Emergency clinician‐delivered screening and intervention for high‐risk alcohol use: A qualitative analysis

Objectives: To evaluate qualitative feedback from patients who received opportunistic screening and brief intervention for harmful alcohol use during an ED attendance; to evaluate emergency staff attitudes to performing alcohol screening and delivering opportunistic brief intervention; and to document process issues associated with the introduction of routine clinician‐initiated opportunistic screening and training and administration of brief intervention. Methods: Structured and semi‐structured interviews with emergency staff and recipients of brief intervention. Results: Sixty‐nine patients were interviewed 3 months after an ED attendance where they received emergency clinician‐delivered brief intervention for high‐risk alcohol use. Twenty‐two (32%; 95% CI 21–43%) reported a positive effect of brief intervention on thoughts or behaviour, but 29% (95% CI 18–40%) felt the intervention was not relevant for them or could not recall it. Four people (6%; 95% CI 1–12%) felt confronted or embarrassed, and 17 (25%; 95% CI 15–36%) felt timing or delivery could be improved. Staff had a positive attitude to delivering brief intervention, but nominated lack of time as the main barrier. Fourteen of 15 staff felt brief intervention should become routine in emergency care. Conclusion: Emergency clinicians can be trained to provide brief intervention for high‐risk alcohol in an ED. The use of emergency clinician brief intervention is acceptable to most staff and patients.     

腹腔镜胆囊切除术后胆总管残石护理新视野

目的 总结腹腔镜胆囊切除术（LC）后胆总管残留结石的护理措施。方法 回顾性分析我院1991年9月～2004年12月14000例LC术后17例胆总管残留结石的原因、治疗及护理。结果 LC术后17例胆总管残留结石，均由内镜逆行性胰胆管造影术（ERCP）确诊，其中通过十二指肠镜乳头括约肌切开术（EST）取出结石10例，再次手术取石7例。结论 通过应用ERCP和EST，不仅提高了对LC术后胆总管残留结石的诊断水平，尤其为胆总管残留结石找到了微创、有效、安全的治疗途径，并为相关的护理提供了新思路。     

Functional and ultrastructural alterations of canine myocardium subjected to very brief coronary occlusions

The effects of very brief and recurrent coronary occlusionson myocardial regional shortening and its ultrastructure havebeen analysed. Ultrasonic crystals were implanted in the leftventricular subendocardium of 23 anaesthetized dogs with thethorax open, to measure the shortening fractions of an ischaemicand a control segment Twenty 2 min total occlusions were provokedin the left anterior descending coronary artery, with 3 minrecovery intervals (reperfusion) between occlusions. The shortening fraction decreased progressively with each occlusion,reaching a value 189% lower than the basal after the last ischaemicepisode (P<0.05); 32.3% after 4 h of reperfusion (P<0.01),and 28.6% after 24 h (P<0.01). Qualitative and quantitative ultrastructural analysis showedan increase in the mitochondrial volume of the ischaemic tissue(158% vs control, P<0.001) with significant damage to thecell components (7.7-fold increases vs control mitochondria). These results show that when the myocardium is subjected tovery brief and repeated coronary occlusions, there is progressivedeterioration of systolic function with structural alterations,mainly at the mitochondrial level. These modifications are stillobservable 24 h after the end of ischaemic stimulation and couldbe the cause of transitory andlor chronic systolic dysfunctionsin the absence of previous heart attack.     

The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up

Aims To examine the long‐term impact of brief and early interventions for hazardous and harmful alcohol consumption. Design A 9‐month and 10‐year follow‐up of subjects recruited into a randomized controlled trial of a range of alcohol‐related brief interventions. Setting General practices, the outpatient or acute care services of a major city hospital, and a privately run health screening programmeme. Participants The cohort of 554 (non‐dependent) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption. Intervention The effectiveness of three forms of intervention, ranging from 5 to 60 minutes in duration, were compared with a no‐treatment control condition. Measurements Included drinking behaviour and biological markers of alcohol use. In addition, at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol‐related psychological, social and physical harm. Mortality was also assessed. Findings Results provide further evidence for the short‐term effectiveness of alcohol‐related brief interventions. In comparison to controls, subjects offered intervention: (1) report significantly lower consumption; and (2) less unsafe drinking at 9‐month follow‐up. The intensity of intervention was not related to the amount of change in drinking behaviour. Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption, mean reduction in consumption from baseline to follow‐up, mortality and ICD‐10 diagnoses of alcohol dependence or harmful alcohol use. Conclusions This study failed to find evidence that brief advice and counselling without regular follow‐up and reinforcement can sustain significant long‐term reductions in drinking behaviour at 10‐year follow‐up.     

Endoscopic sphincterotomy for retained common duct stones

Twenty-one patients with retained stones after biliary surgery were managed by endoscopic sphincterotomy and stone extraction in the postoperative period. The bile duct was cleared of stones in 20 patients (95%). In one patient stone extraction was unsuccessful. There were no complications. Compared to percutaneous trans-T-tube tract stone extraction, endoscopic sphincterotomy does not require a 6 week waiting period. Endoscopic sphincterotomy should be considered for retained bile duct stones if endoscopic expertise is available.     

