Copycat Dietz, Brett W; Winston, Lisa G; Koehler, Jane E ...
The New England journal of medicine,
11/2021, Volume:
385, Issue:
19
Journal Article, Conference Proceeding
Peer reviewed
A 75-year-old man with a history of an untreated hepatitis C virus infection presented with a 4-day history of a pruritic rash on his lower legs. He noted generalized malaise and an unintentional ...weight loss of 7 kg over the past 2 months. A video showing aortic vegetation is available at NEJM.org.
Nerve growth factor (NGF) is a neurotrophin that mediates pain sensitization in pathologic states, including osteoarthritis. In clinical trials, antibodies to NGF reduce pain and improve physical ...function due to osteoarthritis of the knee or hip and have a long duration of action. Rapidly progressive osteoarthritis is a dose-dependent adverse event with these agents, and additional joint safety signals, such as subchondral insufficiency fractures and increased rates of total joint replacement, are reported. The effects on pain and potential mechanisms behind these joint events both are of considerable importance in the consideration of future use of anti-NGF therapies for osteoarthritis.
Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those ...readmitted remains largely unknown.
Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death.
Retrospective cohort study.
A total of 17,716 30-day readmissions in an academic health system.
We used mixed-effects multivariable logistic regression models to identify risk factors associated with the primary outcome, in-hospital death, or transition to hospice during 30-day readmissions.
Of 17,716 30-day readmissions, 1144 readmissions resulted in death or transition to hospice care (6.5%). Risk factors identified included: age, burden, and type of comorbid conditions, recent hospitalizations, nonelective index admission type, outside hospital transfer, low discharge hemoglobin, low discharge sodium, high discharge red blood cell distribution width, and disposition to a setting other than home. Sepsis (OR=1.33; 95% CI, 1.02-1.72; P=0.03) and shock (OR=1.78; 95% CI, 1.22-2.58; P=0.002) during the index admission were associated with the primary outcome, and in-hospital mortality specifically. In patients who died, infection was the primary cause for readmission in 51.6% of readmissions after sepsis and 28.6% of readmissions after a nonsepsis hospitalization (P=0.009).
We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.
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Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation ...of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP) and N-terminal prohormone (NT-proBNP), mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases.
Dyspnea is a common chief complaint in the emergency department, with over 4 million visits annually in the US. Establishing the correct diagnosis can be challenging, because the subjective sensation ...of dyspnea can result from a wide array of underlying pathology, including pulmonary, cardiac, neurologic, psychiatric, toxic, and metabolic disorders. Further, the presence of dyspnea is linked with increased mortality in a variety of conditions, and misdiagnosis of the cause of dyspnea leads to poor patient-level outcomes. In combination with the history and physical, efficient, and focused use of laboratory studies, the various cardiopulmonary biomarkers can be useful in establishing the correct diagnosis and guiding treatment decisions in a timely manner. Use and interpretation of such tests must be guided by the clinical context, as well as an understanding of the current evidence supporting their use. This review discusses current standards and research regarding the use of established and emerging cardiopulmonary laboratory markers in the evaluation of acute dyspnea, focusing on recent evidence assessing the diagnostic and prognostic utility of various tests. These markers include brain natriuretic peptide (BNP) and N-terminal prohormone (NT-proBNP), mid-regional peptides proatrial NP and proadrenomedullin, cardiac troponins, D-dimer, soluble ST2, and galectin 3, and included is a discussion on the use of arterial and venous blood gases. Keywords: cardiopulmonary, emergency, heart failure, troponin, BNP, galectin 3, MR-proANP, MR-proADM
Metastatic progression defines the final stages of tumor evolution and underlies the majority of cancer-related deaths. The heterogeneity in disseminated tumor cell populations capable of seeding and ...growing in distant organ sites contributes to the development of treatment resistant disease. We recently reported the identification of a novel tumor-derived cell population, circulating hybrid cells (CHCs), harboring attributes from both macrophages and neoplastic cells, including functional characteristics important to metastatic spread. These disseminated hybrids outnumber conventionally defined circulating tumor cells (CTCs) in cancer patients. It is unknown if CHCs represent a generalized cancer mechanism for cell dissemination, or if this population is relevant to the metastatic cascade. Herein, we detect CHCs in the peripheral blood of patients with cancer in myriad disease sites encompassing epithelial and non-epithelial malignancies. Further, we demonstrate that in vivo-derived hybrid cells harbor tumor-initiating capacity in murine cancer models and that CHCs from human breast cancer patients express stem cell antigens, features consistent with the potential to seed and grow at metastatic sites. Finally, we reveal heterogeneity of CHC phenotypes reflect key tumor features, including oncogenic mutations and functional protein expression. Importantly, this novel population of disseminated neoplastic cells opens a new area in cancer biology and renewed opportunity for battling metastatic disease.
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Rhizosphere interactions are affected by many different regulatory signals. As yet, however, only a few have been identified. Signals, by definition, contain information, react with a receptor, and ...elicit a response. Signals may thus represent the highest level of evolved response in rhizosphere communities and, in that sense, occupy a supreme control point. At the same time, some signals may function as modulators of downstream responses, rather than on/off switches. To assess these possibilities, several interactions between plants and soil organisms are described, starting with the molecular interactions between leguminous plants and symbiotic bacteria of the family Rhizobiaceae, one of the best-characterized plant-microbe associations in the rhizosphere. We then examine other interactions between plants and soil organisms for overlap and/or connections with the rhizosphere signals utilized in the legume-Rhizobium symbiosis. Whether information currently available reflects the interaction of the organisms in nature or only in the laboratory has not always been determined. Thus, the key ecological issue of how important some of the signals are under field conditions remains to be addressed. Molecular tools now available make this task less daunting than in the past, and thus a new age of experimental field ecology may soon burst forth in rhizosphere studies. By identifying the signals, receptors, and the critical control points, we can better understand the organismal dynamics in this key belowground ecosystem.
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BFBNIB, FZAB, GIS, IJS, INZLJ, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK, ZRSKP
We investigated the ability of the meadow vole, Microtus pennsylvanicus, to produce tannin-binding salivary proteins when fed quebracho tannin-containing diets or when injected with the drug ...isoproterenol. None of the treatments induced production of new salivary proteins. None of the salivary proteins from voles bound tannin in vitro, and none of the proteins in vole saliva reacted with antibodies to tannin-binding proteins from saliva of rats. Diets containing 2.9% crude quebracho tannin had no effect on growth or survival of voles. Voles consuming diets containing 6% crude quebracho tannin had increased rates of loss of body mass and mortality and decreased rates of food consumption early in the trial, but began to accommodate to the diet by the end of the 10-day trial. Voles fed diets containing 6% tannin prepared by moistening and heating a mixture of lab chow and quebracho tannin had significantly higher rates of mortality than voles fed 6% tannin added directly to dry chow. Nitrogen, dry matter, and caloric digestibilities did not differ significantly among treatments.
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