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https://www.readbyqxmd.com/read/28743130/sglt-2-inhibition-a-potential-new-treatment-for-diabetic-kidney-disease
#1
Robert D Toto
Diabetic nephropathy is the leading cause of kidney failure. Treatments with drugs that block the renin-angiotensin system have proven beneficial in slowing kidney disease progression among those with diabetes; their benefit is limited and they do not stop disease progression. Despite multiple clinical trials of various interventions including dual blockade of the renin-angiotensin system over the past 15 years, no new therapies have emerged to slow kidney disease progression in diabetes. SGLT-2 inhibitors are a new class of antiglycemic drugs that have been shown to lower blood glucose by inhibition of the sodium-glucose transporter 2 in the proximal tubule of the kidney...
July 26, 2017: Nephron
https://www.readbyqxmd.com/read/28742427/a-comparison-of-multimodal-analgesic-approaches-in-institutional-eras-protocols-for-colorectal-surgery-pharmacological-agents
#2
Erik M Helander, Michael P Webb, Meghan Bias, Edward E Whang, Alan D Kaye, Richard D Urman
INTRODUCTION: Enhanced recovery after surgery (ERAS(®)) protocols are the cornerstone of improved recovery after colorectal surgery. Their implementation leads to reduced morbidity and shorter hospital stays while attenuating the surgical stress response. Multimodal analgesia is an important part of ERAS protocols. We compared and contrasted protocols from 15 institutions to test our hypothesis that there is a fundamental consensus among them. MATERIALS AND METHODS: ERAS protocols for open and laparoscopic colorectal surgery were compared from 15 different healthcare facilities...
July 25, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28742381/systemic-error-in-radiology
#3
Stephen Waite, Jinel Moore Scott, Alan Legasto, Srinivas Kolla, Brian Gale, Elizabeth A Krupinski
OBJECTIVE: Interpretive errors in diagnostic imaging result in significant patient morbidity and mortality, but the importance of errors and process failures in the imaging cycle other than during image interpretation is underappreciated. In this article, we describe these errors and potential solutions, providing a framework to improve patient safety and understand the changing roles of radiologists beyond image interpretation. CONCLUSION: For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error-such as ordering inappropriate studies, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)-should be recognized as contributors to patient harm because they lead to wasted resources and delayed care...
July 25, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28741873/cost-effectiveness-of-left-ventricular-assist-devices-for-patients-with-end-stage-heart-failure-analysis-of-the-french-hospital-discharge-database
#4
Abir Tadmouri, Josefin Blomkvist, Cécile Landais, Jerome Seymour, Alexandre Azmoun
AIMS: Although left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost-effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system. METHODS AND RESULTS: Individual patient data from the 'French hospital discharge database' (Medicalization of information systems program) were analysed using Kaplan-Meier method...
July 25, 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28741700/financial-aspects-of-organ-procurement-from-deceased-donors-in-the-usa-relevance-to-xenotransplantation
#5
REVIEW
Ryan J Saari, David K C Cooper
When clinical xenotransplantation is introduced, the costs associated with acquisition of a genetically engineered pig organ are as yet unknown. How will these costs compare with those currently associated with the acquisition of deceased human organs? An understanding of the financial aspects of deceased organ and tissue procurement in the USA is therefore worthwhile. We have therefore attempted to review certain economic aspects of non-profit and for-profit organizations that provide cadaveric organs and/or tissues for purposes of transplantation into patients with end-stage organ failure, cellular deficiencies, or in need of reconstructive procedures...
July 25, 2017: Xenotransplantation
https://www.readbyqxmd.com/read/28740625/pulmonary-valve-replacement-in-patients-with-corrected-tetralogy-of-fallot
#6
Fotios M Mitropoulos, Meletios A Kanakis, Christos Ntellos, Constantinos Loukas, Periklis Davlouros, Theophili Kousi, Andrew C Chatzis
Introduction: Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients. Methods: From 2005-2013, 99 consecutive patients (71 males/28 females, mean age 38±8 years), underwent PVR after 7 to 40 (mean 29 ± 8) years from the initial correction. Seventy nine of the symptomatic patients presented in NYHA II, 14 in III and 2 in IV...
