To provide information about arginine, its metabolism, and its role in acute and chronic wound healing, to assist providers in understanding the recommendations for arginine supplementation.
This ...continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
After participating in this educational activity, the participant will:1. Describe the characteristics of arginine.2. Choose the metabolic processes that define arginine's role in wound healing.3. Identify the average daily intake of arginine in an American diet.4. Select the evidence that demonstrates the effectiveness of arginine supplementation for wound healing.
Nutrition has an important and integral role in wound healing. Arginine, a type of indispensable amino acid, has long been thought to have wound healing properties. The 2019 international guideline by the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance recommends use of a high-protein, high-calorie oral nutrition supplement fortified with arginine and other antioxidants to treat adults with stage 2 or greater pressure injury and who are malnourished or at risk of malnutrition to foster healing. This article provides necessary background on this conditionally indispensable amino acid, its metabolism, and its role in acute and chronic wound healing to assist providers in understanding the recommendation for arginine supplementation.
Chu et al question the use of Odom et al of albumin as a nutrition assessment marker in a retrospective cohort study that addresses the pediatric population, which is truly a vulnerable population in ...regard to pressure injuries. Historically, hepatic proteins such as albumin, prealbumin, and transferrin have been linked to nutrition status. However, recent published research, review articles, and editorials show that serum levels of these hepatic proteins correlate with morbidity and mortality rather than nutrition status. Given advances in nutrition science, the following parameters to assess nutrition status are suggested instead: involuntary weight loss, muscle mass loss, subcutaneous fat loss, insufficient energy intake, fluid accumulation, and reduced handgrip strength.
Acute Skin Failure in the Critical Care Patient Delmore, Barbara; Cox, Jill; Smith, Daniel ...
Advances in skin & wound care,
2020-April, 2020-Apr, 2020-4-00, 20200401, Letnik:
33, Številka:
4
Journal Article
Recenzirano
OBJECTIVEThe purpose of this research was to build on previous work regarding predictive factors of acute skin failure (ASF) in the critically ill population.
METHODSResearchers conducted a ...retrospective case-control study with a main and validation analysis. Data were extracted from the New York Statewide Planning and Research Cooperative System. For the main analysis, there were 415 cases with a hospital-acquired pressure injury (HAPI) and 194,872 controls without. Researchers then randomly selected 100 cases with a HAPIs and 300 controls without for the validation analysis. A step-up logistic regression model was used. Researchers generated receiver operating characteristic curves for both the main and validation analyses, assessing the overall utility of the regression model.
RESULTSEleven variables were significantly and independently related to ASFrenal failure (odds ratio OR, 1.4, P = .003), respiratory failure (OR, 2.2; P = < .001), arterial disease (OR, 2.4; P = .001), impaired nutrition (OR, 2.3; P = < .001), sepsis (OR, 2.2; P = < .001), septic shock (OR, 2.3; P = < .001), mechanical ventilation (OR, 2.5; P = < .001), vascular surgery (OR, 2.2; P = .02), orthopedic surgery (OR, 3.4; P = < .001), peripheral necrosis (OR, 2.5; P = .003), and general surgery (OR, 3.8; P = < .001). The areas under the curve for the main and validation analyses were 0.864 and 0.861, respectively.
CONCLUSIONSThe final model supports previous work and is consistent with the current definition of ASF in the setting of critical illness.
The comprehensive multiplatform genomics data generated by The Cancer Genome Atlas (TCGA) Research Network is an enabling resource for cancer research. It includes an unprecedented amount of microRNA ...sequence data: ~11 000 libraries across 33 cancer types. Combined with initiatives like the National Cancer Institute Genomics Cloud Pilots, such data resources will make intensive analysis of large-scale cancer genomics data widely accessible. To support such initiatives, and to enable comparison of TCGA microRNA data to data from other projects, we describe the process that we developed and used to generate the microRNA sequence data, from library construction through to submission of data to repositories. In the context of this process, we describe the computational pipeline that we used to characterize microRNA expression across large patient cohorts.
PURPOSE:The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients.
TARGET ...AUDIENCE:This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
OBJECTIVES:After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF.
ABSTRACTTo develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories(1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio OR, 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners—the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidence-based practice to patients.
OBJECTIVETo replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient ...population.
METHODSResearchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression modelʼs ability to predict HPI development.
RESULTSSeven variables were significant and independent predictors associated with HPIsdiabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model.
CONCLUSIONSBeyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.
GENERAL PURPOSETo provide information on obesity, bariatric surgery, and the nutrient deficiency-related dermatoses that may result from these surgeries.
TARGET AUDIENCEThis continuing education ...activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMESAfter participating in this educational activity, the participant should be better able to:1. Examine issues related to obesity and bariatric surgery.2. Identify the sources and role of specific nutrients.3. Recognize the clinical signs and symptoms of nutrient deficiency following bariatric surgery.
ABSTRACTObesity is a global epidemic that increases the risk of weight-related comorbidities in modern society. It is complex, multifactorial, and largely preventable. Noninvasive treatments for obesity include diet, exercise, and medication. However, bariatric surgeries are becoming popular procedures for those who do not achieve success with noninvasive weight management treatment. Bariatric surgeries often result in dietary restriction and/or malabsorption, which lead to drastic weight loss. Individuals who had bariatric surgeries need lifelong follow-up and monitoring to ensure adequate intake of nutrients. Nutrient deficiencies can ensue when long-term vitamin and mineral supplementation is not followed. Severe nutrient deficiencies may lead to dermatoses that can be corrected by nutrient repletion and careful monitoring. A case report of nutrient deficiency-related dermatoses is followed by a review of obesity and its treatments with a focus on bariatric surgeries.
The Epstein-Barr virus (EBV)-positive subtype of gastric adenocarcinoma is conventionally identified by in situ hybridization (ISH) for viral nucleic acids, but next-generation sequencing represents ...a potential alternative. We therefore determined normalized EBV read counts by whole-genome, whole-exome, mRNA and miRNA sequencing for 295 fresh-frozen gastric tumor samples. Formalin-fixed, paraffin-embedded tissue sections were retrieved for ISH confirmation of 13 high-EBV and 11 low-EBV cases. In pairwise comparisons, individual samples were either concordantly high or concordantly low by all genomic methods for which data were available. Empiric cutoffs of sequencing counts identified 26 (9 %) tumors as EBV positive. EBV positivity or negativity by molecular testing was confirmed by EBER-ISH in all but one tumor evaluated by both approaches (kappa = 0.91). EBV-positive gastric tumors can be accurately identified by quantifying viral sequences in genomic data. Simultaneous analyses of human and viral DNA, mRNA and miRNA could streamline tumor profiling for clinical care and research.
Ovarian cancer presents as an aggressive, advanced stage cancer with widespread metastases that depend primarily on multicellular spheroids in the peritoneal fluid. To identify new druggable pathways ...related to metastatic progression and spheroid formation, we integrated microRNA and mRNA sequencing data from 293 tumors from The Cancer Genome Atlas (TCGA) ovarian cancer cohort. We identified miR-509-3p as a clinically significant microRNA that is more abundant in patients with favorable survival in both the TCGA cohort (P = 2.3E-3), and, by in situ hybridization (ISH), in an independent cohort of 157 tumors (P < 1.0E-3). We found that miR-509-3p attenuated migration and disrupted multi-cellular spheroids in HEYA8, OVCAR8, SKOV3, OVCAR3, OVCAR4 and OVCAR5 cell lines. Consistent with disrupted spheroid formation, in TCGA data miR-509-3p's most strongly anti-correlated predicted targets were enriched in components of the extracellular matrix (ECM). We validated the Hippo pathway effector YAP1 as a direct miR-509-3p target. We showed that siRNA to YAP1 replicated 90% of miR-509-3p-mediated migration attenuation in OVCAR8, which contained high levels of YAP1 protein, but not in the other cell lines, in which levels of this protein were moderate to low. Our data suggest that the miR-509-3p/YAP1 axis may be a new druggable target in cancers with high YAP1, and we propose that therapeutically targeting the miR-509-3p/YAP1/ECM axis may disrupt early steps in multi-cellular spheroid formation, and so inhibit metastasis in epithelial ovarian cancer and potentially in other cancers.
Solid organ transplant is increasing globally. According to Kidney Research UK, around 5000 people in the UK are on the waiting list for a kidney and this is only increasing. Improved ...immunosuppression therapy and general management of transplanted patients mean their survival has improved. It will get more common for these patients to require input from a non-transplant centres. There are nuances of transplant patients which non-transplant anaesthetists and intensivists may not be aware of. A good understanding of some of these complexities are crucial to optimizing perioperative care and outcome.
PDF
