Factors that determine refractoriness of ascites to conventional therapy.

We compared the charts of 33 patients who had refractory ascites with those of 33 patients who had responsive ascites to identify factors responsible for resistance to conventional therapy. The results of biochemical tests of liver function were more abnormal in the responsive group than in the refractory group on admission to hospital, whereas the results of kidney function tests were worse in the refractory group. The transhepatic portal pressure was similar in the 7 patients with refractory ascites and the 11 patients with responsive ascites in whom it was measured. The portal vein pressure as calculated from the difference in albumin content between the serum and the ascitic fluid was similar in the two groups, as were the findings at histologic examination of the liver. We conclude that neither the severity of the liver disease nor the portal pressure is a critical factor in the development of refractory ascites. Kidney dysfunction, however, is important, but its mechanism remains unclear.     

Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review

Background  

The primary objective was to systematically review the medical literature for instruments validated for use in epidemiological and clinical research on waterpipe smoking.     

Hypoprolactinemic effect of calcitonin gene-related peptide in the rat

The effect of calcitonin gene-related peptide (CGRP) on prolactin (PRL) secretion was studied in female rats. Prepubertal female rats were submitted to the stressful stimuli of injection, blood puncture and thermal stress. Lactating rats were exposed to suckling stimulus. The effects of CGRP on PRL release were compared to those of calcitonin (CT). CGRP i.p. or s.c. prevents the increase in circulating PRL induced by stress. This effect was observed two hrs and even 24 hrs after CGRP administration. It was elicited at all doses tested, 2.5, 1.25 and 0.6 micrograms per animal. The time course of the actions of CGRP and CT are different. It is proposed that CGRP and CT act on different receptors.     

Hepatic iron overload: quantitative MR imaging

Iron deposits demonstrate characteristically shortened T2 relaxation times. Several previously published studies reported poor correlation between the in vivo hepatic 1/T2 measurements made by means of midfield magnetic resonance (MR) units and the hepatic iron content of iron-overloaded patients. In this study, the authors assessed the use of in vivo 1/T2 measurements obtained by means of MR imaging at 0.5 T using short echo times (13.4 and 30 msec) and single-echo-sequences as well as computed tomographic (CT) attenuation as a measure of liver iron concentration in 10 severely iron-overloaded patients with beta-thalassemia major. The iron concentrations in surgical wedge biopsy samples of the liver, which varied between 3 and 9 mg/g of wet weight (normal, less than or equal to 0.5 mg/g), correlated well (r = .93, P less than or equal to .0001) with the preoperative in vivo hepatic 1/T2 measurements. The CT attenuation did not correlate with liver iron concentration. Quantitative MR imaging is a readily available noninvasive method for the assessment of hepatic iron concentration in iron-overloaded patients, reducing the need for needle biopsies of the liver.     

Bioengineering and regeneration of gastrointestinal tissue: where are we now and what comes next?

Introduction: The field of tissue engineering and regenerative medicine has been applied to the gastrointestinal (GI) tract for a couple decades. Several achievements have been accomplished that provide promising tools for treating diseases of the GI tract.

Areas covered: The work described in this review covers the traditional aspect of using cells and scaffolds to replace parts of the tract. Several studies investigated different types of biomaterials and different types of cells. A more recent approach involved the use of gut-derived organoid units that can differentiate into all gut cell layers. The most recent approach introduced the use of organ-on-a-chip concept to understand the physiology and pathophysiology of the GI system.

Expert opinion: The different approaches tackle the diseases of the GI tract from different perspectives. While all these different approaches provide a promising and encouraging future for this field, the translational aspect is yet to be studied.     

A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial

Purpose

Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort.

Methods

In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge.

Results

During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was ? 7.00 (95% CI ? 9.89 to ? 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference ? 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items.

Conclusions

This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients. Trial Registration: Clinicaltrials.gov Identifier NCT02442934.

     

Granulocyte Transfusions in Patients with Chronic Granulomatous Disease Undergoing Hematopoietic Cell Transplantation or Gene Therapy

Journal of Clinical Immunology - Granulocyte transfusions are sometimes used as adjunctive therapy for the treatment of infection in patients with chronic granulomatous disease (CGD). However,...