Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases

Objectives  

To evaluate the outcome of patients with colorectal liver metastasis (CRLM) treated with stereotactic radiofrequency ablation (SRFA).     

An electronic walkway can predict short-term fall risk in nursing home residents with dementia

ObjectivesTo evaluate the feasibility and validity of gait parameters measured with an electronic walkway system in predicting short-term fall risk in nursing home residents with dementia.Methods57 ambulatory nursing home residents with moderate to severe dementia participated in this prospective cohort study. We used the GAITRite^® 732 walkway system to assess gait parameters. Measurements were collected every 3 months over a 15 month period, with each measurement being a baseline for the subsequent measurement. Falls were retrieved from incident reports. The predictive validity of the GAITRite^® parameters was expressed in terms of sensitivity and specificity. Logistic regression analysis was conducted to examine the association between these parameters and falls occurrence within three months.ResultsReduced velocity (OR = 1.22; 95% CI 1.04–1.43) and reduced mean stride length (OR = 1.19; 95% CI 1.03–1.40) were the best significant gait predictors of a fall within three months, with a sensitivity of 82% for velocity and 86% for mean stride length, and a specificity of 52% for velocity and for mean stride length. The test procedure took an average of 5 min per participant. Some verbal persuasion or physical cueing was necessary in 142 measurements (80.7%).ConclusionGait parameters as measured with an electronic walkway system can be used for the prediction of short-term fall risk in nursing home residents with moderate to severe dementia. However some form of persuasion might be needed to perform the task. To refine our findings, large prospective studies on the predictive validity of gait parameters in this type of population are needed.     

CT angiography helps to differentiate acute from chronic carotid occlusion: the “carotid ring sign”

Introduction  

Currently, there is no reliable method to differentiate acute from chronic carotid occlusion. We propose a novel CTA-based method to differentiate acute from chronic carotid occlusions that could potentially aid clinical management of patients.     

The NutriChip project - translating technology into nutritional knowledge

Advances in food transformation have dramatically increased the diversity of products on the market and, consequently, exposed consumers to a complex spectrum of bioactive nutrients whose potential risks and benefits have mostly not been confidently demonstrated. Therefore, tools are needed to efficiently screen products for selected physiological properties before they enter the market. NutriChip is an interdisciplinary modular project funded by the Swiss programme Nano-Tera, which groups scientists from several areas of research with the aim of developing analytical strategies that will enable functional screening of foods. The project focuses on postprandial inflammatory stress, which potentially contributes to the development of chronic inflammatory diseases. The first module of the NutriChip project is composed of three in vitro biochemical steps that mimic the digestion process, intestinal absorption, and subsequent modulation of immune cells by the bioavailable nutrients. The second module is a miniaturised form of the first module (gut-on-a-chip) that integrates a microfluidic-based cell co-culture system and super-resolution imaging technologies to provide a physiologically relevant fluid flow environment and allows sensitive real-time analysis of the products screened in vitro. The third module aims at validating the in vitro screening model by assessing the nutritional properties of selected food products in humans. Because of the immunomodulatory properties of milk as well as its amenability to technological transformation, dairy products have been selected as model foods. The NutriChip project reflects the opening of food and nutrition sciences to state-of-the-art technologies, a key step in the translation of transdisciplinary knowledge into nutritional advice.     

Activated protein C-cleaved protease activated receptor-1 is retained on the endothelial cell surface even in the presence of thrombin

Activated protein C (APC) signals in endothelial cells ex vivo through protease activated receptor-1 (PAR1). However, it is controversial whether PAR1 can mediate APC's protective effects in sepsis because the inflammatory response results in thrombin generation and thrombin proteolytically activates PAR1 much more efficiently than APC. Here we show that APC can induce powerful barrier protective responses in an endothelial cell monolayer in the presence of thrombin. Using cell surface immunoassays with conformation sensitive monoclonal anti-PAR1 antibodies we analyzed cleavage of endogenous PAR1 on the endothelial cell surface by APC in the absence and presence of thrombin. Incubation with APC caused efficient PAR1 cleavage and upon coincubation with thrombin APC supported additional PAR1 cleavage. Thrombin-cleaved PAR1 rapidly disappeared from the cell surface whereas, unexpectedly, the APC-cleaved PAR1 remained and could be detected on the cell surface, even when thrombin at concentrations of up to 1 nM was also present. Our findings demonstrate for the first time directly that APC can generate a distinct PAR1 population on endothelial cells in the presence of thrombin. The data suggest that different trafficking of activated PAR1 might explain how PAR1 signaling by APC can be relevant when thrombin is present.     

Contact system activation in human sepsis - 47kD HK, a marker of sepsis severity?

AIM: This pilot study seeks to determine whether contact system activation (CSA) occurs in human sepsis patients and to characterise blood levels of the 47kD light chain of high-molecular weight kininogen (47kD HK). METHODS: Six consecutive patients with clinical suspicion of sepsis were evaluated on days 1, 2, 3 and 6-8 for 47kD HK blood levels expressed in U/ml of whole blood and as percent of total HK. 47kD HK was measured in whole blood by quantitative immunoblot analysis. RESULTS: On study day 1 or 2, analysis of 47kD HK in U/ml of whole blood identified CSA in 3/6 patients.When 47kD HK levels were expressed as percent of total HK, 4/6 patients were identified with CSA before day 3. The degree of CSA as assayed by the presence of 47kD HK correlated with the severity of the systemic inflammatory syndrome (SIRS), i.e. mean CSA increased progressively from basal levels in healthy controls (0.08 U/ml or 10.4%) to patients without SIRS (0.10 U/ml or 15.1%), to patients with sepsis (0.12 U/ml or 15.0%), and finally to patients in a combined category of severe sepsis and septic shock (0.13 U/ml or 17.4%). CONCLUSION: CSA, defined by increased 47kD HK, occurred early on in the course of sepsis in a subset of sepsis patients. 47kD HK levels, an indicator of bradykinin release, correlated with sepsis severity. Future larger studies will need to evaluate the role of 47kD HK as a biomarker for both prognosis and treatment response in human sepsis..     

Gait variability while dual-tasking: fall predictor in older inpatients?

BACKGROUND AND AIMS: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single- (i.e., usual walking) or dual-task conditions can predict inpatient falls. METHODS: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. RESULTS: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual- task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cut-off value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). CONCLUSION: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatients.