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https://www.readbyqxmd.com/read/29348012/coronary-embolus-an-underappreciated-cause-of-acute-coronary-syndromes
#1
REVIEW
Claire E Raphael, John A Heit, Guy S Reeder, Melanie C Bois, Joseph J Maleszewski, R Thomas Tilbury, David R Holmes
Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation...
January 22, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29345395/patient-carer-and-public-involvement-in-major-system-change-in-acute-stroke-services-the-construction-of-value
#2
Christopher McKevitt, Angus I G Ramsay, Catherine Perry, Simon J Turner, Ruth Boaden, Charles D A Wolfe, Naomi J Fulop
BACKGROUND: Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. AIMS: To understand how patients and carers were involved in major system changes (MSCs) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. METHODS: Analysis of documents from both MSC projects, and retrospective in-depth interviews with 45 purposively selected individuals (providers, commissioners, third-sector employees) involved in the MSC...
January 18, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/29341200/human-agency-in-disaster-planning-a-systems-approach
#3
John Hamer Powell, Michael Hammond, Albert Chen, Navonil Mustafee
Current approaches to risk management place insufficient emphasis on the system knowledge available to the assessor, particularly in respect of the dynamic behavior of the system under threat, the role of human agents (HAs), and the knowledge available to those agents. In this article, we address the second of these issues. We are concerned with a class of systems containing HAs playing a variety of roles as significant system elements-as decisionmakers, cognitive agents, or implementers-that is, human activity systems...
January 16, 2018: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/29339169/the-timing-of-p2y12-inhibitor-initiation-in-the-treatment-of-acs-does-the-evidence-exist-in-this-era
#4
REVIEW
Harsh Golwala, Deepak L Bhatt
The majority of acute coronary syndromes (ACS) are well characterized as a consequence of plaque rupture and subsequent thrombosis. Antiplatelet agents targeting inhibition of P2Y12 receptors on the platelets have shown to reduce future risk of cardiovascular events in this patient population. However, the timing of initiation of these agents, in particular, in patients managed with invasive strategy with percutaneous coronary interventions (PCI) is debatable. The data supporting pretreatment with antiplatelet agents prior to PCI in ACS patients dates to trials performed >15 years ago, wherein the time to PCI was >5 days, and henceforth, the utility of pretreatment with these agents in the contemporary era remains uncertain...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29338315/the-chronic-ischaemic-cardiovascular-disease-esc-pilot-registry-results-of-the-six-month-follow-up
#5
Michel Komajda, Mathieu Kerneis, Luigi Tavazzi, Serban Balanescu, Francesco Cosentino, Alberto Cremonesi, Roberto Ferrari, Serge Kownator, Hanna Szwed, Iveta Mintale, Zoran Olivari, Harald Rittger, Evgeny V Shlyakhto, Rimvydas Slapikas, Philippe Gabriel Steg, Marco Valgimigli, Eric Van Belle, Konstantinos Tsioufis, Wojciech Majda, Cécile Laroche, Aldo P Maggioni
Aim Chronic ischaemic cardiovascular disease (CICD) remains a leading cause of morbidity and mortality worldwide. The CICD Pilot Registry enrolled 2420 patients across 10 European Society of Cardiology countries prospectively to describe characteristics, management strategies and clinical outcomes in this setting. We report here the six-month outcomes. Methods and results From the overall population, 2203 patients were analysed at six months. Fifty-eight patients (2.6%) died after inclusion; 522 patients (23...
January 1, 2018: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/29338071/the-financial-burden-and-distress-of-patients-with-cancer-understanding-and-stepping-up-action-on-the-financial-toxicity-of-cancer-treatment
#6
REVIEW
Pricivel M Carrera, Hagop M Kantarjian, Victoria S Blinder
"Financial toxicity" has now become a familiar term used in the discussion of cancer drugs, and it is gaining traction in the literature given the high price of newer classes of therapies. However, as a phenomenon in the contemporary treatment and care of people with cancer, financial toxicity is not fully understood, with the discussion on mitigation mainly geared toward interventions at the health system level. Although important, health policy prescriptions take time before their intended results manifest, if they are implemented at all...
