Trauma is a global disease, with over 2.5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. ...Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics.
To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry.
A prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009 was performed. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis of > 15%. Fibrinolytic activation (FA) was determined according to plasmin-antiplasmin (PAP) complex and D-dimer levels. Data were collected on demographics, mechanism, severity of injury, and baseline vital signs. The primary outcome measure was 28-day mortality. The secondary outcome measures were 28-day ventilator-free days and 24-h transfusion requirement.
Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of 'moderate' fibrinolysis, with PAP complex levels elevated to over twice normal (> 1500 μg L(-1)) without lysis on TEM. TEM detected clot lysis only when PAP complex levels were increased to 30 times normal (P < 0.001) and antiplasmin levels were < 75% of normal. Patients with FA had increased 28-day mortality as compared with those with no FA (12% vs. 1%, P < 0.001), fewer ventilator-free days, and longer hospital stay.
FA occurs in the majority of trauma patients, and the magnitude of FA correlates with poor clinical outcome. This was not detected by conventional TEM, which is an insensitive measure of endogenous fibrinolytic activity.
Veterans with post-traumatic stress disorder (PTSD) face significant barriers that make it less likely for them to pursue treatment. A randomized controlled non-inferiority trial was used to ...determine if providing psychotherapy for PTSD via videoconference (VC) is as effective as in-person (IP) psychotherapy.
All eligible veterans (
= 207) received cognitive processing therapy (CPT) to treat PTSD symptoms in one of the two treatment modalities. Participant symptoms were collected at baseline, post-treatment, and six months after treatment completion. The primary outcome measure, the Clinician-Administered PTSD Scale (CAPS), was used to assess PTSD diagnosis and symptom severity. Secondary outcomes included two self-report measures of symptom severity, the Post-traumatic Stress Disorder Checklist - Specific (PCL-S) for PTSD and the Patient Health Questionnaire - 9 (PHQ-9) for depressive symptoms. A linear mixed-effects model was used to assess non-inferiority for participants who completed treatment (completers) and those who were randomized to treatment (intention-to-treat (ITT)).
Both completer and ITT analyses showed that improvement in CAPS scores in the VC condition was non-inferior to that in the IP condition at six-month follow-up, but VC was inferior to IP for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL-S and PHQ-9 in both post-treatment change and six-month follow-up change, and the ITT analysis supported the significant non-inferiority for PCL at post-treatment change.
These findings generally suggest that CPT delivered via VC can be as effective as IP for reducing the severity of PTSD symptoms.
•We examined residual PTSD symptoms after Prolonged Exposure, Sertraline, or both.•Conditions did not differ in which PTSD symptoms persisted after treatment.•In those who no longer had PTSD, sleep ...symptoms were still likely to persist.
Although prolonged exposure (PE) and SSRI antidepressants are effective in treating posttraumatic stress disorder (PTSD), previous studies have shown that some symptoms tend to persist. The current study compared sertraline hydrochloride plus enhanced medication management (EMM), PE plus placebo, or PE plus sertraline hydrochloride in the likelihood of each individual PTSD symptom persisting in veterans with a PTSD diagnosis. We compared the likelihood of individual PTSD symptoms persisting in those with versus without a PTSD diagnosis at posttreatment. We found no significant differences across conditions in which symptoms were likely to persist posttreatment. Among those without a PTSD diagnosis at posttreatment, sleeping difficulties (63.0%), hypervigilance (47.3%), and nightmares (45.0%) were most likely to persist. Findings indicate no consistent differences in residual symptoms between PE and medications, and shared decision making with patients is encouraged in selecting treatments. Gold standard treatments (e.g., CBT-I) may be warranted for residual symptoms like insomnia.
Abstract Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic ...aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener’s), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet’s disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.
In Cystic Fibrosis (CF), a rapid and standardized definition of chronic infection would allow a better management of Pseudomonas aeruginosa (Pa) infections, as well as a quick grouping of patients ...during clinical trials allowing better comparisons between studies. With this purpose, we compared the metabolic profiles of 44 in vitro cultures of Pa strains isolated from CF patients at different stages of infection in order to identify metabolites differentially synthetized according to these clinical stages. Compounds produced and secreted by each strain in the supernatant of a liquid culture were analysed by metabolomic approaches (UHPLC-DAD-ESI/QTOF, UV and UPLC-Orbitrap, MS). Multivariate analyses showed that first colonization strains could be differentiated from chronic colonization ones, by producing notably more Alkyl-Quinolones (AQs) derivatives. Especially, five AQs were discriminant: HQC5, HQNOC7, HQNOC7:1, db-PQS C9 and HQNOC9:1. However, the production of HHQ was equivalent between strain types. The HHQ/HQNOC9:1 ratio was then found to be significantly different between chronic and primo-colonising strains by using both UV (p = 0.003) and HRMS data (p = 1.5 × 10
). Our study suggests that some AQ derivatives can be used as biomarkers for an improved management of CF patients as well as a better definition of the clinical stages of Pa infection.
