Hypoplastic left heart syndrome with anomalous origin of left coronary artery from the right pulmonary artery: successful surgical treatment in a neonate.

Anomalous origin of the left coronary artery from the right pulmonary artery in association with hypoplastic left heart syndrome is a rare congenital anomaly. We describe a successful simultaneous surgery for both anomalies during the first stage palliation in a neonate.     

No association between the Pro197Leu polymorphism in the glutathione peroxidase (GPX1) gene and schizophrenia

OBJECTIVE: Oxidative stress such as free radical-mediated neuronal dysfunction may be involved in the pathophysiology of schizophrenia. The human glutathione peroxidase (GPX1) is a selenium-dependent enzyme, which plays an important role in the detoxification of free radicals. We therefore hypothesized that the GPX1 gene, which is located on chromosome 3p21.3, may be involved in the pathophysiology of schizophrenia. The aim of this study is to examine whether a potentially functional polymorphism, a proline (Pro) to leucine (Leu) substitution at codon 197 (Pro197Leu) of the human GPX1 gene, is associated with susceptibility to schizophrenia. METHODS: We genotyped the Pro197Leu polymorphism in a total of 113 nuclear families that had a proband with schizophrenia. Genetic association was tested using the transmission disequilibrium test (TDT), the sib transmission disequilibrium test (STDT), and the family-based association test (FBAT). RESULTS: The minor allele (Leu) frequency was calculated to be 0.282. We could not find significant transmission disequilibrium of the alleles for the Pro197Leu polymorphism in the GPX1 gene in association with the presence of schizophrenia in our family sample (TDT, chi2=0.03, degrees of freedom=1, P=0.86; combined TDT-STDT, Z'=-0.052, P=0.47; FBAT, Z=0.000, P=1.000). CONCLUSION: The results of this study suggest that the GPX1 polymorphism is unlikely to be associated with susceptibility to schizophrenia.     

Optical penalization can improve vision after occlusion treatment

BACKGROUND: Optical penalization (OP) has previously been shown to successfully maintain vision in amblyopic eyes of older children when patching compliance is poor and when vision decreases once patching is discontinued. This study shows that the final vision in optically penalized eyes is often better than the vision obtained after patching alone. SUBJECTS AND METHODS: During the 5-year period from January 1992 to February 1997, 28 children aged between 3.7 and 8.2 years (average age, 6.5+/-1.1 years) were optically penalized for an average of 1.5+/-0.75 years. The maximum length of penalization was 3.3 years, whereas the minimum time was 6 months. There were 21 children with strabismic amblyopia and 7 children with anisometropic amblyopia. All 28 children had worn a patch to achieve their best visual levels and then had shown a loss of best vision when occlusion was stopped. Patching was usually resumed and continued until the previous best vision was obtained; at this point OP was started to "maintain" vision. Eighteen of the 28 children have discontinued penalization and have been followed up an average of 1(1/2) years. RESULTS: Twenty-six (93%) of the 28 patients showed an increase in best vision from that found at the conclusion of patching, and 2 patients maintained their vision at the initial level. The average visual acuity at the start of penalization was 20/50 (0.42+/-0.11 logarithm of the minimum angle of resolution [log MAR]). Final average visual acuity was 20/27 (0.15+/-0.12 log MAR). The average increase in vision was nearly 3 lines or 0.27+/-0.12 log MAR. CONCLUSION: OP alone (without the use of pharmacologic agents such as atropine) not only maintains vision after patching therapy, but also appears to improve the final visual outcome.     

盐酸特拉唑嗪胶囊的稳定性研究

目的：考察盐酸特拉唑嗪胶囊的稳定性。方法：通过影响因素(强光照射、高温、高温)，加速和留样考察实验，以含量为测定指标，考察胶囊的含量变化。结果：在温度40℃、60℃、光照3500LX及RH75％等因素影响下，胶囊的含量无明显变化。结论：在25℃时，通过经典恒温加速试验推测盐酸特拉唑嗪胶囊的失效期为2年。     

Too Big to Fail: Successful Resection of a Large Hepatocellular Carcinoma with Portal Tumor Thrombus

Digestive Diseases and Sciences -     

Hospital Strategy Uptake and Reductions in Unplanned Readmission Rates for Patients with Heart Failure: A Prospective Study

BACKGROUND

Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR).

OBJECTIVE

We examined associations between the change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies over 12–18 months in a national sample of hospitals.

DESIGN

We conducted a prospective study of hospitals using a Web-based survey at baseline (November 2010–May 2011, n = 599, 91.0 % response rate) and 12–18 months later (November 2011–October 2012, n = 501, 83.6 % response rate), with RSRR measured at the same time points. The final analytic sample included 478 hospitals.

PARTICIPANTS

The study included hospitals participating in the Hospital-to-Home (H2H) and State Action on Avoidable Rehospitalizations (STAAR) initiatives.

MAIN MEASURES

We examined associations between change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies previously demonstrated to have increased between baseline and follow-up, using unadjusted and adjusted linear regression.

KEY RESULTS

The average number of strategies taken up from baseline to follow-up was 1.6 (SE = 0.06); approximately one-quarter (25.3 %) of hospitals took up at least three new strategies. Hospitals that adopted the strategy of routinely discharging patients with a follow-up appointment already scheduled experienced significant reductions in RSRR (reduction of 0.63 percentage point, p value < 0.05). Hospitals that took up three or more strategies had significantly greater reductions in RSRR compared to hospitals that took up only zero to two strategies (reduction of 1.29 versus 0.57 percentage point, p value < 0.05). Among the 117 hospitals that took up three or more strategies, 93 unique combinations of strategies were used.