January 16, 2018: CA: a Cancer Journal for Clinicians
https://www.readbyqxmd.com/read/29337842/perioperative-coagulation-management-in-liver-transplant-recipients
#7
Dmitri Bezinover, Daniel Dirkmann, James Findlay, Cosmin Guta, Matthias Hartmann, Ramona Nicolau-Raducu, Ahmed M Mukhtar, Marina Moguilevitch, Evan Pivalizza, David Rosenfeld, Fuat Saner, Christopher Wray, Gebhardt Wagener, James West
We review contemporary coagulation management for patients undergoing liver transplantation. A better understanding of the complex physiologic changes that occur in patients with end-stage liver disease has resulted in significant advances in anesthetic and coagulation management. A group of internationally recognized experts have critically evaluated current approaches for coagulopathy detection and management. Strategies for blood component and factor replacement have been evaluated and recommended therapies proposed...
January 15, 2018: Transplantation
https://www.readbyqxmd.com/read/29331965/right-iliac-fossa-pain-treatment-rift-study-protocol-for-an-international-multicentre-prospective-observational-study
#8
Dmitri Nepogodiev
INTRODUCTION: Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy)...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331874/thyroid-hormone-resuscitation-after-brain-death-in-potential-organ-donors-a-primer-for-neurocritical-care-providers-and-narrative-review-of-the-literature
#9
REVIEW
Ian A Buchanan, Vivek A Mehta
Solid organ transplantation has become a mainstay in the contemporary management of end-stage organ failures fueled by advances in immunosuppression, intensive care and surgical technology. Every year, a vast number of transplantable organs is lost on account of hemodynamic instability in potential brain-dead organ donors. Because of a growing organ shortage, measures that increase total donor supply pools are desperately needed. Thyroid hormone has been identified as an adjunctive therapy in donor management due to its potential for increasing organ supply and is currently endorsed by transplant organizations such as United Network for Organ Sharing (UNOS)...
January 8, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29330368/evidence-of-subtle-genetic-structure-in-the-sympatric-species-mullus-barbatus-and-mullus-surmuletus-linnaeus-1758-in-the-mediterranean-sea
#10
Sanja Matić-Skoko, Tanja Šegvić-Bubić, Ivana Mandić, David Izquierdo-Gomez, Enrico Arneri, Pierluigi Carbonara, Fabio Grati, Zdravko Ikica, Jerina Kolitari, Nicoletta Milone, Paolo Sartor, Giuseppe Scarcella, Adnan Tokaç, Evangelos Tzanatos
Using thirteen microsatellite loci for Mullus barbatus and Mullus surmuletus collected in the Mediterranean Sea, the biogeographic boundaries, genetic distribution among and within basins and the impact of prolonged exploitation in both species were investigated as a basis for understanding their population dynamics and for improving Mullus spp. stock management. Different level of diversity indices among these co-occurring species were obtained, with M. barbatus showing higher allele richness and higher mean observed and expected heterozygosity than M...
January 12, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29329768/management-of-pediatric-ovarian-torsion-evidence-of-follicular-development-after-ovarian-preservation
#11
Sarah K Walker, Dave R Lal, Kevin P Boyd, Thomas T Sato
PURPOSE: This study reviews contemporary management and follow-up of pediatric ovarian torsion. METHODS: This is a retrospective series of patients from birth to 19 years undergoing operative management of ovarian torsion from 2012 to 2016. RESULTS: We studied 43 girls who underwent 51 operations for ovarian torsion. The median age was 8.3 years. Ultrasound was utilized for diagnosis in 24/29 patients (83%) evaluated in a children's hospital...
January 9, 2018: Surgery
https://www.readbyqxmd.com/read/29326110/contemporary-management-and-outcomes-in-congenitally-corrected-transposition-of-the-great-arteries
#12
REVIEW
Shelby Kutty, David A Danford, Gerhard-Paul Diller, Oktay Tutarel
Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration...
January 11, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29322287/metaplastic-breast-cancer-practice-patterns-outcomes-and-the-role-of-radiotherapy
#13
Waqar Haque, Vivek Verma, Nilan Naik, E Brian Butler, Bin S Teh
PURPOSE: Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer with limited data to guide management. This study of a large, contemporary US database described national practice patterns and addressed the impact of radiotherapy (RT) on survival. METHODS: The National Cancer Data Base was queried (2004-2013) for women with non-metastatic MBC. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with either lumpectomy or mastectomy with or without RT, while substratifying patients into pT1-2N0 and pT3-4/N+ subcohorts...
January 10, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29320518/increased-mitochondrial-dna-diversity-in-ancient-columbia-river-basin-chinook-salmon-oncorhynchus-tshawytscha
#14
Bobbi M Johnson, Brian M Kemp, Gary H Thorgaard
The Columbia River and its tributaries provide essential spawning and rearing habitat for many salmonid species, including Chinook salmon (Oncorhynchus tshawytscha). Chinook salmon were historically abundant throughout the basin and Native Americans in the region relied heavily on these fish for thousands of years. Following the arrival of Europeans in the 1800s, salmon in the basin experienced broad declines linked to overfishing, water diversion projects, habitat destruction, connectivity reduction, introgression with hatchery-origin fish, and hydropower development...