2017: Journal of Cardiovascular and Thoracic Research
https://www.readbyqxmd.com/read/28740584/cardiovascular-disease-in-acromegaly
#7
Morali D Sharma, Anh V Nguyen, Spandana Brown, Richard J Robbins
In patients with acromegaly, chronic excess of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) leads to the development of acromegalic cardiomyopathy. Its main features are biventricular hypertrophy, diastolic dysfunction, and in later stages, systolic dysfunction and congestive heart failure. Surgical and/or pharmacological treatment of acromegaly and control of cardiovascular risk factors help reverse some of these pathophysiologic changes and decrease the high risk of cardiovascular complications...
April 2017: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/28740583/hyperthyroidism-and-the-heart
#8
Patricia Mejia Osuna, Maja Udovcic, Morali D Sharma
Thyroid hormones have a significant impact on cardiac function and structure. Excess thyroid hormone affects cardiovascular hemodynamics, leading to high-output heart failure and, in late stages, dilated cardiomyopathy. In this review, we discuss how hyperthyroidism affects cardiovascular pathophysiology and molecular mechanisms and examine the complications caused by excess thyroid hormone, such as heart failure and atrial fibrillation.
April 2017: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/28740483/a-case-with-spondyloenchondrodysplasia-treated-with-growth-hormone
#9
Takanori Utsumi, Satoshi Okada, Kazushi Izawa, Yoshitaka Honda, Gen Nishimura, Ryuta Nishikomori, Rika Okano, Masao Kobayashi
Spondyloenchondrodysplasia (SPENCD) is an autosomal recessive skeletal dysplasia caused by loss of function mutations in acid phosphatase 5, tartrate resistant (ACP5). Hypomorphic ACP5 mutations impair endochondral bone growth and create an interferon (INF) signature, which lead to distinctive spondylar and metaphyseal dysplasias, and extraskeletal morbidity, such as neurological involvement and immune dysregulation, respectively. We report an affected boy with novel ACP5 mutations, a splice-site mutation (736-2 A>C) and a nonsense mutation (R176X)...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/28740355/insights-into-cruciform-sample-design
#10
A Creuziger, M A Iadicola, T Foecke, E Rust, D Banerjee
Four different cruciform sample designs, based on the work of Abu-Farha et al., were studied in this paper. Key features of this design are a recessed pocket with fillet and re-entrant corners. These samples were shown via digital image correlation to achieve widely differing strain values inside and outside the pocket. From the results of these tests, there are two competing failure mechanisms in the sample. The pocket region is affected by stress concentrations caused by the fillet, and re-entrant notches lead to strain limited constraints similar to diffuse and localized necks in uniaxial samples...
May 2017: JOM: the Journal of the Minerals, Metals & Materials Society
https://www.readbyqxmd.com/read/28739219/systematic-review-of-hardware-related-complications-of-deep-brain-stimulation-do-new-indications-pose-an-increased-risk
#11
Onanong Jitkritsadakul, Roongroj Bhidayasiri, Suneil K Kalia, Mojgan Hodaie, Andres M Lozano, Alfonso Fasano
INTRODUCTION: Deep Brain Stimulation (DBS) is an effective treatment extended broadly to many neurological and psychiatric disorders. Nevertheless, complications may arise during DBS procedures or following implantation due to implanted hardware. This may result in both minor and major adverse events that may necessitate hardware removal and/or compromise maximal therapeutic benefit for the patient. OBJECTIVES AND METHODS: To identify relevant literature on hardware-related complications from DBS procedures by performing a systematic review, and propose how to identify at-risk group and possible preventive approaches...
