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Alison S Witkin, Savanah Harshbarger, Christopher Kabrhel
Pulmonary embolism is a common and often life-threatening event. Treatment options include anticoagulation alone, catheter-directed therapies, and surgical thromboembolectomy. While guidelines exist, there is often controversy over which treatment is most appropriate, particularly for intermediate-risk patients. The traditional care model, in which the primary team is responsible for consulting the appropriate specialists, may be inadequate and inefficient for emergent situations, as ensuring coordination and communication between various consulting services can be a time consuming and confusing process...
October 21, 2016: Seminars in Thrombosis and Hemostasis
Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
Andrew M Luks, Colin Grissom, Luanne Freer, Peter Hackett
Luks, Andrew M., Colin Grissom, Luanne Freer, and Peter Hackett. Medication use among mount Everest climbers: practice and attitudes. High Alt Med Biol. 00:000-000, 2016.-The lay public, media, and medical experts have expressed concern about the ethics of climbers using medications to improve performance and increase the odds of summit success while climbing at high altitude, but the true incidence of this practice remains unclear. We conducted an anonymous survey of climbers who have attempted to climb Mt...
October 20, 2016: High Altitude Medicine & Biology
Mark Corbett
Conceivably, in an ideal world, all patients with a life-limiting illness would receive optimal hospice and palliative care so that no one would ever wish to hasten their own death. The reality, however, is that despite provision of optimal hospice and palliative care, individuals with terminal illness experience suffering, loss of meaning, or deterioration in quality of life to the extent where they express the desire to expedite the dying process. While there has been extensive discussion surrounding physician-assisted death (PAD), there has been less attention paid to the practice of voluntary stopping eating and drinking (VSED) near the end of life...
2016: Narrative Inquiry in Bioethics
Kelly E Kim, Brian M Stoltz
An improved synthesis of the cyanthiwigin natural product core enabled by new catalytic technology is reported. The key double catalytic enantioselective alkylation has been reoptimized using a recently developed protocol employing low loadings of palladium catalyst, thereby facilitating large-scale production of the tricyclic cyanthiwigin framework. Additionally, preparation of the penultimate aldehyde intermediate is expedited through the application of anti-Markovnikov Tsuji-Wacker oxidation.
October 20, 2016: Organic Letters
Shannon E Kelly, David Moher, Tammy J Clifford
BACKGROUND: Rapid reviews expedite the knowledge synthesis process with the goal of providing timely information to healthcare decision-makers who want to use evidence-informed policy and practice approaches. A range of opinions and viewpoints on rapid reviews is thought to exist; however, no research to date has formally captured these views. This paper aims to explore evidence producer and knowledge user attitudes and perceptions towards rapid reviews. METHODS: A Q methodology study was conducted to identify central viewpoints about rapid reviews based on a broad topic discourse...
2016: PeerJ
Clemens Glombitza, Rishi R Adhikari, Natascha Riedinger, William P Gilhooly, Kai-Uwe Hinrichs, Fumio Inagaki
Sulfate reduction is the predominant anaerobic microbial process of organic matter mineralization in marine sediments, with recent studies revealing that sulfate reduction not only occurs in sulfate-rich sediments, but even extends to deeper, methanogenic sediments at very low background concentrations of sulfate. Using samples retrieved off the Shimokita Peninsula, Japan, during the Integrated Ocean Drilling Program (IODP) Expedition 337, we measured potential sulfate reduction rates by slurry incubations with (35)S-labeled sulfate in deep methanogenic sediments between 1276...
2016: Frontiers in Microbiology
Jacek Z Kubiak, Claude Prigent
The aim of this short review is to describe the contribution of Xenopus laevis egg extracts to the discovery and understanding of the regulation and function of the serine/threonine kinase Aurora-A. The power of these extracts to recapitulate cell cycle events makes them a precious tool to decipher complex biological processes at the molecular level, including the mechanisms that affect Aurora-A (post-translational modifications) and mechanisms in which Aurora-A plays a crucial role (bipolar spindle assembly)...
2016: International Journal of Developmental Biology
Nasrin Rafieian, Hamidreza Abdolsamadi, Aliakbar Moghadamnia, Mina Jazayeri, Mohammadali Seif-Rabiee, Mina Salmanzadeh, Shahrbanoo Radi
BACKGROUND: Recurrent aphthous stomatitis (RAS) is the most common painful ulcers of oral mucosal which can cause many sufferings. Treatment of RAS often includes administration of corticosteroids, analgesics and regulators of the immune system. However, considering the side effects of these medications, even their topical application must be done with caution. Alum is used in traditional medicine for treatment of oral ulcers without significant side effect. This study sought to assess the effect of topical application of alum on aphthous ulcers...
2016: Caspian Journal of Internal Medicine
Dat T Vo, George F Cravens, Robert E Germann
BACKGROUND: Intramedullary abscess is a rare neurosurgical condition that usually arises in the setting of penetrating trauma to the spinal cord, infected congenital dural sinuses, or tuberculosis. CASE PRESENTATION: We describe a case of a 35-year-old African American male who presented with sepsis and a clinical picture of meningitis. The patient continued to have declining neurological status with decreasing sensation and worsening motor strength in all four extremities...
October 19, 2016: Journal of Medical Case Reports
Meri Kankaanpää, Maria Raitakari, Leila Muukkonen, Siv Gustafsson, Merja Heitto, Ari Palomäki, Kimmo Suojanen, Veli-Pekka Harjola
BACKGROUND: To assess whether the use of point-of-care testing (POCT) and early assessment team (EAT) model shortens emergency department (ED) length of stay (LOS). METHODS: This prospective, observational study with comparison between three study periods was performed in three phases in a metropolitan ED with 57,000 annual visits. Data were collected from adult ambulatory patients who were discharged home. Phase 1 served as a control (n = 1559 in one month)...
