Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement

Despite significant improvements in systemic therapy for patients with colorectal liver metastases (crlms), response rates in the first-line setting are not optimal, and response rates in the second-line setting remain disappointing. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms, but it remains infrequently used.We convened an expert panel to discuss the role of haip in the contemporary management of patients with crlm. Using a consensus process, we developed these statements:

• haip chemotherapy should be given in combination with systemic chemotherapy.
• haip chemotherapy should be offered in the context of a multidisciplinary program that includes expertise in hepatobiliary surgery, medical oncology, interventional radiology, nursing, and nuclear medicine.
• haip chemotherapy in combination with systemic therapy should be considered in patients with unresectable crlms who have progressed on first-line systemic treatment. In addition, haip chemotherapy is acceptable as first-line treatment in patients with unresectable colorectal liver metastases.
• haip chemotherapy is not recommended in the setting of extrahepatic disease outside the context of a clinical trial.
• haip chemotherapy in combination with systemic therapy is an option for select patients with resected colorectal liver metastases.

These consensus statements provide a framework that clinicians who treat patients with crlm can use when considering treatment with haip     

The Influence of Sport Nutrition Knowledge on Body Composition and Perceptions of Dietary Requirements in Collegiate Athletes

Sport nutrition knowledge has been shown to influence dietary habits of athletes. The purpose of the current study was to examine relationships between sport nutrition knowledge and body composition and examine potential predictors of body weight goals in collegiate athletes. Participants included National Collegiate Athletic Association Division III women (n = 42, height: 169.9 ± 6.9 cm; body mass: 67.1 ± 8.6 kg; fat-free mass: 51.3 ± 6.6 kg; body fat percent: 24.2 ± 5.3%) and men (n = 25, height: 180.8 ± 7.2 cm; body mass: 89.2 ± 20.5 kg; fat-free mass: 75.9 ± 12.2 kg; body fat percent: 13.5 ± 8.9%) athletes. Body composition was assessed via air displacement plethysmography. Athletes completed a validated questionnaire designed to assess sport nutrition knowledge and were asked questions about their perceived dietary energy and macronutrient requirements, as well as their body weight goal (i.e., lose, maintain, gain weight). Athletes answered 47.98 ± 11.29% of questions correctly on the nutrition questionnaire with no differences observed between sexes (men: 49.52 ± 11.76% vs. women: 47.03 ± 11.04%; p = 0.40). An inverse relationship between sport nutrition knowledge scores and body fat percentage (BF%) (r = −0.330; p = 0.008), and fat mass (r = −0.268; p = 0.032) was observed for all athletes. Fat mass (β = 0.224), BF% (β = 0.217), and body mass index (BMI) (β = 0.421) were all significant (p < 0.05) predictors of body weight goal in women. All athletes significantly (p < 0.001) underestimated daily energy (−1360 ± 610.2 kcal/day), carbohydrate (−301.6 ± 149.2 grams/day [g/day]), and fat (−41.4 ± 34.5 g/day) requirements. Division III collegiate athletes have a low level of sport nutrition knowledge, which was associated with a higher BF%. Women athletes with a higher body weight, BF% and BMI were more likely to select weight loss as a body weight goal. Athletes also significantly underestimated their energy and carbohydrate requirements based upon the demands of their sport, independent of sex.     

Ultrasonography of jugular vein as a marker of hypovolemia in healthy volunteers

Background

Our aim in this study was to use ultrasonography of internal jugular vein (IJV) instead of visual estimation by eye and to get more precise estimation of central venous pressure at supine position for estimating blood loss in healthy volunteers.

Methods

The values of the sonographic IJV collapse index and corrected IJV longitudinal length (cIJV LL) (vertical height of the jugular vein from the sternal angle of Louis plus 5 cm) were compared before and after blood donation. The correlations between the mean arterial pressure, pulse rate, IJV collapse index, and cIJV LL were analyzed using SPSS version 15.0 (SPSS, Chicago, IL) and G*Power version 3.1.2. (Franz Faul, Universitat Kiel, Germany) was used for power and sample size analysis.

Results

A total of 80 volunteers were enrolled in the study. The medians of cIJV LLs before and after blood donation were 6.67 (95% confidence interval [CI], 6.72-7.07) and 5.98 (95% CI, 6.09-6.40), respectively. The medians of IJV collapse indices before and after blood donation were 32.74 (95% CI, 32.73-39.50) and 38.88 (95% CI, 35.54-42.95), respectively. Preliminary results of our study revealed that cIJV LL and IJV collapse index were not well correlated (Spearman ρ correlation coefficient, 0.257; r = 0.128).

Conclusion

Although, the IJV collapse index was not found to be a useful parameter for evaluation of hypovolemia, cIJV LL is more valuable marker for the detection of blood loss at bedside.     

A Randomized Controlled Study Comparing Educational Outcomes of Examination Room Versus Conference Room Staffing

Background: This prospective randomized controlled study examined outpatient clinical teaching in the presence of the patient. Methods: In 2006, patients in ambulatory internal medicine clinics at the University of Iowa were randomized to have faculty-learner presentations either in their presence or in the conference room. Staffing encounters were timed and faculty, learners and patients completed postencounter surveys. Results: Participation included 254 patients and 12 faculty. Comparison of patient encounters randomized to exam room ( n = 120) or conference room ( n = 134) staffing demonstrated increased time spent with the patient in exam room staffing (91% vs. 54% of total staffing time; p < .0001) but no significant differences in mean total staffing time. Patients, learners, and faculty preferred exam room staffing. Conclusions: Concerns about time efficiency and patient and learner satisfaction during exam room staffing were not supported. This approach may allow attending physicians to maximize billing levels while increasing learner/patient involvement.     

An extremely rare bifurcation pattern of the caudal abdominal aorta: case report demonstrated by angiography

An extremely rare bifurcation pattern at the caudal abdominal aorta was encountered on the pelvic angiography and MR angiography of a male patient. Instead of dividing into two common iliac arteries, the caudal abdominal aorta first gave the right external iliac artery at the level of the last lumbar arteries, then bifurcated into a right internal iliac artery and a left common iliac artery. The median sacral artery originated at this anomalous bifurcation. This high origin of the right external iliac artery and separate branching of these right iliac vessels from the abdominal aorta are important during the interventions in the region. We present the angiography findings and discuss the embryological origin of this unusual and unreported congenital anomaly.     

Role of B cells in systemic lupus erythematosus and rheumatoid arthritis

B cell tolerance to many self-proteins is actively maintained by either purging self-reactive B receptors through clonal deletion and receptor editing, or by functional silencing known as anergy. However, these processes are clearly incomplete as B cell driven autoimmune diseases still occur. The significance of B cells in two such diseases, rheumatoid arthritis and systemic lupus erythematosus, is highlighted by the ameliorative effects of B cell depletion. It remains to be determined, however, whether the key role of the B cell in autoimmune disease is autoantibody production or another antibody-independent function.