July 13, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/28739197/type-1-and-2-myocardial-infarction-and-myocardial-injury-clinical-transition-to-high-sensitivity-cardiac-troponin-i
#12
Yader Sandoval, Stephen W Smith, Anne Sexter, Sarah E Thordsen, Charles A Bruen, Michelle D Carlson, Kenneth W Dodd, Brian E Driver, Yan Hu, Katherine Jacoby, Benjamin K Johnson, Sara A Love, Johanna C Moore, Karen Schulz, Nathaniel L Scott, Fred S Apple
BACKGROUND: Studies addressing patients with type 2 myocardial infarction and myocardial injury, including the impact of using high-sensitivity (hs) cardiac troponin (cTn) assays on their incidence are needed. METHODS: Prospective, observational US cohort study. Consecutive emergency department patients with serial cTnI measurements. Outcomes included 180-day mortality and major adverse cardiac events, including 2-year follow-up for those with myonecrosis. RESULTS: Among 1,640 patients, using a contemporary cTnI assay, 30% (n=497) had ≥1 cTnI >99(th) percentile; with 4...
July 21, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28738446/single-stage-versus-two-stage-arteriovenous-loop-microsurgical-reconstruction-a-meta-analysis-of-the-literature
#13
REVIEW
Rebecca Knackstedt, Rachel Aliotta, James Gatherwright, Risal Djohan, Brian Gastman, Graham Schwarz, Mark Hendrickson, Raffi Gurunluoglu
BACKGROUND: Arteriovenous (AV) loops can be utilized in a single- or two-stage approach in free flap reconstruction when proper vessels are not available. However, there exists no consensus on which method leads to superior microsurgical and patient outcomes. The purpose of this article was to review single- versus two-stage AV loops utilized in free flap reconstruction with a focus on complications and overall outcomes. METHODS: A systematic review of AV loops for autologous free tissue transfer was conducted...
July 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28738143/sustained-high-nutrient-supply-as-an-allelopathic-trigger-between-periphytic-biofilm-and-microcystis-aeruginosa
#14
Yonghong Wu, Jun Tang, Junzhuo Liu, Bruce Graham, Philip G Kerr, Hong Chen
Allelopathy among aquatic organisms, especially microorganisms, has received growing attention in recent years for its role in shaping interactions with bloom-forming algae. Many studies have shown that allelopathy occurs and increases under nutrient limiting conditons. However, to date there is no reported direct evidence to indicate allelopathy occurs under the condition of constant high nutrient supply. Here we report the allelopathic action of periphytic biofilm on bloom-forming cyanobacteria (Microcystis aeruginosa), which was triggered by the stress of high nutrient conditions, and continues while nutrients are sustained at high levels (trophic state index at 159 and 171)...
July 24, 2017: Environmental Science & Technology
https://www.readbyqxmd.com/read/28738140/high-prevalence-of-subclinical-cerebral-infarction-in-patients-with-heart-failure-with-preserved-ejection-fraction
#15
Rebecca J Cogswell, Faye L Norby, Rebecca F Gottesman, Lin Y Chen, Scott Solomon, Amil Shah, Alvaro Alonso
AIMS: Undetected atrial fibrillation (AF) may be common in the heart failure with preserved ejection fraction (HFpEF) population, and failure to detect this may lead to the missing of opportunities to prevent associated subclinical cerebral infarctions (SCIs) and cognitive decline. METHODS AND RESULTS: We studied 1527 participants in the Atherosclerosis Risk in Communities (ARIC) Study, who underwent echocardiography, brain magnetic resonance imaging (MRI) and detailed cognitive assessment during 2011-13...
July 24, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28737696/targeting-platelets-for-the-treatment-of-cancer
#16
REVIEW
Omar Elaskalani, Michael C Berndt, Marco Falasca, Pat Metharom
The majority of cancer-associated mortality results from the ability of tumour cells to metastasise leading to multifunctional organ failure and death. Disseminated tumour cells in the blood circulation are faced with major challenges such as rheological shear stresses and cell-mediated cytotoxicity mediated by natural killer cells. Nevertheless, circulating tumour cells with metastatic ability appear equipped to exploit host cells to aid their survival. Despite the long interest in targeting tumour-associated host cells such as platelets for cancer treatment, the clinical benefit of this strategy is still under question...
