Acceptance of a New Technology for Management of Obstetric Hemorrhage: A Qualitative Study From Rural Mexico

We conducted a qualitative study to explore responses to a low-technology first-aid device for management of life-threatening obstetric hemorrhage in rural health facilities in Mexico. This entailed in-depth, semistructured interviews with clinical and administrative staff (n = 70) involved in pilot studies of the nonpneumatic antishock garment (NASG) at primary health care facilities and rural hospitals. We found that staffs’ response fell into four categories: owning, doubting, resisting, and rejecting. Overall, there were positive reactions to the garment as a relevant technology for saving women's lives. Findings will be used for future implementation of the garment and other new technologies.     

Time Course for the Hazard of Radiation-induced Pneumonitis Death in Mice

The form of the hazard function for radiation-induced pneumonitis death in mice was investigated. ‘Hazard’ refers to the instantaneous failure rate at a specified time, conditional upon non-failure to that time. Thus, the hazard function describes the time profile for the risk of pneumonitis death among still-surviving subjects. Single-dose lethality data from nine previously published studies involving irradiation of the lung were combined. Sufficient data were then available to estimate the hazard for eight different dose groups (dose range 12–15 Gy). The results of this study suggest that there are multiple distinct peaks in the hazard function for radiation pneumonitis, corresponding to distinct waves of death separated by an average interval of 33 days. The times of the peak hazards are dose dependent, with the peak hazards occurring earlier after larger doses, and the values of the hazards at the peaks are also dose dependent, with larger doses corresponding to a greater risk of death. The implications of a multiply-peaked hazard function for the possible mechanisms of response to whole-lung irradiation are discussed.     

Case Report: Halicephalobus gingivalis: A Rare Cause of Fatal Meningoencephalomyelitis in Humans

The genus Halicephalobus consists of eight species of free-living nematodes. Only one species (H. gingivalis) has been reported to infect vertebrates. Human infection is extremely rare, and only four cases have been reported in the literature. These nematodes seem to exhibit neurotropism, but their life cycle, mode of infection, and risk factors are poorly understood. Neurohelminthiases are not commonly recognized in the United States and when they do occur, pose great diagnostic challenges because of lack of appropriate non-invasive screening and/or confirmatory tests. We report a challenging case of meningoencephalomyelitis caused by a Halicephalobus sp., in which the patient had a rapidly deteriorating clinical course. The case did not raise any clinical suspicion of neurohelminthiases, although increased eosinophils were present in the cerebrospinal fluid. This case presents an opportunity to highlight the importance of considering parasitic infection in meningoencephalitis or meningoencephalomyelitis presenting atypically.     

Activation time course of activator protein-1 and effect of proline dithiocarbamate during ischemia-reperfusion in rat skeletal muscle

In this report the authors describe a new method that avoids autocannibalization by free transfer of a flap to the dorsum of the rat by means of a simple exposure technique. A total of 22 Wistar rats of both sexes (weight, 200-290 g) were used in this experiment. An anatomic study performed in 12 rats revealed that a wide exposure could be created in the axillary fossa by retracting the inferior tip of the scapular bone superiorly (after severing its attachments with the deep extrinsic back muscles), the latissimus dorsi muscle laterally, and the serratus anterior muscle medially. Furthermore, after obtaining vessel diameter measurements, it was ascertained that the subscapular and the lateral thoracic vessels could serve as the recipient vessels. Based on the anatomic study, a total of 10 conventional groin cutaneous flaps, measuring 2 x 3 cm in size, were harvested based on the femoral vessels and transferred to the dorsum of the same animal by the exposure method as just described, with microvascular anastomoses performed between the femoral vessels of the flap and either the subscapular artery and the lateral thoracic vein (N = 5) or the lateral thoracic artery and vein (N = 5). Results showed that 9 of the 10 transplanted flaps were totally viable on postoperative day 7, giving a success rate of 90%, with one failing flap belonging to the latter group. The authors conclude that by this simple method of recipient vessel exposure in the axillary fossa, free flap transfer to the dorsum of the rat is a simple and reproducible technique by microvascular anastomoses performed between the pedicle vessels of a flap and the subscapular artery and the lateral thoracic vein. This model offers the unique advantage of a dorsally located flap that is protected by autocannibalization. Moreover, daily observation and monitoring of the flap are easy and practical without the need to have the animal wear protective material such as vest.     

Screening for depression in older medical inpatients

BACKGROUND: Older people with depression make greater use of healthcare services, but the detection of the disorder is poor. The National Service Framework for Older People recommended screening for depression in acute healthcare settings to improve health outcomes of older people. Previous studies, mainly outside the UK, report widely differing rates for depression that do not usefully inform UK practice. Thus the aim of this study is to estimate, in a large representative sample of older medical inpatients in a UK hospital setting, the prevalence of depressive symptoms and ICD-10 depressive disorder and to examine the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15) as a screening instrument. METHODS: A two-phase prevalence study of depressive disorder was carried out in acute wards of a district general hospital. Six hundred and eighteen (61%) of 1,009 eligible older medical inpatients were screened using the GDS-15. A stratified sample (n = 223) was further assessed using the Geriatric Mental State, from which ICD-10 diagnoses were determined. RESULTS: The weighted prevalence estimate of ICD-10 depressive disorder was 17.7% (95%CI: 12.9-22.5). Forty-four percent of participants scored above the normally recommended cut-point of >or=5 on the GDS-15. However, on the basis of ROC, the optimal cut-point of the GDS-15 for screening for depressive disorder in this hospitalised population is two points higher at >or=7 (sensitivity 0.74, specificity 0.81). CONCLUSIONS: This study confirms that depression is common amongst older UK medical inpatients with 1 in 6 suffering from clinical depression. The cut-point for GDS-15 for this population is >or=7.     

Plasmacytoid variant urothelial bladder cancer: Is it time to update the treatment paradigm?

ObjectivesPlasmacytoid variant (PCV) urothelial cancer (UC) of the bladder is rare, with poor clinical outcomes. We sought to identify factors that may better inform expectations of tumor behavior and improve management options in patients with PCV UC.Materials and methodsA retrospective analysis of the Indiana University Bladder Cancer Database between January 2008 and June 2013 was performed comparing 30 patients with PCV UC at cystectomy to 278 patients with nonvariant (NV) UC at cystectomy who underwent surgery for muscle-invasive disease. Multivariable logistic regression was used to assess precystectomy variables associated with non–organ-confined disease at cystectomy and Cox regression analysis to assess variables associated with mortality.ResultsPatients with PCV UC who were diagnosed with a higher stage at cystectomy (73% pT3-4 vs. 40%, P = 0.001) were more likely to have lymph node involvement (70% vs. 25%, P<0.001), and positive surgical margins were found in 40% of patients with PCV UC vs. 10% of patients with NV UC (P<0.001). Median overall survival and disease-specific survival were 19 and 22 months for PCV, respectively. Median overall survival and disease-specific survival had not been reached for NV at 68 months (P<0.001). Presence of PCV UC on transurethral resection of bladder tumor was associated with non–organ-confined disease (odds ratio = 4.02; 95% CI: 1.06–15.22; P = 0.040), and PCV at cystectomy was associated with increased adjusted risk of mortality (hazard ratio = 2.1; 95% CI: 1.2–3.8; P = 0.016).ConclusionsPCV is an aggressive UC variant, predicting non–organ-confined disease and poor survival. Differentiating between non–muscle- and muscle-invasive disease in patients with PCV UC seems less important than the aggressive nature of this disease. Instead, any evidence of PCV on transurethral resection of bladder tumor may warrant aggressive therapy.