Tracheocarotid Fistula Fortson, James K.; Su, Roger; Patel, Vijaykumar G. ...
The American surgeon,
09/2016, Letnik:
82, Številka:
9
Journal Article
Recenzirano
The artery involved in the tracheoarterial fistula can either be left to maintain its blood flow by patch closure with an autologous tissue (sternocleidomastoid patches or pericardial graft) or ...replacement with a venous graft. in our case, a saphenous vein graft was used. Risk factors for development of tracheoarterial fistula include chronic vascular inflammation, low-placed tracheostomy tube, and high cuff pressures leading to pressure necrosis, malpositioned cannula tip, and prolonged intubation. immediate control of the bleed and maintenance of oxygenation must be followed by angiography to identify the bleeding site.
Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been ...characterized in the EB patient population.
To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications.
English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects.
Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0-10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%).
CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs.
Agricultural intensification is a leading cause of global biodiversity loss, which can reduce the provisioning of ecosystem services in managed ecosystems. Organic farming and plant diversification ...are farm management schemes that may mitigate potential ecological harm by increasing species richness and boosting related ecosystem services to agroecosystems. What remains unclear is the extent to which farm management schemes affect biodiversity components other than species richness, and whether impacts differ across spatial scales and landscape contexts. Using a global metadataset, we quantified the effects of organic farming and plant diversification on abundance, local diversity (communities within fields), and regional diversity (communities across fields) of arthropod pollinators, predators, herbivores, and detritivores. Both organic farming and higher in‐field plant diversity enhanced arthropod abundance, particularly for rare taxa. This resulted in increased richness but decreased evenness. While these responses were stronger at local relative to regional scales, richness and abundance increased at both scales, and richness on farms embedded in complex relative to simple landscapes. Overall, both organic farming and in‐field plant diversification exerted the strongest effects on pollinators and predators, suggesting these management schemes can facilitate ecosystem service providers without augmenting herbivore (pest) populations. Our results suggest that organic farming and plant diversification promote diverse arthropod metacommunities that may provide temporal and spatial stability of ecosystem service provisioning. Conserving diverse plant and arthropod communities in farming systems therefore requires sustainable practices that operate both within fields and across landscapes.
Organic farming and on‐farm plant diversification can reduce biodiversity loss and boost‐related ecosystem services like pollination and pest control. Using a global dataset, we found that both management schemes enhanced richness at local and regional scales, mainly by promoting rare taxa that are critical for ecosystem resilience. Positive effects were greatest for two groups of beneficial insects: pollinators and predators. We also found stronger impacts of farm management for fields embedded in complex landscapes.
Aims
Borderline personality disorder (BPD) is characterized by self‐regulation deficits, including impulsivity and affective lability. Transference‐focused psychotherapy (TFP) is an evidence‐based ...treatment proven to reduce symptoms across multiple cognitive–emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP.
Methods
BPD subjects (n = 10) were scanned pre‐ and post‐TFP treatment using a within‐subjects design. A disorder‐specific emotional–linguistic go/no‐go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control.
Results
Analyses demonstrated significant treatment‐related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior‐medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post‐treatment improvements in constraint were predicted by pre‐treatment right dorsal anterior cingulate cortex hypoactivation, and pre‐treatment left posterior‐medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability.
Conclusions
These preliminary findings demonstrate potential TFP‐associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy.
Ebola virus disease in humans is highly lethal, with case fatality rates ranging from 25 to 90%. There is no licensed treatment or vaccine against the virus, underscoring the need for efficacious ...countermeasures. We ascertained that a human survivor of the 1995 Kikwit Ebola virus disease outbreak maintained circulating antibodies against the Ebola virus surface glycoprotein for more than a decade after infection. From this survivor we isolated monoclonal antibodies (mAbs) that neutralize recent and previous outbreak variants of Ebola virus and mediate antibody-dependent cell-mediated cytotoxicity in vitro. Strikingly, monotherapy with mAb114 protected macaques when given as late as 5 days after challenge. Treatment with a single human mAb suggests that a simplified therapeutic strategy for human Ebola infection may be possible.
The burden of leptospirosis in Puerto Rico remains unclear due to underreporting.
A cross-sectional survey and rodent trapping was performed in a community within San Juan, Puerto Rico to determine ...the seroprevalence and risk factors for Leptospira infection. The microscopic agglutination test was used to detect anti-Leptospira antibodies as a marker of previous infection. We evaluated Leptospira carriage by quantitative polymerase chain reaction among rodents trapped at the community site.
Of 202 study participants, 55 (27.2%) had Leptospira agglutinating antibodies. Among the 55 seropositive individuals, antibodies were directed most frequently against serogroups Icterohaemorrhagiae (22.0%) and Autumnalis (10.6%). Of 18 captured rodents, 11 (61.1%) carried pathogenic Leptospira (Leptospira borgpetersenii, 7 and Leptospira interrogans, 2). Four participants showed their highest titer against an isolate obtained from a rodent (serogroup Ballum). Increasing household distance to the canal that runs through the community was associated with decreased risk of infection (odds ratio = 0.934 per 10-meter increase; 95% confidence interval, .952-.992).
There are high levels of Leptospira exposure in an urban setting in Puerto Rico, for which rodents may be an important reservoir for transmission. Our findings indicate that prevention should focus on mitigating risk posed by infrastructure deficiencies such as the canal.
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