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Volume management

Marcelo Alcantara Holanda, Renata Dos Santos Vasconcelos, Juliana Carvalho Ferreira, Bruno Valle Pinheiro
Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow...
July 16, 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Elizabeth A Burgess, Kathleen E Hunt, Scott D Kraus, Rosalind M Rolland
Exhaled breath analysis is a non-invasive assessment tool that has shown promise in human diagnostics, and could greatly benefit research, management, and conservation of large whales. However, hormone assessment of whale respiratory vapor (blow) has been challenged by variable water content and unknown total volume of collected samples. To advance this technique, we investigated urea (a compound present in narrow range in circulation) as a normalizing factor to correct for blow sample concentration. Normalized progesterone, testosterone, and cortisol concentrations of 100 blow samples from 46 photo-identified North Atlantic right whales (Eubalaena glacialis) were more biologically relevant compared to absolute estimates, varying by sex, age class, or individual...
July 17, 2018: Scientific Reports
Shamima Khan, Joshua J Spooner, Harlan E Spotts
The objective of this study was to perform a nationwide investigation of the financial performance of community pharmacies in the United States since the inception of Medicare Part D. A nationwide, cross-sectional survey of pharmacists was conducted in 2013. The 43-item online survey collected information about demographics, financial implications of Part D on community pharmacy and patients, provision of Medication Therapy Management (MTM) services and opinions about Medicare Part D 2010 updates. The adjusted response rate was 22...
July 17, 2018: Pharmacy (Basel, Switzerland)
Subhas K Konar, Dhaval Shukla, B Indira Devi
Bilateral occlusion of theforamen of Monro with aqueductal stenosis is a rare entity.Only one case has beenreported in theliterature. We present a 25-year-old lady who presented withchronic headache for sevenyears. Neurological examination revealedonly papilledema. Imaging showedsymmetrical dilation of both lateral ventricles with mild dilatation of thirdventricle, and normal fourth ventricle suggestive of occlusion of both foramina of Monrowith membranous web formation at upper part of Aqueduct.There was tonsillar herniationwithout syrinx...
July 11, 2018: World Neurosurgery
Rikki John, Jujju Jacob Kurian, Sudipta Sen, Manish Kumar Gupta, Susan Jehangir, Leni Grace Mathew, John Mathai
INTRODUCTION: Wilms tumor is the most common pediatric renal malignancy. While developed countries have had excellent survival, it remains poorer by comparison in developing countries. The aim was to analyze the clinical outcome of children with Wilms tumor managed in a developing country from 2004 to 2014 by the SIOP WT 2001 protocol. METHODS: Fifty-nine children with Wilms tumor managed by a SIOP WT 2001 regimen from 2004 to 2014 were analyzed. RESULTS: The median age at presentation was 36 months, and 59% were boys...
June 28, 2018: Journal of Pediatric Urology
Jiun-Liang Chen, Fu-Chun Chang, Shih-Jie Lin, Po-Yao Chuang, Kuo-Ti Peng, Kuo-Chin Huang, Tsan-Wen Huang
BACKGROUND: Locking plate fixation appears to be a standard treatment for proximal humeral fracture. Different locking plate designs might result in different radiographic and functional outcomes. The original version of the Proximal Humeral Internal Locking System (PHILOS; DePuy Synthes, Warsaw, IN, USA) occupied the largest volume of the humeral head by screw distribution, whereas the Zimmer Periarticular Locking Plate (ZPLP) system (Zimmer Biomet, Warsaw, IN, USA) occupied the smallest...
July 13, 2018: Journal of Shoulder and Elbow Surgery
Yasmine Yousef, Angela Lee, Frehun Ayele, Dan Poenaru
BACKGROUND: The purpose of this study was to estimate the unmet burden of surgically correctable congenital anomalies in African low- and middle-income countries (LMICs). METHODS: We conducted a chart review of children operated for cryptorchidism, isolated cleft lip, hypospadias, bladder exstrophy and anorectal malformation at an Ethiopian referral hospital between January 2012 and July 2016 and a scoping review of the literature describing the management of congenital anomalies in African LMICs...
