Association between prehospital delay and subsequent clinical course in patients with/hospitalized for heart failure

BackgroundThe clinical consequences of prehospital delay in heart failure (HF) patients are unknown. This study explores the relationship between prehospital delay of HF patients and length of hospital stay, plasma values of brain natriuretic peptides (BNP) as well as the association of delay with all-cause mortality, readmission for HF, or all-cause readmissions during short- (60 days) and long-term (18 months) follow-up.MethodsData from 1023 hospitalized HF patients mean aged 71 years from the Coordinating study evaluating Outcomes of Advising and Counselling in HF study were analyzed.ResultsPatients who delayed less than 1 day had significantly shorter stay in hospital (10 days vs. 11 days, P = 0.033). They also had significantly (P = 0.004) lower median plasma values of BNP (377 pg/mL) at discharge compared to patients who delayed >24 hours (492 pg/mL). Delay was not related to all-cause mortality and/or readmissions for HF.ConclusionAlthough patients with a prehospital delay less than 1 day were more symptomatic on admission, they had a shorter hospital stay as well as lower plasma values of BNP at discharge. Delay was not associated hospital readmissions or mortality after discharge.     

Introduction of the "Rotterdam mandibular distractor" and a biomechanical skull analysis of mandibular midline distraction

The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P=0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.     

Open reduction versus endoscopically controlled reconstruction of orbital floor fractures: a retrospective analysis

The aim of this study was to compare the postoperative results of open reduction versus endoscopically controlled reconstructions of orbital floor fractures. The medical records of 83 patients, treated between January 2000 and December 2008, were reviewed for enophthalmos, diplopia and complications. Fifty-eight patients were operated on using open reduction and in 25 patients the open reduction was endoscopically controlled. A significantly better outcome, regarding enophthalmos and diplopia improvement, was found in the endoscopically controlled group. Endoscopically controlled reconstruction of orbital floor fractures seems to be a more accurate and successful treatment.     

A new potential anti-cancer beta-carboline derivative decreases the expression levels of key proteins involved in glioma aggressiveness: A proteomic investigation

Gliomas remain highly fatal due to their high resistance to current therapies. Deregulation of protein synthesis contributes to cancer onset and progression and is a source of rising interest for new drugs. CM16, a harmine derivative with predicted high blood–brain barrier penetration, exerts antiproliferative effects partly through translation inhibition. We evaluated herein how CM16 alters the proteome of glioma cells. The analysis of the gel-free LC/MS and auto-MS/MS data showed that CM16 induces time- and concentration-dependent significant changes in the total ion current chromatograms. In addition, we observed spontaneous clustering of the samples according to their treatment condition and their proper classification by unsupervised and supervised analyses, respectively. A two-dimensional gel-based approach analysis allowed us to identify that treatment with CM16 may downregulate four key proteins involved in glioma aggressiveness and associated with poor patient survival (HspB1, BTF3, PGAM1, and cofilin), while it may upregulate galectin-1 and Ebp1. Consistently with the protein synthesis inhibition properties of CM16, HspB1, Ebp1, and BTF3 exert known roles in protein synthesis. In conclusion, the downregulation of HspB1, BTF3, PGAM1 and cofilin bring new insights in CM16 antiproliferative effects, further supporting CM16 as an interesting protein synthesis inhibitor to combat glioma.     

Influence of controlled immediate loading and implant design on peri-implant bone formation

AIM: Tissue formation at the implant interface is known to be sensitive to mechanical stimuli. The aim of the study was to compare the bone formation around immediately loaded versus unloaded implants in two different implant macro-designs. MATERIAL AND METHODS: A repeated sampling bone chamber with a central implant was installed in the tibia of 10 rabbits. Highly controlled loading experiments were designed for a cylindrical (CL) and screw-shaped (SL) implant, while the unloaded screw-shaped (SU) implant served as a control. An F-statistic model with alpha=5% determined statistical significance. RESULTS: A significantly higher bone area fraction was observed for SL compared with SU (p<0.0001). The mineralized bone fraction was the highest for SL and significantly different from SU (p<0.0001). The chance that osteoid- and bone-to-implant contact occurred was the highest for SL and significantly different from SU (p<0.0001), but not from CL. When bone-to-implant contact was observed, a loading (SL versus SU: p=0.0049) as well as an implant geometry effect (SL versus CL: p=0.01) was found, in favour of the SL condition. CONCLUSIONS: Well-controlled immediate implant loading accelerates tissue mineralization at the interface. Adequate bone stimulation via mechanical coupling may account for the larger bone response around the screw-type implant compared with the cylindrical implant.     

Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review

Many health professionals (HPs) express discomfort at having to broach the topic of prognosis, including limited life expectancy, and may withhold information or not disclose prognosis. A systematic review was conducted of 46 studies relating to truth-telling in discussing prognosis with patients with progressive, advanced life-limiting illnesses and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane Register of Controlled Trials) up to November 2004, with handsearching of studies, as well as inclusion of studies satisfying selection criteria reported in 2005 by the authors. The reference lists of identified studies were hand-searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Results showed that although the majority of HPs believed that patients and caregivers should be told the truth about the prognosis, in practice, many either avoid discussing the topic or withhold information. Reasons include perceived lack of training, stress, no time to attend to the patient's emotional needs, fear of a negative impact on the patient, uncertainty about prognostication, requests from family members to withhold information and a feeling of inadequacy or hopelessness regarding the unavailability of further curative treatment. Studies suggest that patients can discuss the topic without it having a negative impact on them. Differences and similarities in findings from different cultures are explored.