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Failure to rescue

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https://www.readbyqxmd.com/read/28810909/a-multi-center-randomized-controlled-open-label-trial-evaluating-the-effects-of-eosinophil-guided-corticosteroid-sparing-therapy-in-hospitalised-patients-with-copd-exacerbations-the-cortico-steroid-reduction-in-copd-cortico-cop-study-protocol
#1
Pradeesh Sivapalan, Mia Moberg, Josefin Eklöf, Julie Janner, Jørgen Vestbo, Rasmus Rude Laub, Andrea Browatzki, Karin Armbruster, Jon Torgny Wilcke, Niels Seersholm, Ulla Møller Weinreich, Ingrid Louise Titlestad, Helle Frost Andreassen, Charlotte Suppli Ulrik, Uffe Bødtger, Thyge Lynghøj Nielsen, Ejvind Frausing Hansen, Jens Ulrik Stæhr Jensen
BACKGROUND: The most commonly applied treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is a 5-day course of high-dose systemic corticosteroids. However, this treatment has not been shown to reduce mortality and can potentially have serious side effects. Recent research has shown that, presumably, only a subgroup of COPD patients identifieable by blood eosinophil count benefit from a rescue course of prednisolone. By applying a biomarker-guided strategy, the aim of this study is to determine whether it is possible to reduce the use of systemic corticosteroids in AECOPD without influencing the outcome...
August 15, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28806284/is-extracorporeal-cardiopulmonary-resuscitation-practical-in-severe-chest-trauma-a-systematic-review-in-single-center-of-developing-country
#2
Up Huh, Seunghwan Song, Sung Woon Chung, Sang-Pil Kim, Chung Won Lee, Hyo Young Ahn, Miju Bae, Seon Hee Kim
BACKGROUND: We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS: From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels following focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a level I trauma centre presenting with cardiac tamponade and tension haemothorax due to severe chest trauma...
August 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28803914/targeted-disruption-of-tcf12-reveals-heb-as-essential-in-human-mesodermal-specification-and-hematopoiesis
#3
Yang Li, Patrick M Brauer, Jastaranpreet Singh, Sintia Xhiku, Kogulan Yoganathan, Juan Carlos Zúñiga-Pflücker, Michele K Anderson
Hematopoietic stem cells arise from mesoderm-derived hemogenic endothelium (HE) during embryogenesis in a process termed endothelial-hematopoietic transition (EHT). To better understand the gene networks that control this process, we investigated the role of the transcription factor HEB (TCF12) by disrupting the TCF12 gene locus in human embryonic stem cells (hESCs) and inducing them to differentiate toward hematopoietic outcomes. HEB-deficient hESCs retained key features of pluripotency, including expression of SOX2 and SSEA-4 and teratoma formation, while NANOG expression was reduced...
August 2, 2017: Stem Cell Reports
https://www.readbyqxmd.com/read/28803505/extracorporeal-membrane-oxygenation-in-an-hiv-positive-man-with-severe-acute-respiratory-distress-syndrome-secondary-to-pneumocystis-and-cytomegalovirus-pneumonia
#4
Deirdre Morley, Almida Lynam, Edmund Carton, Ignacio Martin-Loeches, Gerard Sheehan, Niamh Lynn, Serena O'Brien, Fiona Mulcahy
The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO...
January 1, 2017: International Journal of STD & AIDS
https://www.readbyqxmd.com/read/28797755/failure-to-rescue-in-patients-undergoing-surgery-for-esophageal-or-gastric-cancer
#5
L A Busweiler, D Henneman, J L Dikken, M Fiocco, M I van Berge Henegouwen, B P Wijnhoven, R van Hillegersberg, C Rosman, M W Wouters, J W van Sandick
BACKGROUND: Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. METHODS: All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included...
July 29, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28795680/-severe-disease-of-immune-imbalance-in-icu-persistent-inflammation-immunosuppression-catabolism-syndrome
#6
Heyi Su, Zexun Mo, Zhen Chen, Zhenhui Guo
Terminology of persistent inflammation immunosuppression and catabolism syndrome (PICS) is developed based on the concept of multiple organ failure (MOF), which reflect that the preponderance is gradually reversed from pro-inflammation to anti-inflammation, and eventually the state of simultaneously persistent inflammation and severe immunosuppression appeared. Although the improvement of rescue technology and management increase the early survival rates of patient with critical illnesses, the long-term outcomes of most patients are not optimistic...
