The Natural Course of Serum D-Dimer,C-Reactive Protein,and Erythrocyte Sedimentation Rate Levels After Uneventful Primary Total Joint Arthroplasty

BackgroundThis study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty.MethodsThis prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR.ResultsThe mean preoperative serum D-dimer, CRP, and ESR level was 412 ± 260 (range 200-980) ng/mL, 2.93 ± 2.1 (range 1-18) mg/L, and 22.88 ± 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively.ConclusionD-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.     

Correlation between symptoms and course duration of upper aerodigestive tract cancer at early and advanced stages

There still are many clinical and biological aspects of the natural history of cancer of the upper aerodigestive tract to be unveiled; which in Brazil is a direct consequence of the failure of systematic prevention and early diagnosis campaigns.ObjectiveTo analyze the signs and symptoms presented by patients with the disease at initial and advanced stages. Other variables such as disease duration, general and nutritional status were considered.MethodA historical cohort study with a cross-section involving 895 subjects with cancer of the upper aerodigestive tract.ResultsClinical findings were not statistically correlated with disease progression, nor with the disease in early stages, but it showed rapid disease development.ConclusionThe results suggest a disease of insidious onset in the early stages and fast course afterwards. The long disease duration - greater than three months, was associated with worsening in general and nutritional states of patients.     

The effect of appendectomy on the course of ulcerative colitis: a systematic review

Aim Previous studies have shown significantly lower appendectomy rates in ulcerative colitis (UC) patients compared with healthy controls. Evidence indicating that the appendix has an immunomodulatory role in UC has been accumulating. To examine the latest evidence on the effect of appendectomy on the disease course of UC. Method PubMed, The Cochrane Library and EMBASE were searched. Primary end‐points were number of relapses, use of steroids, number of hospital admissions and number of colectomies. Results The search resulted in six observational studies (five case–control studies and one cohort study) totalling 2532 patients. Owing to clinical heterogeneity, no meta‐analysis could be conducted. One study found lower relapse rates in patients appendectomized before the onset of UC [absolute risk reduction (ARR) = 21.5%; 95% CI: 1.71–45.92%]. Another two studies found a reduced requirement for immunosuppression in appendectomized patients (ARR = 20.2%; 95% CI: 9.67–30.46% in the first study and ARR = 21.4%; 95% CI: 10.32–32.97% in the second study). In addition, one study found lower colectomy rates in nonappendectomized patients (ARR = 8.7%; 95% CI: 1.29–18.66%) and two studies found lower colectomy rates in appendectomized patients (ARR = 21.4%; 95% CI: 13.17–28.79% in the first study and ARR = 18.7%; 95% CI: 7.50–29.97% in the second study). Conclusion There are limited and conflicting data available regarding the effect of appendectomy on the disease course of UC. Most studies suggest a beneficial effect and the minority find no, or a negative, effect.     

An Elective Course on Dermatological Topics and Cosmeceutical Compounding

Objective. To implement and assess a pharmacy dermatology and cosmeceutical compounding elective course and its impact on graduates’ careers.Design. A 3-credit elective course that incorporated classroom lectures on ambulatory dermatologic diseases and cosmeceutical products with case studies, weekly quizzes, and a comprehensive business plan project was implemented in a doctor of pharmacy (PharmD) program in 2010.Assessment. Assessment instruments including weekly quizzes, a business plan project, and pre- and post-course tests were used to evaluate course content. Across 3 offerings of the course (2010, 2011, 2012), pre- and post-course test scores improved. Results of a postgraduate survey showed that 54% of respondents worked at a pharmacy offering compounding services, and 57% felt that the course played a significant or very significant role in their counseling on dermatologic conditions.Conclusions. Assessment methods revealed student learning of course content and the course appeared moderately beneficial to graduates’ early careers. A more longitudinal analysis is needed to assess the course’s impact on long-term career choices, particularly those dealing with compounding of cosmeceutical products.     

