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21.
Abidov A Kaluski E Hod H Leor J Vered Z Gottlieb S Behar S Cotter G;Israel Working Group on Intensive Cardiac Care 《The American journal of cardiology》2004,93(1):76-80
Right bundle branch block and complete atrioventricular (AV) block are conduction disorders (CDs) that have been observed in 14% of patients admitted with ST-elevation acute myocardial infarction. CDs carry a poor prognosis, with a threefold increase in the mortality rate, mainly due to cardiogenic shock and recurrent fatal myocardial infarction at 1-year follow-up. According to multivariable analysis, CD was the second strongest predictor of death, after high Killip class. Compared with patients without CD, the 1-year outcome of patients with CD was identically worse, irrespective of whether CD appeared during admission, disappeared, or remained constant. Similar adverse outcomes were seen in patients with complete AV block and right bundle branch block. 相似文献
22.
Meirav Pevsner-Fischer Vered Morad Michal Cohen-Sfady Liat Rousso-Noori Alexandra Zanin-Zhorov Shmuel Cohen Irun R Cohen Dov Zipori 《Blood》2007,109(4):1422-1432
Mesenchymal stem cells (MSCs) are widespread in adult organisms and may be involved in tissue maintenance and repair as well as in the regulation of hematopoiesis and immunologic responses. Thus, it is important to discover the factors controlling MSC renewal and differentiation. Here we report that adult MSCs express functional Toll-like receptors (TLRs), confirmed by the responses of MSCs to TLR ligands. Pam3Cys, a prototypic TLR-2 ligand, augmented interleukin-6 secretion by MSC, induced nuclear factor kappa B (NF-kappaB) translocation, reduced MSC basal motility, and increased MSC proliferation. The hallmark of MSC function is the capacity to differentiate into several mesodermal lineages. We show herein that Pam3Cys inhibited MSC differentiation into osteogenic, adipogenic, and chondrogenic cells while sparing their immunosuppressive effect. Our study therefore shows that a TLR ligand can antagonize MSC differentiation triggered by exogenous mediators and consequently maintains the cells in an undifferentiated and proliferating state in vitro. Moreover, MSCs derived from myeloid factor 88 (MyD88)-deficient mice lacked the capacity to differentiate effectively into osteogenic and chondrogenic cells. It appears that TLRs and their ligands can serve as regulators of MSC proliferation and differentiation and might affect the maintenance of MSC multipotency. 相似文献
23.
Almost every woman and some men will encounter hot flushes during their lifetime. Despite the prevalence of the symptoms, the pathophysiology of hot flushes remains unknown. A decline in hormone concentrations might lead to alterations in brain neurotransmitters and to instability in the hypothalamic thermoregulatory setpoint. The most effective treatments for hot flushes include oestrogens and progestagens. However, many women and their physicians are reluctant to accept hormonal treatments. Women want non-pharmacological treatments but unfortunately such treatments are not very effective, and non-hormonal drugs are often associated with adverse effects. Results from recent studies showed that selective serotonin reuptake inhibitors and other similar compounds can safely reduce hot flushes. Moreover, the efficacy of these drugs provides new insight into the pathophysiology of hot flushes. In this critical review, we assess knowledge of the epidemiology, pathophysiology, and treatment of hot flushes. 相似文献
24.
Elisha Lilienfeld Patrice K. Nicholas Suellen Breakey Inge B. Corless 《Nursing outlook》2018,66(5):482-494
Background
In 2000, the United Nations (UN) introduced the Millennium Development Goals (MDG), described as a global movement with the primary aim of ending world-wide poverty (“Millennium Summit,” 2000). The second phase of the project, known as the post-2015 Sustainable Development Goals (SDG) agenda offers an increased emphasis on lessening the mitigating factors associated with climate change and adapting to the negative effects of climate change. Nurses are in the unique position to address the health-related impacts related to climate change through community health approaches aimed at education and promotion of environmental stewardship.Purpose
The purpose of this scoping review was to examine the relationships among the health consequences of climate change, nursing literature on climate change, and nursing implications. The following will be addressed: “What is nursing's role in policy, practice, and advocacy when addressing the effects of climate change? What is the importance of the SDGs as a framework for addressing climate change in the role of nursing?”Method
This scoping review of the literature was conducted which included the evaluation of a broad range of articles using scoping methods as frameworks.Findings
An overarching theme regarding the nursing community's responsibility in addressing the effects of climate change and their role as advocates, educators, and global citizens was extracted from the scoping review.Discussion
There are many opportunities for nurses to become actively involved in efforts aimed at mitigation, adaptation, and resilience efforts in climate change, including becoming involved in policy, advocacy, research, and practice opportunities. 相似文献25.
