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https://www.readbyqxmd.com/read/100001003/emergency-management-of-sepsis-the-simple-stuff-saves-lives
#1
David Sweet, Julian Marsden, Kendall Ho, Christina Krause, James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: BC medical journal: BCMJ
https://www.readbyqxmd.com/read/29223955/high-density-lipoprotein-cholesterol-concentration-and-acute-kidney-injury-after-cardiac-surgery
#2
Loren E Smith, Derek K Smith, Jeffrey D Blume, MacRae F Linton, Frederic T Billings
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is associated with increased short- and long-term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High-density lipoproteins (HDLs) have anti-inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti-inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association...
December 9, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29223743/early-vs-late-tracheostomy-in-intensive-care-settings-impact-on-icu-and-hospital-costs
#3
Brent Herritt, Dipayan Chaudhuri, Kednapa Thavorn, Dalibor Kubelik, Kwadwo Kyeremanteng
INTRODUCTION: Up to 12% of the 800,000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review showed that early tracheostomy was associated with better outcomes: more ventilator-free days, shorter ICU stays, less sedation and reduced long-term mortality. However, the financial impact of early tracheostomies remain unknown. OBJECTIVES: To conduct a cost-analysis on the timing of tracheostomy in mechanically ventilated patients...
December 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29223620/impact-of-obesity-on-modality-longevity-residual-kidney-function-peritonitis-and-survival-among-incident-peritoneal-dialysis-patients
#4
Yoshitsugu Obi, Elani Streja, Rajnish Mehrotra, Matthew B Rivara, Connie M Rhee, Melissa Soohoo, Daniel L Gillen, Wei-Ling Lau, Csaba P Kovesdy, Kamyar Kalantar-Zadeh
BACKGROUND: The prevalence of severe obesity, often considered a contraindication to peritoneal dialysis (PD), has increased over time. However, mortality has decreased more rapidly in the PD population than the hemodialysis (HD) population in the United States. The association between obesity and clinical outcomes among patients with end-stage kidney disease remains unclear in the current era. STUDY DESIGN: Historical cohort study. SETTING & PARTICIPANTS: 15,573 incident PD patients from a large US dialysis organization (2007-2011)...
December 6, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29223537/rankl-signaling-sustains-primary-tumor-growth-in-genetically-engineered-mouse-models-of-lung-adenocarcinoma
#5
Julien Faget, Caroline Contat, Nadine Zangger, Solange Peters, Etienne Meylan
HYPOTHESIS: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality. Recent retrospective clinical analyses suggest that blocking the receptor activator of NF-κB (RANK) signaling pathway inhibits the growth of NSCLC and might represent a new treatment strategy. METHODS: RANK and RANKL expression in human lung adenocarcinoma was interrogated from publicly available gene expression datasets. Several genetically engineered mouse models were used to evaluate treatment efficacy of RANK-Fc to block RANKL, with primary tumor growth measured longitudinally using micro-computed tomography...
December 6, 2017: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/29223466/long-term-pulmonary-and-cardiovascular-morbidities-of-neonatal-hyperoxia-exposure-in-mice
#6
Renuka T Menon, Amrit Kumar Shrestha, Corey L Reynolds, Roberto Barrios, Binoy Shivanna
Pulmonary hypertension (PH) frequently occurs in infants with bronchopulmonary dysplasia (BPD), causing increased mortality and right ventricular (RV) dysfunction that persists into adulthood. A first step in developing better therapeutic options is identifying and characterizing an appropriate animal model. Previously, we characterized the short-term morbidities of a model in which C57BL/6J wild-type (WT) mice were exposed to 70% O2 (hyperoxia) during the neonatal period. Here, we aimed to determine the long-term morbidities using lung morphometry, echocardiography (Echo), and cardiac magnetic resonance imaging (cMRI)...
