Radial approach to right heart catheterization: early experience with a promising technique.

Transradial cardiac catheterization has been historically limited to arterial catheterization. Using small-diameter introducers and catheters, a technique of combined right and left heart catheterization is described using both the radial artery and its neighboring vein. Evaluation of 55 sequential right and left heart procedures showed that it could be accomplished in > 50% using venous access in the forearm. This approach has many potential advantages, although the ability to access routinely both venous and arterial vessels at the level of the wrist is unclear.     

Characteristics of, and risk factors for, infections in patients with cancer treated with dasatinib and a brief review of other complications

Dasatinib has transformed the treatment of chronic myelogenous leukemia, resulting in durable remissions and prolonged survival. The spectrum of infectious complications during and after dasatinib therapy is not known. Retrospective analysis of records among 69 patients treated with dasatinib showed that 35 (51%) developed 57 episodes of infection. Twenty-nine (51%) episodes occurred during neutropenia, and 25 (44%) were microbiologically confirmed. Compared with patients who did not develop infection with dasatinib therapy, patients with infection were significantly more likely to have acute lymphocytic leukemia (51% vs. 18%; p ≤ 0.005) and to have received high-dose corticosteroids (51% vs. 26%; p ≤ 0.05). Patients with infection were also more likely to have received dasatinib with another antineoplastic agent (57% vs. 35% without infection; p = 0.09). On multivariate analysis, treatment with three or more cycles of dasatinib increased the risk of infection (odds ratio 11.7; 95% confidence interval 2.5-54.3; p = 0.002). The presence of comorbidities tended to increase the risk of infection (odds ratio 3.9; 95% confidence interval 0.9-17.9; p = 0.07). Interestingly, viral infections, including a single case of cytomegalovirus colitis, were uncommon (7%). The rate of death in 57 patients during follow-up was non-significantly higher in patients with infection versus those without infection (35% vs. 18%; p = 0.18). Infection-associated deaths were noted in only two patients (10%) who had an infection and died. The results of our analysis suggest that antibacterial prophylaxis is important in patients who develop neutropenia during dasatinib therapy, although routine antifungal and anti-cytomegalovirus prophylaxis may not be necessary.     

The EAHAD blood coagulation factor VII variant database

Hereditary blood coagulation factor VII (FVII) deficiency is a rare autosomal recessive bleeding disorder resulting from variants in the gene encoding FVII (F7). Integration of genetic variation with functional consequences on protein function is essential for the interpretation of the pathogenicity of novel variants. Here, we describe the integration of previous locus‐specific databases for F7 into a single curated database with enhanced features. The database provides access to in silico analyses that may be useful in the prediction of variant pathogenicity as well as cross‐species sequence alignments, structural information, and functional and clinical severity described for each variant, where appropriate. The variant data is shared with the F7 Leiden Open Variation Database. The updated database now includes 221 unique variants, representing gene variants identified in 728 individuals. Single nucleotide variants are the most common type (88%) with missense representing 74% of these variants. A number of variants are found with relatively high minor allele frequencies that are not pathogenic but contribute significantly to the likely pathogenicity of coinherited variants due to their effect on FVII plasma levels. This comprehensive collection of curated information significantly aids the assessment of pathogenicity.     

Allosteric Modulation of GABAA Receptor Subtypes: Effects on Visual Recognition and Visuospatial Working Memory in Rhesus Monkeys

