Challenges in diagnosing mesenteric ischemia

Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.     

Successful emergency endovascular treatment of juxtarenal and infrarental mycotic aortic aneurysms in patients with small diameter aortae using Cook? Zenith ESLE Stentgrafts

BACKGROUND:

Endovascular repair of mycotic aneurysm is an alternative to open repair if the patho-anatomy is suitable. The aortic size above and below the mycotic aneurysm may be small.

METHODS:

A retrospective review was made of prospectively collected departmental computerised database.

RESULTS:

Three oriental patients with juxta- and infra-renal mycotic aortic aneurysms with a small aortic diameter of 17 mm to 18 mm underwent successful emergency endovascular treatment using Cook^® Zenith ESLE stentgrafts. These are ancillary devices aimed at iliac extensions usually.

CONCLUSION:

This is to our knowledge the first case series of Cook^® Zenith ESLE iliac component endografts for the treatment of aortic mycotic aneurysms with small aortae, and short- and mid-term results are encouraging.KEY WORDS: Endovascular, Mycotic, Small aorta, Oversizing, Cook^®, Zenith ESLE Stentgrafts     

Dental care utilization and retirement

Objective: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).
Methods: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.
Results: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.
Conclusions: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.     

The process of orthognathic care in an NHS region

INTRODUCTION

The aim of this study was to evaluate, within an NHS region, the process of care and the standard of record for orthognathic patients.

PATIENTS AND METHODS

A retrospective analysis of the medical records of 372 patients who underwent orthognathic surgery 1 January 1995 and 31 April 2000 in the South West Region of the UK.

RESULTS

Most patients underwent joint orthodontic and maxillofacial planning and had third molars extracted under general anaesthesia prior to orthognathic surgery. There was a significant difference in the median operation times and length of stay for bimaxillary surgery (4 h/4 days) compared with single jaw surgery (2 h/3 days; P < 0.001). Just over 15% of patients required removal of internal fixation plates after surgery, with nearly 90% of these requiring a further episode of general anaesthesia. The level of record keeping and patient review was variable with no regional standardisation.

CONCLUSIONS

This study is evidence of a generally acceptable standard in the process of care, which was found to follow international and national practices. However, at the time of the study there was no regional protocol for patient records or patient review, highlighting the need for the establishment of a regional database.     

Prevalence and correlates of patient-reported symptoms and comorbidities in breast cancer survivors at a tertiary center

Purpose

Survivorship care is an essential component in the management of cancer patients. Optimal delivery of survivorship care requires an understanding of patient concerns and factors associated with treatment-related symptoms and comorbidities.

Methods

We conducted a retrospective cohort study evaluating 34 patient-reported conditions (symptoms and comorbidities) as well as self-reported health habits of stage 0–III breast cancer patients using a questionnaire completed at the time of the initial survivorship visit (SV). Logistic regression analysis was used to assess effects of treatment, age, body mass index, health habits, and timing of SV on these 34 conditions.

Results

Data from 1126 patients seen between April 2009 and November 2015 were analyzed. Hot flashes/night sweats (44%) and numbness/tingling (34%) were the most commonly reported conditions. Significant associations (P < 0.05) were observed with chemotherapy and increased prevalence of 26 conditions, as well as higher BMI and increased prevalence of 10 conditions. Age and timing of SV were associated (P < 0.05) with 20 and 17 conditions, and the direction of associations varied. Exercise was associated (P < 0.05) with reduced reporting of 8 conditions.

Conclusions

Symptom burden is high in this group of breast cancer survivors, particularly following chemotherapy and in those who are overweight or obese. Health concerns vary by patient age and time since treatment. Exercise appears to attenuate patient-reported concerns.

Implications for cancer survivors

Survivorship care models should account for a variety of patient needs. Survivors who are overweight or obese and those who received chemotherapy appear to be at higher risk for adverse consequences of treatment.

     

Universal constant for heat production in protists

Using a high sensitivity differential scanning calorimeter in isothermal mode, we directly measured heat production in eukaryotic protists from 5 phyla spanning over 5 orders of magnitude in carbon biomass and 8 orders of magnitude in cell volume. Our results reveal that metabolic heat production normalized to cell mass is virtually constant in these organisms, with a median of 0.037 pW pg C⁻¹ (95% confidence interval = 0.022–0.061 pW pg C⁻¹) at 5 °C. Contrary to allometric models, the relationship between heat production and cell carbon content or surface area is isometric (scaling exponents, 1.056 and 1.057, respectively). That heat production per unit cell surface area is constant suggests that heat flux through the cell surface is effectively instantaneous, and hence that cells are isothermal with their environment. The results further suggest that allometric models of metabolism based on metazoans are not applicable to protists, and that the underlying metabolic processes in the latter polyphyletic group are highly constrained by evolutionary selection. We propose that the evolutionary constraint leading to a universally constant heat production in single-celled eukaryotes is related to cytoplasmic packaging of organelles and surface area to volume relationships controlling diffusion of resources to these organelles.     

外周血纤维细胞升高是判断特发性肺纤维化预后的指标

背景和目的:由于缺乏有效的治疗药物和反映疾病进展的准确指标,特发性肺纤维化(IPF)的临床处理依然是个难题.纤维细胞是循环间充质细胞的前体,参与组织修复和纤维化.该研究的目的是探讨纤维细胞计数在IPF临床和预后研究中的价值.