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981.
982.
Abhishek D Parmar Kristin M Sheffield Gabriela M Vargas Henry A Pitt E Molly Kilbane Bruce L Hall Taylor S Riall 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2013,15(10):763-772
Background
The factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known.Methods
From November 2011 through to May 2012, data were prospectively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project. Bivariate and multivariate models were employed to determine the factors that predicted DGE.Results
In the 711 patients, the overall rate of DGE was 20.1%. In a bivariate analysis, intra-operative factors such as pylorus-preservation (47.1% versus 43.7%, P = 0.40), intra-operative drain placement (85.5%, versus 85.1%, P = 0.91) and an antecolic compared with a retrocolic gastrojejunostomy (60.1% versus 65.1%, P = 0.26) were not different between the DGE and no DGE groups. Pancreatic fistula formation (31.2% versus 10.1%), post-operative sepsis (21.7% versus 7.0%), organ space surgical site infection (SSI) (23.9% versus 7.9%), need for percutaneous drainage (23.0% versus 10.6%) and reoperation (10.6% versus 3.1%) were higher in patients with DGE (P < 0.0001). In a multivariable model, only pancreatic fistula, post-operative sepsis and reoperation were independently associated with DGE.Discussion
In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying. 相似文献983.
984.
Karin F. Hoth Molly E. Zimmerman Kimberly A. Meschede J. Todd Arnedt Mark S. Aloia 《Sleep & breathing》2013,17(2):811-817
Purpose
Attempts to understand the causes of cognitive impairment in obstructive sleep apnea (OSA) are complicated by the overlap among clinical and demographic factors that may impact cognition. The goal of the current study was to isolate the contribution of hypoxemia to cognitive impairment in OSA.Methods
Two groups of 20 patients with newly diagnosed OSA were compared. The groups differed on severity of hypoxemia but not other demographic (e.g., age, gender, education, estimated premorbid IQ) or clinical (e.g., sleep related respiratory disturbances, daytime sleepiness, depressive symptoms) variables. Participants completed polysonmography and cognitive assessment.Results
We compared patients with high and low hypoxemia on measures of memory, attention, executive functioning, and motor coordination using independent sample t-tests. The high hypoxemia group performed significantly better on immediate recall (Hopkins Verbal Learning Test — Revised; t?=??2.50, p?<?0.02) than the low hypoxemia group. No group differences were observed on other neuropsychological measures.Conclusions
This study is one of the first to compare the cognitive performance of patients with high and low hypoxemia after controlling for demographic factors and aspects of OSA severity that could confound the relationship. In our carefully matched sample, we observed an unexpected advantage of higher hypoxemia on memory. These preliminary findings are discussed in the context of basic science literature on the protective effects of adaptation to intermittent hypoxemia. Our data suggest that the association between hypoxemia and cognition may not straightforward. Future research targeting the effects of hypoxemia on cognition controlling for other clinical factors in large groups of patients with OSA will be important. 相似文献985.
986.
Louise Byrne Brenda Happell Tony Welch Lorna Jane Moxham 《International journal of mental health nursing》2013,22(3):195-204
Mental health policy in Australia is committed to the development of recovery‐focused services and facilitating consumer participation in all aspects of mental health service delivery. Negative attitudes of mental health professionals have been identified as a major barrier to achieving these goals. Although the education of health professionals has been identified as a major strategy, there is limited evidence to suggest that consumers are actively involved in this education process. The aim of this qualitative study was to evaluate students’ views and opinions at having been taught ‘recovery in mental health nursing’ by a person with a lived experience of significant mental health challenges. In‐depth interviews were held with 12 students. Two main themes were identified: (i) ‘looking through fresh eyes’ – what it means to have a mental illness; and (ii) ‘it's all about the teaching’. The experience was perceived positively; students referred to the impact made on their attitudes and self‐awareness, and their ability to appreciate the impact of mental illness on the individual person. Being taught by a person with lived experience was considered integral to the process. This innovative approach could enhance consumer participation and recovery‐focused care. 相似文献
987.
