Night-time experiences and daytime dissociation: A path analysis modeling study

Dissociative symptoms may be the by-products of a labile sleep–wake cycle (Koffel and Watson, 2009a). This may help to explain why dissociation overlaps with fantasy proneness and cognitive failures. Using path analysis, we tested to what extent data gathered in a nonclinical, predominantly female sample (N=139) supported two conceptual models. The first model assumes that unusual sleep experiences increase fantasy proneness and cognitive failures, which in turn encourage trait dissociation and reports of trauma. The second model assumes that trauma leads to dissociative experiences both directly and through its influence on sleep. In this cross-sectional design, the data were reasonably well described by both models. Importantly, in both models, unusual sleep experiences serve as antecedents of trait dissociation. Our analysis underlines the importance of unusual sleep experiences and may inspire treatment intervention focusing on sleep normalization.     

THE OH‐SO STRAIGHT AND NARROW PATH: CAN THE HEALTH CARE EXPENDITURE CURVE BE BENT?

Although there is much talk about whether or not the current health care reform will 'bend' the health care expenditure 'curve', exactly which 'curve' is to be 'bent' is often ill-specified. This essay notes that the 'curve' defined by the log of US national health care expenditures per capita plotted against the log of the US gross domestic product per capita has been remarkably straight since 1929 despite Medicare and Medicaid and all of the more recent reform attempts. After establishing stationarity and considering cointegration and endogeneity, the slope of this log-log relationship suggests a per capita expenditure-income elasticity of 1.388. The authors suggest two explanatory hypotheses consistent with the observed constant slope. First, many new technologies are endogenous because their introduction is determined by their expected market, which is in turn dependent on GDP per capita. Second, the authors emphasize the potential utility gained by spending disproportionately larger proportions of our growing income on hope, uncertainty-reducing information, and consumer amenities, all of which may be independent of any improved health outcome.     

护士对护理服务补救的认知及运用现状调查

目的了解护士对护理服务补救的认知及运用情况,为医院控制服务失误、制定护理服务补救策略提供参考。方法使用自行设计问卷调查226名临床护士对护理服务补救的认知及运用现状。结果最容易发生的服务失误是沟通技巧失误(2.7±1.1)、病情观察失误(2.6±1.0)和服务态度失误(2.5±1.0);85.8%的护士在发生失误时会设法现场自我补救;服务补救措施运用最多的是发生失误时耐心倾听患者诉说(4.4±0.6)、立即赔礼道歉(4.2±0.7)、表达对患方的理解(4.2±0.7);护龄越短的护士运用二、三级补救越多(P<0.05)。62.4%的护士认为医院有完善的服务失误预警机制。结论各类护理失误都有发生的可能,应健全护理服务补救组织系统,普及护理服务补救相关理论知识,培养护士现场服务补救的能力,高度重视预防性服务补救,最大程度降低服务失误的危害。     

Managing hepatitis C therapy failures and chronic kidney disease

ABSTRACT

Introduction: Hepatitis C virus (HCV) infection leads to important morbidity and mortality through liver disease and extra-hepatic manifestations. Recent evidence suggests the role of HCV in developing chronic kidney disease (CKD); also, HCV adversely affects cardiovascular (CV) disease both in the general population and in patients with CKD.

Areas covered: All-oral, interferon-free direct-acting antiviral agents (DAAs) are currently available; anti-HCV regimens based on DAAs are provided with high efficacy and safety and short treatment duration. However, some difficult-to-treat populations still exist including patients with CKD and those who failed previous DAA regimen.

Expert commentary: Two DAAs regimens (elbasvir/grazoprevir and glecaprevir/pibrentasvir) are now recommended for the treatment of HCV in patients with advanced CKD, these combinations have shown great efficacy, according to two multicenter phase-3 trials (C-SURFER and EXPEDITION-4). These trials reported a minimal impact of baseline resistance-associated substitutions (RASs) on treatment outcomes. The sofosbuvir/velpatasvir/voxaliprevir combination has been recommended as the first-line option for DAAs failures, on the basis of the results given by two randomized clinical trials involving patients who had been previously received DAA-containing regimens (POLARIS 1–4 studies). It has been suggested that clinicians should consider RASs upon the introduction of DAA-based antiviral therapy.     

Comment on: Leishmaniasis: an update of current pharmacotherapy

Sirolimus (SRL) is a macrolide antibiotic that has potent antifungal and immunosuppressive properties; preclinical studies suggest that SRL may possess a significant antiproliferative influence in vitro. Recently, several studies have documented a negative effect by SRL on both primary tumor growth and the proliferation of metastatic foci in various rodent models of hepatocellular carcinoma (HCC). Orthotopic liver transplantation (OLT) is increasingly becoming a viable treatment option for patients with end stage liver disease and concomitant HCC. As such, an immunosuppressive agent with antineoplastic activity is inherently attractive in the setting of OLT for malignancy. Regrettably, the cumulative experience with SRL-based immunosuppresssion in this patient population is limited. Herein, the authors review the experience to date with SRL as a primary immunosuppressive agent following OLT, and discuss the clinical implications of SRL-based therapy in OLT recipients with cirrhosis and cancer.     