CONCLUSIONS

Although most individual strategies were not associated with RSRR reduction, hospitals that took up any three or more strategies showed significantly greater reduction in RSRR compared to hospitals that took up fewer than three strategies.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-014-3105-5) contains supplementary material, which is available to authorized users.KEY WORDS: readmissions, quality improvement, heart failure, discharge     

Epstein-Barr viral load as a marker of lymphoma in AIDS patients

Epstein-Barr virus (EBV) is implicated in the pathogenesis of acquired immunodeficiency syndrome (AIDS) lymphoma, and viral DNA is present within the malignant cells in about half of affected patients. We examined the extent to which EBV viral load is elevated in the plasma of AIDS lymphoma patients compared to AIDS patients with opportunistic infections. Sixty-one AIDS patients were studied including 35 with lymphoma (24 non-Hodgkin, six Hodgkin, and five brain lymphoma) and 26 with various opportunistic infections. In situ hybridization revealed EBV encoded RNA (EBER) expression in the malignant cells of 17/28 AIDS lymphomas (61%). In 232 serial plasma samples from 35 lymphoma patients and in 128 samples from AIDS controls, EBV viral load was assayed by quantitative-polymerase chain reaction (Q-PCR) using a TaqMan probe targeting the BamH1W sequence. EBV was detected in plasma from all 17 EBER-positive AIDS lymphoma patients, with viral loads ranging from 34 to 1,500,000 copies per ml (median 3,210). Viral load usually fell rapidly upon initiation of lymphoma therapy and remained undetectable except in two patients with persistent tumor. In 11 AIDS patients, whose lymphoma lacked EBER expression, and in 26 control patients without lymphoma, levels of EBV in plasma were usually low or undetectable (range 0-1,995 and 0-2,409, median 0 and 0, respectively). There was no association between EBV viral load and human immunodeficiency virus (HIV) load or CD4 count. In conclusion, EBV viral load shows promise as a tool to assist in diagnosis and management of EBV-related lymphoma patients.     

Synergistic postprandial blood glucose modulatory properties of Vernonia amygdalina (Del.), Gongronema latifolium (Benth.) and Occimum gratissimum (Linn.) aqueous decoctions

Ethnopharmacological relevance

Traditional healers in Nigeria use a combination of decoctions from green leafy vegetables in their blood glucose (BG) lowering recipes. Three plants Vernonia amygdalina (Del.) (VA), Gongronema latifolium (Benth.) (GL) and Occimum gratissimum (Linn.) (OG) are found consistently in such recipes. Whereas the anti-diabetic properties of extracts of these plants have been reported in animal models, little is known about the effects of their aqueous decoctions (singly or in combinations) on oral glucose tolerance (OGT) in humans.

Materials and methods

Twenty seven subjects were recruited and (on separate days) were given 150 mL of water, VA, GL and OG decoctions or blends of the decoctions to drink 45 min before a 2-h OGTT. Their OGTT curves were plotted and areas under the curves (AUCs) calculated.

Results

The results show that each of the three decoctions neither altered the peak time of the OGTT nor significantly (P>0.05) reduced the BG concentrations (BGCs) at any time point on the test curves relative to the baseline. VA, OG and GL gave 0.4, 0.2 and 2.8% reductions in the AUCs, respectively, relative to the baseline. Blending GL and VA did not improve the results. However, a decoction containing the three vegetables in equal proportions significantly reduced the BGCs at 90 (96.8±9.5 vs. 107.1±10.2 mg/dL; P=0.041) and 120 (92.8±14.3 vs. 102.5±12.1 mg/dL; P=0.037) minutes relative to the baseline, and gave better reductions in the AUCs (4.1%).

Conclusion

The decoction containing the three vegetables was found to be superior in activity to any 1, or blends of only 2, of the 3 decoctions. This is a case of positive synergism, and justifies the use of these plants in ethnopharmacological BG lowering recipes.     

Azadirachta indica extract–artesunic acid combination produces an increased cure rate of Plasmodium berghei-infected mice

Context: Available artemisinin-combination therapies (ACTs) are expensive. Various traditional herbal remedies for malaria involve plants, proven scientifically to have antiplasmodial effects, e.g., Azadirachta indica A. Juss. (Meliaceae).

Objective: Combination of an artemisinin-based compound and a medicinal herb extract will provide an indigenous alternative/herb-based ACT.

Materials and methods: The in vivo schizontocidal activity of the crude aqueous extract of 100, 500, and 1000?mg/kg of A. indica fresh leaves (NCE) and 6, 15, and 20?mg/kg of artesunic acid were determined, alone and in combination, while keeping the dose of artesunic acid constant at 15?mg/kg, using the Peter’s 4-day suppressive test and Swiss albino mice. The ED₅₀ was calculated from the dose-response relationships. Percentage survival and cure were also determined.

Results: The average yield of two extractions of NCE was 8.33?±?1.67%. Combination of 1000?mg/kg of NCE and 15?mg/kg of artesunic acid, produced a significant reduction of parasitemia (96.87%), compared to 20?mg/kg of artesunic acid alone (68.14%). The combination had an ED₅₀ of 0.58?mg/kg while that of artesunic acid alone was 8.814?mg/kg. The combinations of NCE with artesunic acid produced a cure, although the artesunic acid did not produce a cure in 30?d.

Discussion: NCE increased the activity of artesunic acid in terms of reduction in parasitemia, and increased survival time and cure rate.

Conclusion: The combination of an artemisinin and aqueous extract of neem leaf is possible, providing a potentiated reduction of parasitemia, and increased cure rate.