Effect of pediatric advanced life support course on pediatric residents' intubation success

Background: The Pediatric Advanced Life Support Program (PALS) course very important for teaching about intubation, resuscitation, shock, trauma, respiratory failure and rhythm disturbances. The aim of the present study was to evaluate the effect of the PALS course on pediatric residents' intubation success during their rotation, daytime and night‐time practice in the pediatric intensive care unit (PICU). Methods: The study was carried out from 1 March 2005 to 28 February 2007. The study period had two parts, in that the number of attempts and successful intubations performed by pediatric residents, and the pediatric intensivist successful intubation ratio were evaluated in two different periods: before the PALS course, 1 March 2005–28 February 2006, and after the PALS course, 5 March 2006–28 February 2007. The participating residents' pediatric levels (PL) were classed as PL‐1, PL‐2, PL‐3, PL‐4, and all had first experience in the PICU at the PL‐1 level. The PALS instructor was a pediatric emergency or intensive care doctor. We evaluated whether the PALS course influenced intubation success or not. Results: Sixteen residents participated in the study. The proportion of successful intubations was 110 (53.3%) and 104 (65.4%) attempts before and after the PALS course, respectively. The proportion of intubations done by intensivists decreased from 49.1% to 31.7% before and after PALS. The most frequently used endotracheal tube (ETT) internal diameter (ID) was 4.0 mm, and cuffed ETT was used 16% and 21% before and after the course, respectively. Appropriate placing of ETT tip occurred 70.4% and 82.2% of the time before and after the PALS course, respectively. Proportion of successful intubations by residents increased in all levels, except for PL‐1. The most important reason for unsuccessful attempts was inappropriate patient position. Only one patient could not be intubated, and laryngeal mask airway was used in that case. During intubation, complications were broken teeth in two patients before the course, and subglottic stenosis developed in only one patient due to cuffed ETT. Conclusion: Successful intubation is a life‐saving intervention during resuscitation, ETT revision for extubation or obstruction for extubation or obstruction during mechanical ventilation. This skill can be developed in the PALS course and by clinical study in PICU and pediatric emergency services. The PALS course must be given to pediatric residents especially within the first year. Also, cuffed ETT can be used for infants and children.     

Feasibility and Usefulness of the Peer-Run Course “Recovery Is Up to You” for People with Addiction Problems: A Qualitative Study

“Recovery Is Up to You,” a 12-week peer-run group experience for persons with major psychiatric problems, has had positive effects on important elements of recovery: empowerment, hope, and self-efficacy beliefs. Determining if such an experience would be equally efficacious for persons with addiction problems is the focus of this study. The 12-week course was experienced by eight groups of persons with addiction problems and the outcome, measured in terms of the response of participants and of the group leaders, was a favorable one as the course was found to be supportive of the recovery process, providing the participants and peer group leaders alike with new perspectives on meaningful living.     

药理学实验课融合课程思政的实践探索

药理学是一门医学专业的基础课程,药理学实验课在药理学教学中具有重要地位。通过实验教学,旨在使学生掌握基础的实验技能,加深对理论知识的理解,同时培养学生对科学严肃的工作态度和实事求是的工作作风、为毕业后从事科研或临床工作奠定基础。为实现专业课程和思政课程同向同行,形成协同效应,我们在药理学实验授课中进行了课程思政教学改革。在提升授课教师思想政治素质、挖掘蕴含于教学环节中的思政元素、创新考核模式和做好评教工作的基础上,探索课程思政在药理学实验课教学上的实施途径,旨在将药理学实验课建设成既传授专业知识技能,又培养学生高度的社会责任感、良好的人文素养和职业道德的好课。     

How undifferentiated arthritis evolves into chronic arthritis

Undifferentiated arthritis (UA) is a frequently occurring clinical presentation with a variable outcome. While some forms of UA will spontaneously remit, other forms will progress to chronic arthritis; an outcome that would preferably be prevented.Which immunological factors are normally at the basis of resolution of inflammation, and what, on the other hand, causes inflammation to persist? This review provides an overview of the immunological mechanisms involved in these two scenarios, including specific examples of how these mechanisms apply, or can be influenced in rheumatic diseases.Furthermore, what do we know about risk factors for chronic arthritis, such as the development of autoantibodies? The recent years have provided many insights concerning risk factors for autoantibody-positive versus autoantibody-negative rheumatoid arthritis, which are discussed along with a possible pathophysiological model incorporating autoantibodies into the larger process of disease development. Finally, the evolution of the autoantibody response over time is described.