Non-selective positive allosteric modulators (PAMs) of GABA_A receptors (GABA_ARs) are known to impair anterograde memory. The role of the various GABA_AR subtypes in the memory-impairing effects of non-selective GABA_AR PAMs has not been fully elucidated. The current study assessed, in rhesus monkeys, effects of modulation of α1, α2/3, and α5GABA_ARs on visual recognition and spatial working memory using delayed matching-to-sample (DMTS) and self-ordered spatial search (SOSS) procedures, respectively. The DMTS procedure (n=8) involved selecting a previously presented ‘sample'' image from a set of multiple images presented after a delay. The SOSS procedure (n=6) involved touching a number of boxes without repeats. The non-selective GABA_AR PAM triazolam and the α1GABA_A preferential PAMS zolpidem and zaleplon reduced accuracy in both procedures, whereas the α5GABA_A preferential PAMs SH-053-2′F-R-CH₃ and SH-053-2′F-S-CH₃, and the α2/3GABA_A preferential PAM TPA023B were without effects on accuracy or trial completion. The low-efficacy α5GABA_AR negative allosteric modulator (NAM) PWZ-029 slightly increased only DMTS accuracy, whereas the high-efficacy α5GABA_AR NAMs RY-23 and RY-24 did not affect accuracy under either procedure. Finally, the slopes of the accuracy dose-effect curves for triazolam, zolpidem, and zaleplon increased with box number in the SOSS procedure, but were equivalent across DMTS delays. The present results suggest that (1) α1GABA_ARs, compared with α2/3 and α5GABA_ARs, are primarily involved in the impairment, by non-selective GABA_AR PAMs, of visual recognition and visuospatial working memory in nonhuman primates; and (2) relative cognitive impairment produced by positive modulation of GABA_ARs increases with number of locations to be remembered, but not with the delay for remembering.     

The effect of body mass index on surgical outcomes and survival following pelvic exenteration

Objective

We sought to evaluate whether preoperative body mass index (BMI) impacts surgical outcomes, complication rates, and/or recurrence rates in women undergoing pelvic exenteration.

Methods

All women who underwent pelvic exenteration for gynecologic indications at our institution from 1993 through 2010 were included. Women were stratified into 3 groups based on BMI. Baseline characteristics, surgical outcomes, early (< 60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were collected. Multivariate logistic regression analyses were performed. Kaplan-Meier survival curves were compared using log-rank test.

Results

161 patients were included (59 normal weight, 44 overweight, 58 obese). Median follow-up times were 22, 29, and 25 months. Most patients underwent total pelvic exenteration (68%); 64.6% had a vaginal reconstruction. On multivariate analysis, both overweight and obese patients had a higher risk of early superficial wound separation compared to normal weight patients — OR 10.74 (3.33-34.62, p < 0.001) and OR 4.35 (1.40-13.52, p = 0.011), respectively. Length of surgery was significantly longer for overweight (9.6 h, OR 1.26, 1.02-1.55, p = 0.032) and obese (10.1 h, OR 1.24, 1.04-1.47, p = 0.014) patients than for normal weight patients (8.7 h). Late postoperative complications for patients in the normal weight, overweight, and obese groups were 47.5%, 45.5%, and 43.1% (p = 0.144). There were no differences in time to recurrence (p = 0.752) or overall survival (p = 0.103) between groups.

Conclusion

Although operative times were longer and risk for superficial wound separation was significantly higher, pelvic exenteration appears to be feasible and safe in overweight and obese women with overall complication rates and survival outcomes comparable to normal weight women.     

The use of self-report measures to examine changes in perception in response to fittings using different signal processing parameters

Abstract

Clinicians have long used self-report methods to assess hearing aid benefit. However, there are fewer data as to whether self-report instruments can be used to compare differences between signal processing settings. This study examined how self-perceived performance varied as a function of modifications in signal processing using two self-report measures. Data were collected as part of a double-blind randomised crossover clinical trial. Participants were fit with two fittings: mild processing (slow time constants, disabled frequency lowering) and strong processing (fast time constants, frequency lowering enabled). The speech, spatial, and qualities of hearing (SSQ) questionnaire and the Effectiveness of Auditory Rehabilitation (EAR) questionnaire were collected at multiple time points. Older adults with sensorineural hearing loss who had not used hearing aids within the previous year participated (49 older adults were consented; 40 were included in the final data analyses). Findings show that listeners report a difference in perceived performance when hearing aid features are modified. Both self-report measures were able to capture this change in perceived performance. Self-report measures provide a tool for capturing changes in perceived performance when hearing aid processing features are modified and may enhance provision of an evidence-based hearing aid fitting.