August 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28789610/management-of-refractory-bleeding-post-cardiopulmonary-bypass-in-an-acute-heparin-induced-thrombocytopenia-type-ii-renal-failure-patient-who-underwent-urgent-cardiac-surgery-with-bivalirudin-angiox-%C3%A2-anticoagulation
#7
Kimberly Hassen, Maria R Maccaroni, Haytham Sabry, Smitangshu Mukherjee, Shankari Serumadar, Inderpaul Birdi
Acute heparin-induced thrombocytopenia (HIT) patients present myriad anticoagulation management challenges in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28780656/hus-induced-cardiac-and-circulatory-failure-is-reversible-using-cardiopulmonary-bypass-as-rescue
#8
René F Andersen, Jesper V Bjerre, Johan V Povlsen, Mette Veien, Konstantinos Kamperis, Søren Rittig
BACKGROUND: Extra-renal involvement in hemolytic uremic syndrome (HUS) includes gastrointestinal, pancreatic, hepatic, neurological and cardiac manifestations. The current 3-5% mortality rate in HUS patients is primarily attributed to complications related to the central nervous system and the heart. In this brief report, we illustrate that severe cardiac involvement in a patient with HUS is potentially reversible using cardiopulmonary bypass as rescue. CASE-DIAGNOSIS/TREATMENT: A 12-year-old boy was diagnosed with enterohemorrhagic Escherichia coli-induced HUS related to E...
August 5, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28780497/neonatal-management-and-outcome-after-thoracoamniotic-shunt-placement-for-fetal-hydrothorax
#9
Ruben S G M Witlox, Frans J C M Klumper, Arjan B Te Pas, Erik W van Zwet, Dick Oepkes, Enrico Lopriore
AIM: To evaluate the short-term neonatal outcome after fetal thoracoamniotic shunt placement for isolated hydrothorax. METHODS: Retrospective evaluation of infants with isolated hydrothorax treated with thoracoamniotic shunt placement at our fetal therapy centre between 2001 and 2016. RESULTS: In total 48 fetuses were treated with a thoracoamniotic shunt. All fetuses had signs of hydrops at the time of intervention. Median (IQR) gestational age at shunting was 28...
August 5, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28777159/icu-admission-after-surgery-who-benefits
#10
Sadia Ghaffar, Rupert M Pearse, Michael A Gillies
PURPOSE OF REVIEW: Death following surgery remains a major cause of death worldwide, and ICU admission following major surgery is considered a standard of care in many healthcare systems. However, ICU resources are finite and expensive, thus identifying those most likely to benefit is of great importance. RECENT FINDINGS: Advances in surgical and perioperative management have moved the focus of postoperative care to preventing complications and reducing duration of hospitalisation...
August 1, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28771527/claudin5a-is-required-for-proper-inflation-of-kupffer-s-vesicle-lumen-and-organ-laterality
#11
Jeong-Gyun Kim, Sung-Jin Bae, Hye Shin Lee, Ji-Hyeon Park, Kyu-Won Kim
Left-right asymmetric organ development is critical to establish a proper body plan of vertebrates. In zebrafish, the Kupffer's vesicle (KV) is a fluid-filled sac which controls asymmetric organ development, and a properly inflated KV lumen by means of fluid influx is a prerequisite for the asymmetric signal transmission. However, little is known about the components that support the paracellular tightness between the KV luminal epithelial cells to sustain hydrostatic pressure during KV lumen expansion. Here, we identified that the claudin5a (cldn5a) is highly expressed at the apical surface of KV epithelial cells and tightly seals the KV lumen...
2017: PloS One
https://www.readbyqxmd.com/read/28767678/pharmacoperone-rescue-of-vasopressin-2-receptor-mutants-reveals-unexpected-constitutive-activity-and-coupling-bias
#12
Jo Ann Janovick, Timothy P Spicer, Thomas D Bannister, Louis Scampavia, P Michael Conn
Pharmacoperones are small molecules that diffuse into cells and rescue misfolded, mistrafficked protein mutants, restoring their function. These substances act with high target specificity, serving as templates to fold (or refold) receptors, enzymes, ion channels or other proteins and enable them to pass the scrutiny of the cellular quality control system ("rescue"). In the present study we demonstrate that a rescued mutant (L83Q) of the vasopressin type 2 receptor (V2R), shows a strong bias for Gs coupling unlike the WT V2 receptor, which couples to both Gs and Gq/11...
2017: PloS One
https://www.readbyqxmd.com/read/28760119/autologous-stem-cell-rescue-for-graft-failure-of-second-allogeneic-stem-cell-transplant-after-engraftment-of-primary-allogeneic-transplant
#13
Atsushi Watanabe, Takeshi Inukai, Koshi Akahane, Shinpei Somazu, Hiroko Oshiro, Kumiko Goi, Keiichi Koizumi, Norikazu Harii, Kenichi Matsuda, Kanji Sugita
Here, we describe a case of primary graft failure with severe sepsis in a boy who experienced frequent relapses of osteosarcoma. The patient had undergone haploidentical bone marrow transplant after engraftment of unrelated cord blood transplant performed 10 months earlier. Considering his severe condition, we transfused autologous peripheral stem cells along with a single dose of etoposide (50 mg/m2). Granulocyte engraftment was confirmed on human leukocyte antigen-microsatellite analysis of bone marrow on day 14...
