Mussel-inspired hyperbranched poly(amino ester) polymer as strong wet tissue adhesive

Current medical adhesives based on cyanoacrylates typically exhibit cellular toxicity. In contrast, fibrin adhesives are non-toxic but have poor adhesive properties. To overcome these drawbacks we designed a simple and scalable adhesive precursor inspired by marine mussel adhesion that functioned with strong adhesion in wet conditions and with low cytotoxicity. Dopamine, an-amine derivative of an amino acid abundantly present in mussel adhesive proteins, was co-polymerised with a tri-functional vinyl monomer, to form a hyperbranched poly(β-amino ester) polymer termed poly(dopamine-co-acrylate) (PDA). A variety of molecular weights and crosslinking methods were analysed using an ex vivo porcine skin model and an almost 4 fold increase in wet adhesion strength was observed compared to TISSEEL^® fibrin sealant. With a fast curing time, degradable properties and low cytotoxicity, PDA is highly attractive for medical purposes and could have a broad impact on surgeries where surgical tissue adhesives, sealants, and haemostatic agents are used.     

Medical Emergencies and Cardiopulmonary Arrests in Interventional Radiology

PurposeTo evaluate the circumstances and determine the outcomes of medical emergencies (MEs) and cardiopulmonary arrests (CPAs) in patients undergoing interventional radiology (IR) procedures.Materials and MethodsRetrospective review of all MEs and CPAs that occurred between July 2006 and December 2011 was performed. Procedure type, technical outcome, complications, etiology and location of ME/CPA, event outcome, and postevent mortality were collected.ResultsA total of 58 events occurred during 38,927 procedures (0.15%). Complete records were available for 55 events (43 MEs, 12 CPAs) in 53 patients (mean age, 63 y; 58.5% male) during 37 inpatient (27 MEs, 10 CPAs) and 18 outpatient (16 MEs, two CPAs) encounters. Seven events (13%; six MEs, one CPA) occurred before the start of the procedure, and 18 (33%; 16 MEs, two CPAs) occurred in the periprocedural holding area. Thirty-five procedures (64%) were completed successfully. Forty-two patients (76%) were alive at discharge, 37 (67%) at 1 month, 26 (47%) at 3 months, and 23 (42%) at 1 year. Procedural complications were attributed as the main cause of 22 MEs (51%) and one CPA (8%; P = .018). The relative risk (RR) of an ME or CPA occurring during a hemodialysis access case versus all other cases was 5.2 (95% confidence interval = 3.02–8.95; P < .0001).ConclusionsAlthough the incidence of MEs/CPAs in patients undergoing IR procedures is low, the 1-year mortality rate following these events is high. MEs are significantly more likely than CPAs to be directly attributed to a procedural complication. The RR of MEs/CPAs is significantly higher in hemodialysis access interventions.     

Prostatic artery embolization: Progress and prospect

Prostate artery embolization is a well-known and promising treatment for benign prostatic hyperplasia, with the quantum leaps of research in medicine. We aim to provide an up-to-date review of the novel technique, including large retrospective studies and randomized control trials, ends with discussions of advantages and disadvantages of this minimally invasive technique.     

Once daily high dose tigecycline - pharmacokinetic/pharmacodynamic based dosing for optimal clinical effectiveness: dosing matters,revisited

Introduction: Tigecycline has emerged as first line therapy for serious systemic infections due to important pathogens (except P. aeruginosa and Proteus sp.), including multi-drug resistant (MDR) and Gram negative bacilli (GNB), including carbapenem resistant Enterobacteriae. Tigecycline has a ‘low resistance potential,’ is protective against C. difficile, and is often the only antibiotic effective against MDR GNB, e.g., Klebsiella sp.

Areas covered: Standard dose tigecycline therapy has been used for intra-abdominal infections, complicated skin/skin structure infections (cSSSIs), and CAP. Clinical experience with once daily high dose tigecycline (HDT), i.e., 200 – 400 mg (IV) x 1, then 100 – 200 mg (IV) q24 h, is reviewed. Optimal tigecycline efficacy is dependent on PK/PD based dosing. Suboptimal outcomes have been due to inappropriate use or suboptimal dosing.

Expert commentary: Tigecycline’s spectrum against nearly all important pathogens (including MSSA/MRSA, VSE/VRE, B. fragilis, C. difficile, MDR and GNB) assures tigecycline a critical place in the antibiotic armamentarium. Dosed optimally, HDT can be a cornerstone of antibiotic stewardship programs in preventing C. difficile, treating MDR GNB pathogens, and in preventing resistance. Properly used and optimally dosed, once daily HDT should be considered preferred therapy for severe systemic infections and those due to MDR GNB pathogens.     