June 27, 2018: Journal of Pediatric Surgery
Alexander Leo Luryi, Juliana Lawrence, Dennis Bojrab, Michael LaRouere, Seilesh Babu, Robert Hong, John Zappia, Eric Sargent, Eleanor Chan, Ilka C Naumann, Christopher A Schutt
BACKGROUND: Meniere's disease (MD)-associated benign paroxysmal positional vertigo (BPPV) is complex and difficult to diagnose, and reports of its prevalence, pathologic features and outcomes are sparse and conflicting. OBJECTIVE: Report disease characteristics and outcomes associated with the presence of MD in patients with BPPV. MATERIALS/METHODS: A retrospective study of patients with BPPV between 2007 and 2017 at a single, high-volume institution...
July 17, 2018: Acta Oto-laryngologica
Marta Petitto, Roberta Esposito, Regina Sorrentino, Maria Lembo, Federica Luciano, Anna Maria De Roberto, Lucia La Mura, Enrica Pezzullo, Silvia Maffei, Maurizio Galderisi, Patrizio Lancellotti
: Clinical presentation, diagnosis and outcomes of cardiac diseases are influenced by the activity of sex steroid hormones. These hormonal differences explain the later development of heart diseases in women in comparison with men and the different clinical picture, management and prognosis. Echocardiography is a noninvasive and easily available technique for the analysis of cardiac structure and function. The aim of the present review is to underline the most important echocardiographic differences between sexes...
July 13, 2018: Journal of Cardiovascular Medicine
Jose Nativi-Nicolau, Mathew S Maurer
PURPOSE OF REVIEW: The present article provides an update about the recent advances in the diagnosis and management of the most common types of cardiac amyloidosis, including light chain, wild-type transthyretin (ATTRwt), and mutant transthyretin (ATTRm). RECENT FINDINGS: The document reviews the utility of diagnostic tools including innovative echocardiographic indices, magnetic resonance T1 mapping and measurement of extracellular volume, and the role and validation of bone scintigraphy for the noninvasive assessment of ATTR amyloidosis...
July 13, 2018: Current Opinion in Cardiology
Boris D Heifets, Pedro Tanaka, Mark A Burbridge
PURPOSE OF REVIEW: The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. RECENT FINDINGS: In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint against which we can titrate our patients' fluid balance; and agreement on the composition of fluid we should give in various clinical contexts...
July 14, 2018: Current Opinion in Anaesthesiology
Kai Le, Sisi Mo, Xiang Lu, Abdoulaye Idriss Ali, Dafan Yu, Yijing Guo
OBJECTIVES: Inflammation plays a key role in the pathogenesis and progression of ischemic stroke (IS). The high mobility group box 1 (HMGB1) nucleoprotein is involved in the amplification of inflammatory responses during acute ischemic injury. HMGB1 levels in patients with active disease are higher than those in healthy controls. We performed a meta-analysis to assess currently published data pertaining to circulating blood HMGB1 levels in IS and the relationship with stroke severity...
July 17, 2018: Neurological Research
Rafael Dos Santos de Andrade, Frederico Ozanan Barros Monteiro, Hani Rocha El Bizri, Luciana Pantoja, Richard Bodmer, João Valsecchi, Pedro Mayor
The white-lipped peccary (Tayassu pecari) is an endangered large-sized Neotropical ungulate that is one of the most hunted mammals in the Amazon. Here, we used two embryos and 102 white-lipped peccary fetuses originated from animals hunted for subsistence in the Peruvian and Brazilian Amazon to describe the intrauterine development of external and internal morphology of this Neotropical ungulate. Logistic regressions were used to estimate the probability of occurrence of main external characteristics in relation to the total dorsal length (TDL), while multiple linear and non-linear regressions were conducted to assess the relationship between external and visceral biometry with TDL...
July 10, 2018: Theriogenology
Sailesh Kotecha, Hege Clemm, Thomas Halvorsen, Sarah J Kotecha
BACKGROUND: Preterm-born survivors have increased respiratory symptoms and decreased lung function, but the nature of bronchial hyper-responsiveness (BHR) is unclear. We conducted a systematic review and meta-analysis for BHR in preterm-born survivors including those with and without chronic lung disease in infancy (CLD) comparing results to term-born subjects. METHODS: We searched eight databases up to December 2016. Included articles compared BHR in preterm-born and term-born subjects...