July 31, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28757827/digital-assistance-of-nasogastric-tube-insertion-in-intubated-patients-under-general-anesthesia-a-single-blinded-prospective-randomized-study
#14
Alrefaey Kandeel, Mohammed Elmorhedi, Usama Abdalla
BACKGROUND: Nasogastric tube (NGT) insertion may pose a special problem in patients under general anesthesia with first attempt failure rates up to 50%. To increase insertion success rate and decreases related complications, several techniques have been developed. In this study, digital assistance technique is compared to the classic insertion technique in neck flexion. MATERIALS AND METHODS: In this prospective randomized study, 160 patients were randomly allocated into two groups; control group (Group C, n = 80) where NGT tube will be inserted with the neck in flexion position and digital facilitation group (Group D, n = 80)...
July 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28751042/spontaneous-rupture-of-the-urinary-bladder-srub-a-rare-case-of-recovery-from-cardiopulmonary-arrest
#15
Kohei Taniguchi, Ryo Iida, Koshi Ota, Masahiko Nitta, Takuya Tsujino, Kazumasa Komura, Teruo Inamoto, Haruhito Azuma, Kazuhisa Uchiyama, Akira Takasu
Spontaneous rupture of the urinary bladder (SRUB) is rare and results in a lethal condition, i.e., pan peritonitis. However, early and accurate diagnosis of SRUB is very difficult. A 54-year-old woman was transported to our hospital with suspicion of pan peritonitis after spontaneous return of circulation with pulseless electrical activity. Laboratory investigation seemed to indicate acute renal failure. Namely, her serum urea and creatinine levels were grossly elevated. Exploratory laparotomy showed unexpected rupture of urinary bladder...
July 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28750882/unrecognized-failed-airway-management-using-a-supraglottic-airway-device
#16
Veer D Vithalani, Sabrina Vlk, Steven Q Davis, Neal J Richmond
BACKGROUND: 911 Emergency Medical Services (EMS) systems utilize supraglottic devices for either primary advanced airway management, or for airway rescue following failed attempts at direct laryngoscopy endotracheal intubation. There is, however, limited data on objective confirmation of supraglottic airway placement in the prehospital environment. Furthermore, the ability of EMS field providers to recognize a misplaced airway is unknown. METHODS: Retrospective review of patients who underwent airway management using the King LTS-D supraglottic airway in a large urban EMS system, between 3/1/15-9/30/2015...
July 24, 2017: Resuscitation
https://www.readbyqxmd.com/read/28750802/modeling-neurodegenerative-disorders-for-developing-cannabinoid-based-neuroprotective-therapies
#17
Javier Fernández-Ruiz, María Gómez-Ruiz, Concepción García, Mariluz Hernández, José A Ramos
The increase in lifespan during the last 50 years, mainly in developed countries, has originated a progressive elevation in the incidence of chronic neurodegenerative disorders, for which aging is the key risk factor. This fact will definitively become the major biomedical challenge during the present century, in part because the expectation of a persisting elevation in the population older than 65 years over the whole population and, on the other hand, because the current lack of efficacious therapies to control these disorders despite years of intense research...
2017: Methods in Enzymology
https://www.readbyqxmd.com/read/28747516/redundant-and-diverse-intranodal-pacemakers-and-conduction-pathways-protect-the-human-sinoatrial-node-from-failure
#18
Ning Li, Brian J Hansen, Thomas A Csepe, Jichao Zhao, Anthony J Ignozzi, Lidiya V Sul, Stanislav O Zakharkin, Anuradha Kalyanasundaram, Jonathan P Davis, Brandon J Biesiadecki, Ahmet Kilic, Paul M L Janssen, Peter J Mohler, Raul Weiss, John D Hummel, Vadim V Fedorov
The human sinoatrial node (SAN) efficiently maintains heart rhythm even under adverse conditions. However, the specific mechanisms involved in the human SAN's ability to prevent rhythm failure, also referred to as its robustness, are unknown. Challenges exist because the three-dimensional (3D) intramural structure of the human SAN differs from well-studied animal models, and clinical electrode recordings are limited to only surface atrial activation. Hence, to innovate the translational study of human SAN structural and functional robustness, we integrated intramural optical mapping, 3D histology reconstruction, and molecular mapping of the ex vivo human heart...
July 26, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28746704/role-of-preventability-in-redefining-failure-to-rescue-among-major-trauma-patients
#19
Matthew Coates, Eric Pillado, Jin Kim, Richard Vasak, Arthur Yule, Dennis Y Kim
No abstract text is available yet for this article.
July 26, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28743150/-anesthesiology-and-outcome-impact-of-the-perioperative-process
#20
Jörg Zieger, Helene A Häberle
In recent years, the role of the anesthesiologist has turned tremendously from the "anaesthesia doctor" into a perioperative physician and risk specialist. Patients are older, multimorbid, and are called up for more and more extensive surgery and interventions. Socioeconomic aspects have grown in importance. The anesthesiologist, paving the way for a good outcome, is involved in nearly all perioperative processes: preoperative evaluation, definition and optimization of preoperative and intraoperative conditions, management of modern intraoperative anesthesia as well as postoperative medically indicated, effective and efficient treatment of partially highly complex patients...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
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