a-risk-stratification-tool-in-adult-spinal-deformity-surgery-a-study-of-5805-patients
#20
Sulaiman Somani, John Di Capua, Jun S Kim, Kevin Phan, Nathan J Lee, Parth Kothari, Joung-Heon Kim, James Dowdell, Samuel K Cho
Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery...
December 2017: Global Spine Journal
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