26.
Maharshak N Arbel Y Gal-Oz A Rogowski O Shapira I Berliner S Vered Y Canaani J Dotan I 《Journal of digestive diseases》2008,9(3):140-143
OBJECTIVE: The recently introduced Bayer wide‐range C‐reactive protein (wr‐CRP) assay might be relevant for the real‐time low‐cost and online determination of inflammatory bowel disease (IBD) activity. Our aim was to examine whether wr‐CRP can substitute for the Dade Behring high sensitivity C‐reactive protein (hs‐CRP) assay in IBD patients. METHODS: A total of 71 patients with IBD, of whom 48 had Crohn's disease CD and 23 had ulcerative colitis (UC) with various intensities of disease activity participated in the study. The CRP of patients who were under treatment at the Department of Gastroenterology and Liver Diseases were measured using both wr‐CRP and the hs‐CRP. RESULTS: A significant (r = 0.995; P < 0.001) correlation was noted between the hs‐CRP and wr‐CRP measurements for the whole sample as well as for the two diseases, CD (r = 0.994; P < 0.001) and UC (r = 0.997; P < 0.001), which were analyzed separately. CONCLUSION: The Bayer wr‐CRP assay might be a useful low‐cost and real‐time inflammation‐sensitive biomarker in patients with IBD. 相似文献
27.
Previous investigation demonstrated the potential of L-cysteine (L-Cys) at high concentrations to cause hypoglycemia in mice totally deprived of insulin. For further elucidation of the glucose-lowering mechanism, glucose uptake and quantity of glucose transporters (GLUTs 3 and 4) in mouse soleus muscle and C2C12 muscle cells, as well as in human SH-SY5Y neuroblastoma cells, were investigated. A marked enhancement of glucose uptake was demonstrated, peaking at 5.0 mM L-Cys in soleus muscle (P < 0.05) and SH-SY5Y cells (P < 0.001), respectively. In contrast, glucose uptake was not affected in the C2C12 muscle cells. Kinetic analysis of the SH-SY5Y glucose uptake showed a 2.5-fold increase in maximum transport velocity compared with controls (P < 0.001). In addition, both GLUT3 and GLUT4 levels were increased following exposure to L-Cys. Our findings point to a possible hypoglycemic effect of L-Cys. 相似文献
28.
Vered Bieber Arnon D. Cohen Tamar Freud Nancy Agmon-Levin Smadar Gertel Howard Amital 《Immunologic research》2013,56(2-3):261-266
To assess the association between RA and chronic obstructive pulmonary disease (COPD) in a population-based case-control study. A cross-sectional analysis performed utilizing the database of Clalit Health Services, the largest healthcare provider organization in Israel. Patients over the age of 20 years who were diagnosed with RA (‘cases’) and who were treated with any anti-rheumatic drug were compared with a sample of age- and gender-matched enrollees (‘controls’) without regard for the prevalence of COPD. Data on health-related lifestyles and other comorbidities were collected. χ2, t tests, and logistic regression models were used to compare the study groups. The study included 9,039 RA cases and 15,070 controls. The proportion of COPD was significantly higher in patients with RA as compared to the control group (8.6 vs. 4.4 %, p < 0.0001, odds ratio (OR) 2.06, 95 % confidence interval (CI) 1.85–2.29). A multivariate logistic regression model demonstrated that RA was significantly associated with COPD, after controlling for confounders, including age, sex, socioeconomic status, smoking, and obesity (adjusted OR 1.98, 95 % CI 1.77–2.21, p < 0.0001). In this large data-based study, RA was found to be associated with COPD. 相似文献
29.