December 7, 2017: International Journal of Biochemistry & Cell Biology
https://www.readbyqxmd.com/read/29223432/contemporary-risk-model-for-inhospital-major-bleeding-for-patients-with-acute-myocardial-infarction-the-acute-coronary-treatment-and-intervention-outcomes-network-action-registry%C3%A2-get-with-the-guidelines-gwtg-%C3%A2
#7
Nihar R Desai, Kevin F Kennedy, David J Cohen, Traci Connolly, Deborah B Diercks, Mauro Moscucci, Stephen Ramee, John Spertus, Tracy Y Wang, Robert L McNamara
BACKGROUND: Major bleeding is a frequent complication for patients with acute myocardial infarction (AMI) and is associated with significant morbidity and mortality. OBJECTIVE: To develop a contemporary model for inhospital major bleeding that can both support clinical decision-making and serve as a foundation for assessing hospital quality. METHODS: An inhospital major bleeding model was developed using the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) database...
December 2017: American Heart Journal
https://www.readbyqxmd.com/read/29223424/outcome-after-lung-volume-reduction-surgery-in-patients-with-severely-impaired-diffusion-capacity
#8
Claudio Caviezel, Nadja Schaffter, Didier Schneiter, Daniel Franzen, Ilhan Inci, Isabelle Opitz, Walter Weder
BACKGROUND: Lung volume reduction surgery (LVRS) has been proven to be a successful procedure and can be performed with low mortality when defined selection criteria are met. We hypothesized good outcome and low mortality after LVRS for selected patients with severe hyperinflation and nonhomogeneous morphology even when diffusion capacity of the lung for carbon monoxide (Dlco) is less than 20%. METHODS: The study included all patients scheduled for LVRS between March 2005 and May 2014 with a preoperative Dlco of less than 20%...
December 6, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29223289/frequency-and-consequences-of-right-sided-heart-failure-after-continuous-flow-left-ventricular-assist-device-implantation
#9
Chitaru Kurihara, Andre C Critsinelis, Masashi Kawabori, Tadahisa Sugiura, Gabriel Loor, Andrew B Civitello, Jeffrey A Morgan
Postoperative right-sided heart failure (RHF) is a common complication after continuous-flow left ventricular assist device implantation. Studies have examined RHF in the perioperative period, but few have assessed late-onset RHF. We analyzed the incidence of early and late RHF in patients with HeartMate II and HeartWare left ventricular assist devices and associated morbidity, mortality, and independent predictors of RHF. We retrospectively analyzed records of 526 patients with chronic heart failure who underwent continuous-flow left ventricular assist device implantation; 147 (27...
October 31, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29223281/human-studies-on-hypothalamo-pituitary-adrenal-hpa-axis
#10
REVIEW
Kamani Liyanarachchi, Richard Ross, Miguel Debono
The daily rhythm of the hypothalamo-pituitary-adrenal (HPA) axis is regulated by the central clock in the suprachiasmatic nucleus. Cortisol, a glucocorticoid, acts as a secondary messenger between the central clock and the peripheral tissues. Changes in clock time, as seen in shift workers, alters the HPA axis and results in metabolic disturbances associated with ill health. Depression, anorexia nervosa and obstructive sleep apnoea, are associated with cortisol rhythm phase shifts and increased cortisol exposure...
October 2017: Best Practice & Research. Clinical Endocrinology & Metabolism
https://www.readbyqxmd.com/read/29223064/patient-characteristics-incidence-technique-outcomes-and-early-prediction-of-tracheostomy-in-the-state-of-victoria-australia
#11
Andrew Casamento, Michael Bailey, Ray Robbins, David Pilcher, Stephen Warrillow, Angaj Ghosh, Rinaldo Bellomo
BACKGROUND: Tracheostomy is a relatively common procedure in Intensive Care Unit (ICU) patients. AIMS: To study the patient characteristics, incidence, technique, outcomes and prediction of tracheostomy in the State of Victoria, Australia. METHODS: We used data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) and the Victorian Admitted Episode Dataset (VAED) to identify and match patients who had received a tracheostomy from 2004 to 2014...