Colitis in mice lacking the common cytokine receptor gamma chain is mediated by IL-6-producing CD4+ T cells

BACKGROUND & AIMS: Mice that have a truncated mutation of the common cytokine receptor gamma chain (CR gamma -/Y) are known to spontaneously develop colitis. To identify the pathologic elements responsible for triggering this localized inflammatory disease, we elucidated and characterized aberrant T cells and their enteropathogenic cytokines in CR gamma -/Y mice with colitis. METHODS: The histologic appearance, cell population, T-cell receptor V beta usage, and cytokine production of lamina propria lymphocytes were assessed. CR gamma -/Y mice were treated with anti-interleukin (IL)-6 receptor monoclonal antibody to evaluate its ability to control colitis, and splenic CD4 + T cells from the same mouse model were adoptively transferred into SCID mice to see if they spurred the appearance of colitis. RESULTS: We found marked thickening of the large intestine, an increase in crypt depth, and infiltration of the colonic lamina propria and submucosa with mononuclear cells in the euthymic CR gamma -/Y mice, but not in the athymic CR gamma -/Y mice, starting at the age of 8 weeks. Colonic CD4 + T cells with high expressions of antiapoptotic Bcl-x and Bcl-2 were found to use selected subsets (V beta 14) of T-cell receptor and to exclusively produce IL-6. Treatment of CR gamma -/Y mice with anti-IL-6 receptor monoclonal antibody prevented the formation of colitis via the induction of apoptosis in IL-6-producing CD4 + T cells. Adoptive transfer of pathologic CD4 + T cells induced colitis in the recipient SCID mice. CONCLUSIONS: Colonic IL-6-producing thymus-derived CD4 + T cells are responsible for the development of colitis in CR gamma -/Y mice.     

Acid rereflux: a review,emphasizing detection by impedance,manometry, and scintigraphy,and the impact on acid clearing pathophysiology as well as interpreting the pH record

Acid clearing, the interval while intraesophageal pH is <4 after a traditional acid reflux event (RE), is a potential blind spot during pH monitoring, when reflux of acidified gastric contents may occur undetected by the pH probe. This is termed acid rereflux. Acid rereflux comprised 61% (169/262) of acid REs in recumbent postprandial patients with severe GERD in two reports using simultaneous pH monitoring and manometry as well as multichannel intraluminal impedance (MII) in one, and scintigraphy in the other. Acid rereflux events often recurred with short intervals between them. The pH probe alone was insufficient to detect most acid rereflux REs, since expanding pH criteria for an acid RE (>1 unit fall while pH < 4) detected only 35% of acid rereflux REs. When a variety of patients and study conditions was examined, simultaneous manometry–pH monitoring found more frequent acid rereflux in the following situations: (1) patients with vs those without esophagitis; (2) recumbent vs upright posture, and (3) postprandial vs preprandial. Of pathophysiologic importance, acid rereflux in the blind spot is the most common cause of prolonged daytime acid REs in GERD patients. Of clinical importance, the 24-hr pH parameter % acid exposure should be relied upon most in interpreting the 24-hr pH record, because those parameters that relate to RE frequency may be inaccurate due to acid rereflux REs that are not counted. Furthermore, identifying as many REs as possible gives a more reliable indication of the severity of antireflux barrier incompetence, as well as more REs to correlate with patients symptoms that should improve sensitivity of the symptom index. Ambulatory simultaneous pH monitoring and MII will allow these and other roles for acid rereflux to be assessed during the patients normal day.     

Phase II study of tailored S-1 monotherapy with a 1-week interval after a 2-week dosing period in elderly patients with advanced non-small cell lung cancer

Background

S-1 is an oral fluoropyrimidine that is active in the treatment of non-small cell lung cancer (NSCLC); however, an optimal treatment schedule and appropriate dose adjustments of S-1 in elderly patients have not yet been established.

A novel therapeutic approach for LPIN1 mutation–associated rhabdomyolysis—The Austrian experience

Introduction: Lipin 1 gene (LPIN1) mutations lead to cellular energy deficiency and cause up to 50% of the rhabdomyolysis episodes seen in pediatric patients. These episodes are associated with poor prognosis, as treatment options have been limited. We propose a novel therapeutic strategy based on prevention and early treatment of catabolism. Methods: Five patients were diagnosed with LPIN1 mutations. They were instructed to maintain high caloric intake in situations possibly leading to catabolism such as viral infections or excessive physical activity. When an episode of rhabdomyolysis occurred, patients were treated with intravenous high‐concentration glucose at first symptoms. Results: The therapeutic strategies described limited the number of rhabdomyolyis episodes, and the duration of episodes was reduced from 7–10 days, as reported in the literature, to 5 days. Conclusion: In this small series, patients with LPIN1 mutations appear to have benefited from prevention and early treatment of catabolism. Muscle Nerve 52:437–439, 2015