July 22, 2017: Cancers
https://www.readbyqxmd.com/read/28737647/risk-factors-for-30-day-hospital-readmission-for-diverticular-hemorrhage
#17
Jonah N Rubin, Daniel Shoag, John N Gaetano, Dejan Micic, Neil Sengupta
INTRODUCTION: The 2010 Affordable Care Act introduced the Hospital Readmissions Reduction Program to reduce health care utilization. Diverticular disease and its complications remain a leading cause of hospitalization among gastrointestinal disease. We sought to determine risk factors for 30-day hospital readmissions after hospitalization for diverticular bleeding. MATERIALS AND METHODS: We utilized the 2013 National Readmission Database sponsored by the Agency for Healthcare Research and Quality focusing on hospitalizations with the primary or secondary discharge diagnosis of diverticular hemorrhage or diverticulitis with hemorrhage...
July 21, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28737621/baroreflex-activation-therapy-a-new-approach-to-the-management-of-advanced-heart-failure-with-reduced-ejection-fraction
#18
Edoardo Gronda, Darrel Francis, Faiez Zannad, Christian Hamm, Josep Brugada, Emilio Vanoli
: Chronic heart failure is a common clinical condition characterized by persistent excessive sympathetic nervous system activation. The derangement of the sympathetic activity has relevant implications for disease progression and patient survival. Aiming to positively impact patient outcome, autonomic nervous system modulatory therapies have been developed and tested in animal and clinical studies. As a general gross assumption, direct vagal stimulation and baroreflex activation are considered equivalent. This assumption does not take into account the fact that direct cervical vagal nerve stimulation involves activation of both afferent and efferent fibers innervating not only the heart, but the entire visceral system, leading to undesired responses to and from this compartment...
July 21, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28737559/complex-reconstruction-after-sarcoma-resection-and-the-role-of-the-plastic-surgeon-a-case-series-of-298-patients-treated-at-a-single-center
#19
Jonathan I Leckenby, Rachel Deegan, Adriaan O Grobbelaar
BACKGROUND: More than 1000 new patients present to the London Sarcoma Unit each year and between 5% and 10% require plastic surgery intervention. Advancements in radiotherapy and chemotherapy protocols combined with higher expectations for limb preservation has led to increased reconstructive challenges. Frequently, primary closure is achievable; however, larger tumors often require specialist reconstruction. STUDY DESIGN: A retrospective chart review of all referred patients from the London Sarcoma Unit requiring reconstruction between February 2006 and January 2015 was performed...
July 22, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28737513/loss-of-function-mutations-in-co-chaperone-bag3-destabilize-small-hsps-and-cause-cardiomyopathy
#20
Xi Fang, Julius Bogomolovas, Tongbin Wu, Wei Zhang, Canzhao Liu, Jennifer Veevers, Matthew J Stroud, Zhiyuan Zhang, Xiaolong Ma, Yongxin Mu, Dieu-Hung Lao, Nancy D Dalton, Yusu Gu, Celine Wang, Michael Wang, Yan Liang, Stephan Lange, Kunfu Ouyang, Kirk L Peterson, Sylvia M Evans, Ju Chen
Defective protein quality control (PQC) systems are implicated in multiple diseases. Molecular chaperones and co-chaperones play a central role in functioning PQC. Constant mechanical and metabolic stress in cardiomyocytes places great demand on the PQC system. Mutation and downregulation of the co-chaperone protein BCL-2-associated athanogene 3 (BAG3) are associated with cardiac myopathy and heart failure, and a BAG3 E455K mutation leads to dilated cardiomyopathy (DCM). However, the role of BAG3 in the heart and the mechanisms by which the E455K mutation leads to DCM remain obscure...
July 24, 2017: Journal of Clinical Investigation
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