30.
Elena Thomaidou Liran Horev Deborah Jotkowitz Mariana Zamir Arieh Ingber Claes D. Enk Vered Molho-Pessach 《The American journal of tropical medicine and hygiene》2015,93(4):770-773
Cutaneous leishmaniasis (CL) is diverse in its clinical presentation but usually demonstrates an erythematous, infiltrated, ulcerated, and crusted papule or nodule in exposed areas of the body. Rare clinical features have been reported including lymphatic dissemination, usually with subcutaneous nodules along lymphatic channels. Herein, we present six patients suffering from Old World CL with lymphatic dissemination characterized by sporotrichoid subcutaneous nodules along the lymphatic channels draining the primary lesion. Patients'' history, clinical and laboratory findings were collected and summarized. Lymphatic dissemination of CL in our patients manifested as subcutaneous nodules without epidermal involvement within the axis of lymphatic drainage toward the regional lymph node, at times accompanied by regional lymphadenopathy. In all patients, the lymphatic dissemination was not present at initial diagnosis of CL, appearing only after local (topical or intralesional) treatment was initiated. In three patients, the subcutaneous nodules resolved without systemic treatment. Lymphatic dissemination of Old World CL is not uncommon and may possibly be triggered by local treatment. It should be recognized by dermatologists, especially those working in endemic areas. Systemic treatment may be not necessary since spontaneous resolution may occur.Old World cutaneous leishmaniasis (CL) is diverse in its clinical presentation and outcome. The disease spectrum is governed by an interplay between the parasite and the immuno-inflammatory response of the host. The typical clinical presentation of CL is an erythematous, infiltrated, ulcerated, and crusted papule or nodule on any region of the body, with frequent involvement of exposed areas, especially the face and limbs. Lesions heal slowly over a period of months.1 Although CL often resolves spontaneously, it can result in severe disfiguration. Treatment is usually initiated to hasten healing and prevent scarring.2Old World CL is endemic in Israel and was attributed in the past almost exclusively to Leishmania (Leishmania) major, confined to rural areas of the Negev Desert in southern Israel. Over the last decade, CL due to Leishmania tropica has been increasingly reported in the Judean Desert in central Israel, as well as in northern Israel. Leishmania tropica is often more resistant to treatment and heals more slowly than L. major infections.3Lymphatic dissemination of CL is uncommon but has been reported, usually with dermal or subcutaneous nodules along lymphatic vessels draining the region of the primary lesion.4–7 Herein, we present six cases of CL with subcutaneous sporotrichoid dissemination after local treatment of the primary lesion, probably caused by lymphatic spread of the parasites. The sporotrichoid dissemination was characterized by deep subcutaneous nodules without any sign of epidermal involvement.The demographic, clinical, and laboratory data of the patients are summarized in 8 performed on tissue obtained from primary lesions (patients 4 and 5) or from subcutaneous nodules (patient 6) confirmed L. tropica infection. Regional lymphadenopathy was noted in two patients (patients 2 and 3). In patients 3 and 6, a biopsy from the subcutaneous nodules established the presence of a deep granulomatous process with Leishmania bodies. After the occurrence of subcutaneous nodules, three patients were treated with intravenous sodium stibogluconate (patient 1, 3, and 4), or with sodium stibogluconate injected directly into the primary cutaneous lesion alone (patient 6) or into both the cutaneous lesion and the subcutaneous nodule (patient 5). The patients experienced total resolution of the primary lesions, the subcutaneous nodules, as well as regional lymphadenopathy. On the parents'' request, intralesional injections of pentostam were terminated after a single treatment in patient 2. The primary lesion eventually healed with a scar and the subcutaneous nodules spontaneously regressed within a few weeks.