December 1, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29222967/stimulation-of-the-endogenous-incretin-glucose-dependent-insulinotropic-peptide-by-enteral-dextrose-improves-glucose-homeostasis-and-inflammation-in-murine-endotoxemia
#12
Faraaz Ali Shah, Srikanth Singamsetty, Lanping Guo, Byron W Chuan, Sherie McDonald, Bryce A Cooper, Brett J O'Donnell, Darko Stefanovski, Burton Wice, Yingze Zhang, Christopher P O'Donnell, Bryan J McVerry
Loss of glucose homeostasis during sepsis is associated with increased organ dysfunction and higher mortality. Novel therapeutic strategies to promote euglycemia in sepsis are needed. We have previously shown that early low-level intravenous (IV) dextrose suppresses pancreatic insulin secretion and induces insulin resistance in septic mice, resulting in profound hyperglycemia and worsened systemic inflammation. In this study, we hypothesized that administration of low-level dextrose via the enteral route would stimulate intestinal incretin hormone production, potentiate insulin secretion in a glucose-dependent manner, and thereby improve glycemic control in the acute phase of sepsis...
November 21, 2017: Translational Research: the Journal of Laboratory and Clinical Medicine
https://www.readbyqxmd.com/read/29222858/obesity-lipid-profiles-and-oxidative-stress-in-children-after-liver-transplantation
#13
Piotr Czubkowski, Aldona Wierzbicka, Joanna Pawłowska, Irena Jankowska, Piotr Socha
PURPOSE: In adult liver transplant recipients, coronary artery disease and congestive heart failure are significant cause of morbidity and mortality. This may be attributed to the long-term immunosuppressive treatment, mostly with calcineurin inhibitors and steroids, which in long-term may be associated with hyperlipidemia, oxidative stress and cardiovascular complications. Since such data for children is sparse, the aim of this study was to assess the lipid and oxidative stress markers after pediatric liver transplantation (LTx)...
December 10, 2017: Acta Biochimica Polonica
https://www.readbyqxmd.com/read/29222696/thrombomodulin-favors-leukocyte-microvesicle-fibrinolytic-activity-reduces-netosis-and-prevents-septic-shock-induced-coagulopathy-in-rats
#14
Julie Helms, Raphaël Clere-Jehl, Elsa Bianchini, Pierrick Le Borgne, Mélanie Burban, Fatiha Zobairi, Jean-Luc Diehl, Lelia Grunebaum, Florence Toti, Ferhat Meziani, Delphine Borgel
BACKGROUND: Septic shock-induced disseminated intravascular coagulation is responsible for increased occurrence of multiple organ dysfunction and mortality. Immunothrombosis-induced coagulopathy may contribute to hypercoagulability. We aimed at determining whether recombinant human thrombomodulin (rhTM) could control exaggerated immunothrombosis by studying procoagulant responses, fibrinolysis activity borne by microvesicles (MVs) and NETosis in septic shock. METHODS: In a septic shock model after a cecal ligation and puncture-induced peritonitis (H0), rats were treated with rhTM or a placebo at H18, resuscitated and monitored during 4 h...
December 8, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29222261/symptomatic-subsegmental-pulmonary-embolism-to-treat-or-not-to-treat
#15
REVIEW
Marc Carrier, Fredrikus A Klok
The introduction of computed tomographic pulmonary angiography and its recent increasing availability has led to a significant rise in its use to help clinicians diagnose acute pulmonary embolism (PE). This has led to a significant increase in the incidence of PE diagnoses. Simultaneously, the case fatality rate of acute PE has been decreasing and no significant change in its mortality has been noted, suggesting that the additional PE diagnoses are less severe and these patients might not benefit from anticoagulation therapy...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222133/gdf-15-growth-differentiation-factor-15-is-associated-with-lack-of-ventricular-recovery-and-mortality-after-transcatheter-aortic-valve-replacement
#16
Juyong Brian Kim, Yukari Kobayashi, Kegan J Moneghetti, Daniel A Brenner, Ryan O'Malley, Ingela Schnittger, Joseph C Wu, Gillian Murtagh, Agim Beshiri, Michael Fischbein, D Craig Miller, David Liang, Alan C Yeung, Francois Haddad, William F Fearon
BACKGROUND: Recent data suggest that circulating biomarkers may predict outcome in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association between inflammatory, myocardial, and renal biomarkers and their role in ventricular recovery and outcome after TAVR. METHODS AND RESULTS: A total of 112 subjects undergoing TAVR were included in the prospective registry. Plasma levels of B-type natriuretic peptide, hs-TnI (high-sensitivity troponin I), CRP (C-reactive protein), GDF-15 (growth differentiation factor 15), GAL-3 (galectin-3), and Cys-C (cystatin-C) were assessed before TAVR and in 100 sex-matched healthy controls...