综合评估干预对老年前列腺动脉栓塞术患者的护理效果

【摘要】 目的 通过对老年前列腺动脉栓塞术患者护理措施的探索,以利于患者抑郁、焦虑情绪的改善和生活质量的提高。方法 选取我院51例住院动脉栓塞术的老年前列腺增生患者为研究对象,按入院治疗的时间先后顺序将其随机分为观察组26例、对照组25例。对照组患者给予常规对症治疗及护理措施。观察组患者在此基础上依据老年综合评估的结果给予综合护理干预,比较两组患者治疗依从性、护理满意度、生活质量及抑郁、焦虑情绪改善情况。结果 观察组患者干预后SDS及SAS评分降幅显著优于对照组(P＜0.05);观察组患者干预后生活质量、护理满意度及治疗依从性均优于对照组(P＜0.05)。结论 综合评估干预不仅可明显改善老年前列腺动脉栓塞术患者的抑郁和焦虑情绪,还可提高患者生活质量、治疗依从性和护理满意度,促进患者康复。     

Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series

This retrospective case series details early experience with intra-arterial (IA) and intravenous (IV) contrast-enhanced ultrasound (CEUS) in 8 patients (mean age, 70.4 years) who underwent prostatic arterial embolizations from July 2014 to March 2017. Technical success was achieved in 7 of the 8 patients. IA CEUS demonstrated ipsilateral prostatic perfusion in 15 out of 20 interrogated prostatic arteries (PAs), confirming proper catheter placement. Four of the 20 interrogated PAs demonstrated extraprostatic perfusion. One PA was not successfully interrogated owing to a localized wire perforation. IV CEUS, performed on 4 of the 8 patients, demonstrated decreased enhancement after embolization in all 4 patients, confirming the procedural end point.     

抗菌药物静脉滴注给药方案的设计原理和方法

目的设计抗菌药物静脉滴注给药方案。方法依据药物动力学和抗菌药物药效动力学原理，采用文献报道相关参数设计阿米卡星、环丙沙星和青霉素G静脉滴注给药方案。结果铜绿假单胞菌呼吸道感染患者给予阿米卡星380．64mg，静脉滴注速率33滴／min，每天给药1次；铜绿假单胞菌感染患者给予环丙沙星311．85mg，静脉滴注速率52滴／min，14h后给予第二剂量；化脓性链球菌感染患者给予青霉素G480万U，静脉滴注速率33滴／min，给药时间间隔12h。结论依据药物动力学和抗菌药物药效动力学原理，结合相关试验数据，可以设计静脉滴注给药方案。     

抗生素的药效学指标与给药方案优化

目的：阐述依据抗生素的药效学指标制定给药方案在临床上可以获得最佳疗效。方法：通过分析抗生素的药效学指标与，临床疗效的相关性，阐明药效学指标在优化给药方案中起重要作用。结果：应用药效学的特点可以把抗生素分为浓度依赖性和时间依赖性两类，不同抗生素具有不同的抗生素后效应，目前已有的药效学指标如AUC、AUIC、MIC、PAE可以客观地反映抗生素的疗效，为确定合理给药方案提供依据。结论：临床根据各种抗生素的药效学指标制定给药方案，可以取得理想的抗菌疗效并防止细菌产生耐药性。     

Preserved cortical asymmetry despite thinner cortex in children and adolescents with prenatal alcohol exposure and associated conditions

Prenatal alcohol exposure (PAE) is associated with reduced overall brain volume. Although this has been reported consistently across studies, the status of cortical thickness after PAE is more variable. The cortex is asymmetric in typical controls, but it is unclear whether the left and right counter parts of the cortical gray matter are unevenly influenced in postpartum brain development after PAE. Brain MRI was acquired in a newly recruited sample of 157 participants (PAE: N = 78, 5.5–18.9 years, 40 females and controls: N = 79, 5.8–18.5 years, 44 females) across four Canadian sites in the NeuroDevNet project. The PAE group had other confounds such as psychiatric co‐morbidity, different living environment, and so on, not present in the control group. In agreement with previous studies, the volumes of all brain structures were reduced in PAE compared to controls, including gray and white matter of cerebrum and cerebellum, and all deep gray matter including the hippocampus, amygdala, thalamus, caudate, putamen, and pallidum. The PAE group showed reductions in global and regional cortical thickness, while the pattern and degree of cortical thickness asymmetry were preserved in PAE participants with the greatest rightward asymmetry in the lateral parietal lobe and the greatest leftward asymmetry in the lateral frontal cortex. This persistent asymmetry reflects that the homologous left and right cortical regions followed typical relative developmental patterns in the PAE group despite being thinner bilaterally than controls. Hum Brain Mapp 39:72–88, 2018. © 2017 Wiley Periodicals, Inc.