October 18, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
John W Pickering, Jaimi H Greenslade, Louise Cullen, Dylan Flaws, William Parsonage, Sally Aldous, Peter George, Andrew Worster, Peter A Kavsak, Martin P Than
BACKGROUND: -The European Society of Cardiology (ESC) new guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department (ED) include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at zero and one hour. ED physicians require very high sensitivity to confidently rule-out AMI, while cardiologists aim to minimise false positive results. METHODS: -High-sensitivity troponin I (hs-cTnI) and T (hs-cTnT) assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia and Canada...
October 17, 2016: Circulation
ByungSu Yoo
Heart failure (HF) represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology. The cornerstone of modern drug therapy in chronic HF is the inhibition of neurohormonal activation that plays a crucial role in the pathophysiology of HF development and progression and, more specifically, of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. LCZ696 is a first-in-class, angiotensin receptor NEP inhibitor (ARNI) that consists of a supramolecular complex of a molecule of the ARB valsartan in combination with a molecule of the NEP inhibitor prodrug AHU377 (also known as sacubitril)...
September 2016: Journal of Hypertension
Richard J E James, Claire O'Malley, Richard J Tunney
This manuscript reviews the extant literature on key issues related to mobile gambling and considers whether the potential risks of harm emerging from this platform are driven by pre-existing comorbidities or by psychological processes unique to mobile gambling. We propose an account based on associative learning that suggests this form of gambling is likely to show distinctive features compared with other gambling technologies. Smartphones are a rapidly growing platform on which individuals can gamble using specifically designed applications, adapted websites or text messaging...
October 18, 2016: British Journal of Psychology
Steven L Clark, Emily Hamilton, Thomas J Garite, Audra Timmins, Philip A Warrick, Samuel Smith
BACKGROUND: Despite intensive efforts directed at initial training in fetal heart rate interpretation, continuing medical education, board certification/recertification, team training and the development of specific protocols for the management of abnormal fetal heart rate patterns, the goals of consistently preventing hypoxia-induced fetal metabolic acidemia and neurologic injury remain elusive. OBJECTIVE: To validate a recently published algorithm for the management of category II fetal heart rate tracings , examine reasons for the birth of infants with significant metabolic acidemia despite the use of electronic fetal heart rate monitoring and critically examine the limits of EFHRM in the prevention of neonatal metabolic acidemia...
October 14, 2016: American Journal of Obstetrics and Gynecology
Fatih Sen, Ozcan Ozeke, Ozgur Kirbas, Cengiz Burak, Habibe Kafes, Bahar Tekin Tak, Umran Ozdamar, Kadir Ocak, Serkan Topaloglu, Dursun Aras
Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography...
September 2016: Indian Heart Journal
Michelle L Pickett, Marlene D Melzer-Lange, Melissa K Miller, Seema Menon, Alexis M Vistocky, Amy L Drendel
OBJECTIVES: There is limited literature about physicians' adherence to 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines specific to specimen collection testing methods in adolescent females in the emergency setting is limited. The objectives are to (1) determine physician adherence to CDC guidelines for specimen collection/testing for chlamydia and gonorrhea, (2) determine physician characteristics associated with guideline adherence, and (3) describe physicians' knowledge of expedited partner therapy (EPT) laws...
October 4, 2016: Pediatric Emergency Care
Jessica H Rankin, Marsha Elkhunovich, Dina Seif, Mikaela Chilstrom
Neonatal respiratory distress is an emergent condition with a wide differential diagnosis. A 12-day-old newborn presented to the emergency department in respiratory distress. Point-of-care ultrasound allowed clinicians to rapidly exclude cardiac disease and pneumothorax as possible causes of the patient's respiratory distress, and expedited the identification of congenital diaphragmatic hernia. The ultrasound findings and technique, epidemiology, pathophysiology, and radiological diagnosis of congenital diaphragmatic hernia are reviewed...
October 2016: Pediatric Emergency Care
Edward Gilbert-Kawai, Jonny Coppel, Hennis Phillip, Michael Grocott, Can Ince, Daniel Martin
Present knowledge of how the microcirculation is altered by prolonged exposure to hypoxia at high altitude is incomplete and modification of existing analytical techniques may improve our knowledge considerably. We set out to use a novel simplified method of measuring in vivo capillary density during an expedition to high altitude using a CytoCam incident dark field imaging video-microscope. The simplified method of data capture involved recording one-second images of the mucosal surface of the inner lip to reveal data about microvasculature density in ten individuals...
2016: F1000Research
Lalit Agrawal, Swati Gupta, Shashank K Mishra, Garima Pandey, Susheel Kumar, Puneet S Chauhan, Debasis Chakrabarty, Chandra S Nautiyal
Along with many adaptive strategies, dynamic changes in protein abundance seem to be the common strategy to cope up with abiotic stresses which can be best explored through proteomics. Understanding of drought response is the key to decipher regulatory mechanism of better adaptation. Rice (Oryza sativa L.) proteome represents a phenomenal source of proteins that govern traits of agronomic importance, such as drought tolerance. In this study, a comparison of root cytoplasmic proteome was done for a drought tolerant rice (Heena) cultivar in PEG induced drought conditions...
2016: Frontiers in Plant Science
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