December 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29221878/universal-insurance-and-an-equal-access-healthcare-system-eliminate-disparities-for-black-patients-after-traumatic-injury
#17
Muhammad Ali Chaudhary, Meesha Sharma, Rebecca E Scully, Daniel J Sturgeon, Tracey Koehlmoos, Adil H Haider, Andrew J Schoenfeld
BACKGROUND: Although inequities in trauma care are reported widely, some groups have theorized that universal health insurance would decrease disparities in care for disadvantaged minorities after a traumatic injury. We sought to examine the presence of racial disparities in outcomes and healthcare utilization at 30- and 90-days after discharge in this universally insured, racially diverse, American population treated for traumatic injuries. METHODS: This work studied adult beneficiaries of TRICARE treated at both military and civilian trauma centers 2006-2014...
December 5, 2017: Surgery
https://www.readbyqxmd.com/read/29221869/characteristics-of-hospitalizations-due-to-acute-stroke-in-the-silesian-province-poland-between-2009-and-2015
#18
Anna Starostka-Tatar, Beata Łabuz-Roszak, Michał Skrzypek, Anetta Lasek-Bal, Mariusz Gąsior, Marek Gierlotka
INTRODUCTION: The available data on acute stroke (AS) in Poland come mainly from non-representative cohorts or are outdated. Therefore, the current study was done to access the most recent data on AS in the industrial region that covers 12% (4.6mln) of the country's population. OBJECTIVE: To evaluate the epidemiological data of AS in the Silesian Province, Poland. PATIENTS AND METHODS: Analysis of the data from stroke questionnaires, obligatory for all patients hospitalized due to AS and administered by the only public health insurer in Poland (the National Health Fund) between 2009 and 2015 (n=81,193)...
November 27, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29221519/addressing-noncommunicable-disease-on-short-term-medical-trips-a-longitudinal-study-of-hypertension-treatment-in-santo-domingo
#19
Camille Hochheimer, Marwah Khalid, Michelle Vy, Goldie Chang, Dien Tu, Mark Ryan
BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of mortality worldwide and pose complex challenges in developing nations. Short-term medical trips, which often operate independently of government and pharmaceutical companies, are in a unique position to address NCDs in developing nations. In 2010, the Dominican Aid Society of Virginia shifted the focus of their semiannual clinic to addressing NCDs in Paraíso, Santo Domingo. OBJECTIVE: This study analyzes the longitudinal impact of a short-term medical trip on the control of hypertension in their patient population...
May 2017: Annals of Global Health
https://www.readbyqxmd.com/read/29221502/impact-of-cardiorespiratory-fitness-on-frequency-of-atrial-fibrillation-stroke-and-all-cause-mortality
#20
Nasir Hussain, Bernard J Gersh, Karina Gonzalez Carta, Nóra Sydó, Francisco Lopez-Jimenez, Stephen L Kopecky, Randal J Thomas, Samuel J Asirvatham, Thomas G Allison
Benefits of cardiorespiratory fitness on cardiovascular health are well recognized, but the impact on incidence of atrial fibrillation (AF) and stroke, and, particularly, risk of stroke and mortality in patients with AF is less clear. From 1993 to 2010, patients referred for a treadmill exercise test (TMET) at the Mayo Clinic Rochester, MN, were retrospectively identified (N = 76,857). From this, 14,094 local residents were selected. Exclusions were age <18 years; history of heart failure, structural or valvular heart disease, AF or flutter, or stroke...
January 1, 2018: American Journal of Cardiology
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