ORIGINAL ARTICLE: Women with Multiple Implantation Failures and Recurrent Pregnancy Losses have Increased Peripheral Blood T Cell Activation

Citation Yang KM, Ntrivalas E, Cho HJ, Kim NY, Beaman K, Gilman‐Sachs A, Kwak‐Kim J. Women with multiple implantation failures and recurrent pregnancy losses have increased peripheral blood T cell activation. Am J Reprod Immunol 2010 Problem We aim to determine whether peripheral blood T cell activation is associated with repeated implantation failures or recurrent pregnancy losses (RPLs). Method of study Women with a history of repeated implantation failure (n = 18) or RPLs (n = 17) comprise the study group. Normal fertile women (n = 11) are included as controls. Proportion of activated peripheral blood T cells (CD69⁺, CD154⁺) and Th1/Th2 cell ratios are measured by flow cytometric analysis. Results Proportions (%) of CD4⁺/154⁺ of CD4⁺ and CD8⁺/154⁺ of CD8⁺ cells were significantly higher in study group than those of controls. Proportions (%) of CD3⁺/69⁺ of CD3⁺ cells and CD8⁺/69⁺ of CD8⁺ cells were significantly increased in study group compared to controls. Proportion (%) of CD4⁺/69⁺ cells significantly correlated with % CD4⁺/154⁺ cells (P = 0.003). Activated cytotoxic T cells (CD8⁺/154⁺, CD8⁺/69⁺) inversely correlated with INF‐γ/IL‐10 producing CD3⁺/4⁺ T cell ratios. Proportion of activated CD3⁺/8⁺/69 and CD3⁺/8⁺/154⁺ cells was inversely correlated with IFN‐γ/IL‐10 expressing CD3⁺/4⁺ T cell ratios. Conclusion Women with MIFs or RPLs have increased T cell activation in peripheral blood lymphocytes, and T cell suppressor activation seems to be associated with decreased Th1 immunity. Further studies on T cell activation may elucidate molecular mechanisms controlling Th1 effectors.     

A survey of failed post-retained restorations

Survival of endodontically treated, post-restored teeth depends on a multitude of factors, all of which are practically impossible to include in a randomized, controlled clinical study. The purpose of this survey was to characterize and analyze reported failures of post-retained restorations to identify factors critical to failure and to type of failure. A questionnaire was mailed to private practitioners in Denmark with a request to complete the questionnaire whenever a patient presented with a failed post-retained restoration. Information was gathered on factors related to the patient, the tooth, the restorative materials, and the techniques. Two-hundred and sixty questionnaires were collected from 171 practitioners over a 3-year period. Functioning time until failure varied between 3 months and 38 years. Mean survival time until failure was 11 years. Of the failed restorations, 61% had functioned for 10 years or less. Fracture of the tooth was the most common type of failure reported, followed by loosening of the post and fracture of the post. Tapered posts implied an increased risk of tooth fracture compared to loosening or fracture of the post, and the relative risk of tooth fracture increased with the functioning time until failure. Fracture of the post was more common among male than female patients. On the basis of this survey of failed post-retained restorations, it was concluded that tapered posts were associated with a higher risk of tooth fracture than were parallel-sided posts.     

Survival of Implantable Pacemaker Leads

FURMAN, S., ET AL.: Survival of Implantable Pacemaker Leads. Early polyurethane leads were reported to have a high incidence of materials failure. In 1979 a six-center registry was begun. By October 31, 1989, 7, 311 leads had been registered and lead longevity was calculated by individual manufacturer, cumulatively for all manufacturers and for individual leads. Each lead was registered at implant and at removal from service as having been removed for materials failure or for unrelated reasons. Calculations were made for 23 models and for a total of three manufacturers with more than 100 leads implanted. Four thousand seven hundred and sixty three leads (65.1%) were from Medtronic; 2, 177 (29.8%) from Cordis; 297 (4.1%) from Intermedics; and 77 (1.0%) were from all others. The 10-year cumulative survival of Medtronic leads was 96.6 ± 0.4%; for Cordis leads it was 99.9 ± 0.1% and for Intermedics leads 97.7 ± 0.9%. Three lead models registered over 100 units and had poorer survival at 5 years than the remainder of all manufacturers' experience. They were #6972 (n = 107) with 78.6 ± 4.5%; #6991U (n = 294) with 90.6 ± 1.9%; and #4012 (n = 288) with 97.3 ± 1.5%. Other possibly failed models did not achieve statistical significance. It can be anticipated that a lead which survives to the seventh year will have prolonged longevity as thereafter additional failures are uncommon.