2018: PloS One
https://www.readbyqxmd.com/read/29320322/multidetector-ct-of-midfacial-fractures-classification-systems-principles-of-reduction-and-common-complications
#15
David Dreizin, Arthur J Nam, Silviu C Diaconu, Mark P Bernstein, Uttam K Bodanapally, Felipe Munera
The advent of titanium hardware, which provides firm three-dimensional positional control, and the exquisite bone detail afforded by multidetector computed tomography (CT) have spurred the evolution of subunit-specific midfacial fracture management principles. The structural, diagnostic, and therapeutic complexity of the individual midfacial subunits, including the nose, the naso-orbito-ethmoidal region, the internal orbits, the zygomaticomaxillary complex, and the maxillary occlusion-bearing segment, are not adequately reflected in the Le Fort classification system, which provides only a general framework and has become less relevant in contemporary practice...
January 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29319487/validation-of-predictors-for-lymph-node-status-in-penile-cancer-results-from-a-population-based-cohort
#16
X Melody Qu, D Robert Siemens, Alexander V Louie, Darwin Yip, Aamer Mahmud
INTRODUCTION: The ability to predict lymph node (LN) status is essential in the management of men with localized squamous cell carcinoma (SCC) of the penis. There has been limited external validation of available risk stratification tools, particularly in routine clinical care. The objective of this study was to evaluate the predictive variables of LN metastases within a large population-based cohort of patients. METHODS: In this population-based cohort study, surgical pathology reports were linked to the population-based Ontario Cancer Registry to identify all patients who were diagnosed with penile cancer in Ontario, Canada...
December 22, 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/29314257/contemporary-management-and-outcomes-of-acute-type-a-aortic-dissection-an-analysis-of-the-sts-adult-cardiac-surgery-database
#17
Teng C Lee, Zachary Kon, Faisal H Cheema, Maria V Grau-Sepulveda, Brian Englum, Sunghee Kim, Paramita S Chaudhuri, Vinod H Thourani, Gorav Ailawadi, G Chad Hughes, Matthew L Williams, J Matthew Brennan, Lars Svensson, James S Gammie
PURPOSE: Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. METHODS: Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. RESULTS: In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension...
January 4, 2018: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29313396/the-role-of-tamis-transanal-minimally-invasive-surgery-in-the-management-of-advanced-rectal-cancer-one-shared-story-of-three-exceptional-cases
#18
Dimitrios Giannoulopoulos, Constantinos Nastos, Maria Gavriatopoulou, Antonios Vezakis, Dionysios Dellaportas, Ira Sotirova, Georgios Giokas, Georgios Polymeneas, Theodosios Theodosopoulos
PURPOSE OF THE STUDY: The current gold standard for contemporary treatment of rectal cancer is total mesorectal excision (TME), achieving excellent local disease control and low recurrence rates. However, TME may be associated with postoperative mortality and quality of life deterioration. Therefore, the need to develop less radical treatment strategies has emerged. Transanal minimally invasive surgery (TAMIS) is currently indicated only for early rectal cancer. However, local excision following chemoradiation has yielded promising clinical outcomes in selected cases with more advanced disease...
January 9, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/29313113/epidemiology-and-contemporary-management-of-abdominal-aortic-aneurysms
#19
Brant W Ullery, Richard L Hallett, Dominik Fleischmann
Abdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age > 60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease...
January 9, 2018: Abdominal Radiology
https://www.readbyqxmd.com/read/29312754/management-of-partial-anomalous-pulmonary-venous-connections-in-patients-requiring-pulmonary-resection-a-case-report-and-systematic-review
#20
REVIEW
Kieran Singhal, Andrew D Newton, Christopher Corbett, Jarrod D Predina
Partial anomalous pulmonary venous connections (PAPVCs) are rare congenital anomalies that are frequently asymptomatic in adults. When PAPVCs are encountered in the patient requiring pulmonary resection, improper management can result in fulminant right-heart failure and death. In this report, we note our management of a 70-year-old male who presented with a right upper lobe ground-glass opacity (GGO) and a PAPVC. We also provide a systematic review of all contemporary reports and provide an algorithm for PAPVC management in the adult patient requiring pulmonary resection...
December 2017: Journal of Thoracic Disease
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