Molly Patrick David Berendes Jennifer Murphy Fabienne Bertrand Farah Husain Thomas Handzel 《The American journal of tropical medicine and hygiene》2013,89(4):647-653
Haiti has the lowest improved water and sanitation coverage in the Western Hemisphere and is suffering from the largest cholera epidemic on record. In May of 2012, an assessment was conducted in rural areas of the Artibonite Department to describe the type and quality of water sources and determine knowledge, access, and use of household water treatment products to inform future programs. It was conducted after emergency response was scaled back but before longer-term water, sanitation, and hygiene activities were initiated. The household survey and source water quality analysis documented low access to safe water, with only 42.3% of households using an improved drinking water source. One-half (50.9%) of the improved water sources tested positive for Escherichia coli. Of households with water to test, 12.7% had positive chlorine residual. The assessment reinforces the identified need for major investments in safe water and sanitation infrastructure and the importance of household water treatment to improve access to safe water in the near term. 相似文献
988.
C. Bonner K. C. Nyhan S. Bacon M. P. Kyithar J. Schmid C. G. Concannon I. M. Bray R. L. Stallings J. H. M. Prehn M. M. Byrne 《Diabetologia》2013,56(8):1743-1751
Aims/hypothesis
HNF1A-MODY is a monogenic form of diabetes caused by mutations in the HNF1A gene. Here we identify, for the first time, HNF1A-MODY-associated microRNAs (miRNAs) that can be detected in the serum of HNF1A-MODY carriers.Methods
An miRNA array was carried out in rat INS-1 insulinoma cells inducibly expressing the common human Pro291fsinsC-HNF1A frame shift mutation. Differentially expressed miRNAs were validated by quantitative real-time PCR. Expression of miRNAs in the serum of HNF1A-MODY carriers (n?=?31), MODY-negative family members (n?=?10) and individuals with type 2 diabetes mellitus (n?=?17) was quantified by absolute real-time PCR analysis.Results
Inducible expression of Pro291fsinsC-HNF1A in INS-1 cells caused a significant upregulation of three miRNAs (miR-103, miR-224, miR-292-3p). The differential expression of two miRNAs (miR-103 and miR-224) was validated in vitro. Strongly elevated levels of miR-103 and miR-224 could be detected in the serum of HNF1A-MODY carriers compared with MODY-negative family controls. Serum levels of miR-103 distinguished HNF1A-MODY carriers from HbA1c-matched individuals with type 2 diabetes mellitus.Conclusions/interpretation
Our study demonstrates that the pathophysiology of HNF1A-MODY is associated with the overexpression of miR-103 and miR-224. Furthermore, our study demonstrates that these miRNAs can be readily detected in the serum of HNF1A-MODY carriers. 相似文献989.
M. Bonelli E. Ferner L. Gschl S. Blüml A. Hladik T. Karonitsch H. P. Kiener R. Byrne B. Niederreiter C. W. Steiner E. Rath M. Bergmann J. S. Smolen C. Scheinecker 《Arthritis \u0026amp; Rheumatology》2013,65(3):599-607
Objective
The binding of abatacept (CTLA‐4Ig) to the B7 ligands CD80 and CD86 prevents the engagement of CD28 on T cells and thereby prevents effector T cell activation. In addition, a direct effect of CTLA‐4Ig on antigen‐presenting cells (APCs) could contribute to the therapeutic effect. To further elucidate the mechanism of CTLA‐4Ig, we performed phenotype and functional analyses of APCs in patients with rheumatoid arthritis (RA) before and after the initiation of CTLA‐4Ig therapy.Methods
Peripheral blood mononuclear cells were analyzed before and at 2 and 4 weeks after the initiation of CTLA‐4Ig therapy. Proportions of APCs were determined by flow cytometry. CD14+ monocytes were further analyzed for the expression of costimulatory and adhesion molecules and for their transendothelial migratory capacity in vitro. In addition, CD14+ monocytes from healthy controls were analyzed for their migratory and spreading capacity.Results
Proportions and absolute numbers of monocytes were significantly increased in RA patients treated with CTLA‐4Ig. The expression of several adhesion molecules was significantly diminished. In addition, monocytes displayed a significant reduction in their endothelial adhesion and transendothelial migratory capacity upon treatment with CTLA‐4Ig. Likewise, isolated monocytes from healthy controls revealed a significant reduction in their migratory and spreading activity after preincubation with CTLA‐4Ig or anti‐CD80 and anti‐CD86 antibodies.Conclusion
We describe direct effects of CTLA‐4Ig therapy on phenotype and functional characteristics of monocytes in RA patients that might interfere with the migration of monocytes to the synovial tissue. This additional mechanism of CTLA‐4Ig might contribute to the beneficial effects of CTLA‐4Ig treatment in RA patients.990.
M. Mulroy L. O’Keeffe D. Byrne D. Coakley M. Casey B. Walsh J. Harbison C. Cunningham 《Irish journal of medical science》2013,182(3):499-502