Open in a separate windowF = female; M = male; ITS1-PCR = internal transcribed spacer 1 polymerase chain reaction.Open in a separate windowFigure 1.(A) A 5-cm infiltrated and ulcerated erythematous plaque over the right forearm in patient 1. (B) Lymphatic dissemination without epidermal involvement in patient 1. (C) A 3-cm ulcerated erythematous plaque on the right lower forehead and two 5-mm soft and mobile subcutaneous nodules on the right cheek and right upper eyelid with overlying faint pink discoloration in patient 2.Open in a separate windowFigure 2.Histopathological findings from a subcutaneous nodule on the left forearm in patient 3: inflammatory infiltrate composed of lymphocytes, histiocytes, and abundant macrophages; round or oval basophilic structures can be seen consistent with Leishmania amastigotes (hematoxylin and eosin, original magnification ×600).Open in a separate windowFigure 3.(A) Infiltrated erythematous, ulcerated plaques on the right cheek, right upper lip, and angle of mouth with a painless subcutaneous cord extending from the right angle of the mouth to the right chin in patient 4. (B) A 2-cm erythematous ulcer on nose tip with subcutaneous nodes extending proximally in patient 5. (C) A 1.5-cm ulcer on the dorsal aspect of the middle phalanx of the fourth finger in patient 6. (D) Subcutaneous nodules on the dorsum of the right hand, proximal to the finger lesion in patient 6.Sporotrichoid dissemination is characterized by the development of secondary lesions, often associated with lymphangitis that progresses along dermal and subcutaneous lymphatics.The exact prevalence of Old World sporotrichoid CL is unknown but ranges between 10% and 19% of affected individuals in previous reports.6,7 The majority of reported sporotrichoid CL cases were shown to be caused by L. major,4,7 although L. tropica has also been implicated. The prevalence of this phenomenon may be species dependent but there are no data comparing rates of sporotrichoid CL among various species. Akilov and others9 in their classification of Old World CL also described this pattern of local spread of CL. They regard the sporotrichoid subcutaneous nodules as a form of lymphatic dissemination of the parasite and describe three clinical patterns: 1) subcutaneous nodules in proximity to the primary lesion, 2) dilated palpable lymphatic vessels in the form of a “beaded cord,” and 3) regional lymphadenitis,9 all seen in our case series.Lymphatic dissemination in our patients manifested in the form of subcutaneous nodules without the typical surface changes noted in primary CL lesions (scaling, crusts, erosions, or ulcers). This was confirmed by the biopsy specimens taken from patients 3 and 6 showing the lack of epidermal and superficial dermal involvement. The nodules were either located within the axis of lymphatic drainage toward the regional lymph node or were accompanied by regional lymphadenopathy. The presence of numerous Leishmania bodies in biopsy specimens of patients 3 and 6 supports the notion that the subcutaneous nodules represent metastases of the parasitic infection.In all our patients, the lymphatic dissemination was absent at initial diagnosis of CL and appeared only after local treatment was initiated. In the 261 patients who attended our Leishmania clinic over the last 2 years, sporotrichoid dissemination was observed only in the six herein reported cases (2.3%), suggesting that local treatment may trigger for this phenomenon, although a proof of cause and effect is currently lacking. Previous reports in the literature also suggest that lymphatic dissemination may be evoked by antiparasitic therapy, especially the use of local irritants and local injections.7,9 It has been shown that intralesional sodium stibogluconate induces an inflammatory response at the site of injection as well as tissue damage,10 which may activate lymphatic drainage and result in parasitic dissemination. Therefore, we hypothesize that the tissue damage caused by local treatment triggers the spread of the parasites into the subcutis and lymphatic vessels. Large prospective studies in endemic areas, where ITS1-PCR can be performed for parasite speciation using a large prospective randomized controlled trial, are needed to prove the causative relationship raised here between local treatment and lymphatic spread of CL.Pentavalent antimonials such as sodium stibogluconate and meglumine antimoniate either systemically or intralesionally have been used to treat sporotrichoid CL.4,7 In three patients (patients 2, 5, and 6), we observed disappearance of the subcutaneous nodules following the resolution of the primary lesions, without initiating systemic treatment. Therefore, we suggest that initiation of systemic treatment in cases of lymphatic dissemination of Old World CL should be guided by the response of the primary lesion to the local treatment. Although no information is available, this may not be true for New World CL, where concern for mucosal disease exists.Lymphatic dissemination of Old World CL is uncommon. This pattern of lymphatic and subcutaneous spread of CL, possibly triggered by local treatment, should be recognized by dermatologists, especially those working in endemic areas. Awareness to this phenomenon will prevent unnecessary workup to investigate the nature of the subcutaneous lesions. 相似文献
Table 1
Demographic, clinical, and laboratory findingsCases | Sex | Age (years) | Geographic region | Presenting symptoms | Initial treatment before appearance of subcutaneous nodules | Morphology and location of subcutaneous nodules | Regional lymphadenopathy | Investigations | Treatment with intravenous sodium stibogluconate | Response to treatment |
---|---|---|---|---|---|---|---|---|---|---|
1 | M | 16 | Negev Desert | 8-month history of an infiltrated and ulcerated erythematous plaque on right forearm | Paromomycin ointment | Subcutaneous painless cord extending proximally in a linear pattern from the right antecubital fossa toward the axilla (Figure 1A, ,BB) | No | Smear: positive for amastigotes | Yes | Flattening of the indurated plaque and disappearance of the subcutaneous cord |
Doppler ultrasound: infiltration of lymphatic vessels | ||||||||||
2 | M | 1.8 | Negev Desert | 6-month history of an ulcerated erythematous plaque on the right lower forehead | Paromomycin ointment and intralesional sodium stibogluconate | Two 5-mm soft and mobile subcutaneous nodules on the right cheek and right upper eyelid with overlying faint pink discoloration (Figure 1C and andC),C), appeared a few weeks after the treatment with intralesional sodium stibogluconate | Yes (cervical) | Smear: positive for amastigotes | No | Subcutaneous nodules spontaneously regressed and the ulcerated plaque healed leaving a scar |
Ultrasound: nondiagnostic | ||||||||||
3 | F | 16 | Judean Desert | 1-year history of two ulcerated erythematous plaques on right and left forearms | Paromomycin ointment and four treatment with intralesional sodium stibogluconate once weekly | Numerous 2-mm subcutaneous nodules above the primary lesions up to the armpit in both upper extremities | Yes (axillary) | Smear: positive for amastigotes | Yes | Flattening of the primary lesions and disappearance of the subcutaneous nodules |
Ultrasound: nondiagnostic. | ||||||||||
Biopsy (from a subcutaneous nodule on the left arm):normal epidermis and dermis, an epithelioid granuloma with plasma cells and abundance of Leishmania bodies was noted in the subcutaneous fat (Figure 2 | ||||||||||
4 | M | 9 | Judean Desert | 10-month history of infiltrated erythematous, ulcerated plaques on the right cheek, right upper lip, angle of mouth, and left forearm | Two intralesional treatments with sodium stibogluconate | Subcutaneous cord extending from the right angle of the mouth to the right aspect of the jaw (Figure 3A) | No | Smear: positive for amastigotes | Yes | Resolution of the subcutaneous cord and flattening of the plaques on face and forearm |
ITS1-PCR: tissue from a primary lesion was positive for Leishmania tropica | ||||||||||
5 | F | 7 | Judean Desert | 2 months history of erosive erythematous plaques at the tip of the nose, upper lip and five papules on right arm | Three intralesional treatments with sodium stibogluconate | Two subcutaneous nodules, without overlying erythema, proximal to the nose lesion | No | Smear: positive for amastigotes | No | Continued treatment with intralesional sodium stibogluconate with resolution of the lesions, as well as the subcutaneous nodules |
ITS1-PCR: tissue from a primary lesion was positive for L. tropica | ||||||||||
6 | M | 17 | Judean Desert | 3 months history of an ulcerated plaque on the middle phalanx of the fourth finger and an erythematous erosive plaque on right upper arm | One intralesional treatment with sodium stibogluconate | Two subcutaneous nodules on the dorsal aspect of the right hand, proximal to the lesion on fourth finger (Figure 3C, ,DD) | No | Biopsy (from a subcutaneous nodule): profound granulomatous process in the deep dermis with necrosis in the form of palisading granulomas. Suspicious Leishmania bodies were noticed within necrotic areas | No | Continued treatment with intralesional sodium stibogluconate with resolution of the lesions, as well as the subcutaneous nodules |
ITS1-PCR: tissue from a subcutaneous nodule was positive for L. tropica |