July 17, 2018: Pediatric Allergy and Immunology
Andrew W Mulcahy, Tadeja Gracner, Kenneth Finegold
Importance: The Patient Protection and Affordable Care Act (ACA) increased 2013 to 2014 Medicaid payment rates for qualifying primary care physicians (PCPs) and services to higher Medicare payment levels, with the goal of improving primary care access for Medicaid enrollees. Objectives: To evaluate the payment increase policy and to assess whether it was associated with changes in Medicaid participation rates or Medicaid service volume among PCPs. Design, Setting, and Participants: This study used 2012 to 2015 IMS Health aggregated medical claims and encounter data from PCPs eligible for the payment increase practicing in all states except Alaska and Hawaii and included 20 723 PCPs with observations in each month from January 1, 2012, to December 31, 2015...
July 16, 2018: JAMA Internal Medicine
Claudia Calogero, Grazia Fenu, Enrico Lombardi
Lung function is an important tool in the diagnosis and monitoring of patients with asthma at all ages. Airway obstruction is a typical feature of asthma and it can be assessed with several lung function techniques. Spirometry, respiratory resistance and reactance, and lung volumes are available to measure it at different ages and in children. The assessment of a bronchodilator response is always recommended to show the reversibility of the obstruction. Poor lung function is a predictor of poor asthma outcome and a low Forced Expiratory Volume in the first second of expiration percent predicted measured with spirometry, has been shown to be associated with a higher risk of having an exacerbation during the following year independently of the presence of asthma symptoms...
2018: Frontiers in Pediatrics
Jehan Ahmed Sayed, Sayed Kaoud Abd Elshafy, Emad Zareif Kamel, Mohamed Amir Fathy Riad, Amal Ahmed Mahmoud, Ghada Shalaby Khalaf
Background: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. Methods: Sixty ASA-I pediatric patients aged 3-10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0...
July 2018: Korean Journal of Pain
Jorge E Shortrede, Maria M Montt-Guevara, Gisela Pennacchio, Michele Finiguerra, Andrea Giannini, Alessandro D Genazzani, Tommaso Simoncini
Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) used for emergency contraception and for the medical management of symptomatic uterine fibroids (UF). Treatment with UPA turns in amenorrhea and UF volume reduction. Treatment with UPA is associated with the frequent development of benign, transitory endometrial changes known as SPRM-associated endometrial changes (PAECs). Why PAECs develop and their biological or cellular basis is unknown. Sex steroids, including estrogen and progesterone, are established modulators of the actin cytoskeleton in various cells, including endometrial cells...
2018: Frontiers in Endocrinology
Terrence McDonald, Judy E Seidel, Alka B Patel, Haifeng Zhu, Allan L Bailey, Kerry A McBrien, Lee A Green
BACKGROUND: Alberta is considering capping daily fee-for-service physician billings, but little is known about high-volume practice in the province and its impact on patient health outcomes. In this initial study, we conducted a descriptive analysis of general practitioners' patient volumes and billing practices in relation to associated practitioner demographic characteristics. METHODS: We conducted a retrospective descriptive analysis of the associations of practitioner characteristics, including full-time versus non-full-time practice, provider sex, years in practice, geographic location and international medical graduate status, with high-volume (> 50 visits/d) practice using general practice billing data from 2011 to 2016...
July 2018: CMAJ Open
Monisha Kumar, K Nithyanandan, K Porsezian
A theoretical investigation of the modulational instability (MI) in a composite system with a nonlocal response function is presented. A composite system of silver nanoparticles in acetone is chosen, whose nonlinearity can be delicately varied by controlling the volume fraction of the constituents, thus enabling the possibility of nonlinearity management. A pump-probe counterpropagation configuration has been assumed, and the interplay between the competing nonlinearities and the nonlocalities in the MI dynamics is systematically explored...
June 2018: Physical Review. E
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