ABSTRACT We report on the detection, from observations obtained with the Apache Point Observatory Galactic Evolution Experiment spectroscopic survey, of a metal-poor (Fe/H = −1.3 dex) field giant ...star with an extreme Mg-Al abundance ratio (Mg/Fe = −0.31 dex; Al/Fe = 1.49 dex). Such low Mg/Al ratios are seen only among the second-generation population of globular clusters (GCs) and are not present among Galactic disk field stars. The light-element abundances of this star, 2M16011638-1201525, suggest that it could have been born in a GC. We explore several origin scenarios, studying the orbit of the star in particular to check the probability of its being kinematically related to known GCs. We performed simple orbital integrations assuming the estimated distance of 2M16011638-1201525 and the available six-dimensional phase-space coordinates of 63 GCs, looking for close encounters in the past with a minimum distance approach within the tidal radius of each cluster. We found a very low probability that 2M16011638-1201525 was ejected from most GCs; however, we note that the best progenitor candidate to host this star is GC Centauri (NGC 5139). Our dynamical investigation demonstrates that 2M16011638-1201525 reaches a distance from the Galactic plane and minimum and maximum approaches to the Galactic center of Rmin < 0.62 kpc and Rmax < 7.26 kpc in an eccentric (e ∼ 0.53) and retrograde orbit. Since the extreme chemical anomaly of 2M16011638-1201525 has also been observed in halo field stars, this object could also be considered a halo contaminant, likely to have been ejected into the Milky Way disk from the halo. We conclude that 2M16011638-20152 is also kinematically consistent with the disk but chemically consistent with halo field stars.
Child Health Major, Debra A; Cardenas, Rebekah A; Allard, Carolyn B
Journal of occupational health psychology,
10/2004, Letnik:
9, Številka:
4
Journal Article
Recenzirano
This article reviews evidence substantiating the relationship between child health and business outcomes and evaluates literature regarding organizational interventions that benefit child health and ...reduce associated costs. The review focuses on 4 family-friendly initiatives, including prenatal programs, lactation programs, sick child care, and flexible working arrangements, and considers 4 business outcomes, specifically health care costs, face time, productive time, and employer attractiveness. Limitations of previous research are discussed, and preventive and reactive models of the relationship between child health and business outcomes are developed as guides for future research.
Two studies examined the link between working models of attachment and social construal processes in romantic relationships. In Study 1, individuals high in attachment-related anxiety responded to ...hypothetical partner transgressions by endorsing relationship-threatening attributions, experiencing emotional distress, and endorsing behavioral intentions that were likely to result in conflict. These effects emerged after controlling for pessimistic explanatory style, depressed mood, and self-esteem. In addition, the association between anxiety and emotional distress was mediated by attributions and attachment-related needs. In Study 2, anxious individuals endorsed relationship-threatening attributions for their partner’s transgressions but less so for their partner’s positive behaviors, and these effects occurred primarily among those in unhappy relationships. In contrast, avoidant individuals endorsed pessimistic attributions for their partner’s positive behavior but less so for their partner’s transgressions, and these effects occurred regardless of their level of relationship satisfaction.
The late-onset cerebellar ataxias (LOCAs) have largely resisted molecular diagnosis.
We sequenced the genomes of six persons with autosomal dominant LOCA who were members of three French Canadian ...families and identified a candidate pathogenic repeat expansion. We then tested for association between the repeat expansion and disease in two independent case-control series - one French Canadian (66 patients and 209 controls) and the other German (228 patients and 199 controls). We also genotyped the repeat in 20 Australian and 31 Indian index patients. We assayed gene and protein expression in two postmortem cerebellum specimens and two induced pluripotent stem-cell (iPSC)-derived motor-neuron cell lines.
In the six French Canadian patients, we identified a GAA repeat expansion deep in the first intron of
, which encodes fibroblast growth factor 14. Cosegregation of the repeat expansion with disease in the families supported a pathogenic threshold of at least 250 GAA repeats (GAA
). There was significant association between
(GAA)
expansions and LOCA in the French Canadian series (odds ratio, 105.60; 95% confidence interval CI, 31.09 to 334.20; P<0.001) and in the German series (odds ratio, 8.76; 95% CI, 3.45 to 20.84; P<0.001). The repeat expansion was present in 61%, 18%, 15%, and 10% of French Canadian, German, Australian, and Indian index patients, respectively. In total, we identified 128 patients with LOCA who carried an
(GAA)
expansion. Postmortem cerebellum specimens and iPSC-derived motor neurons from patients showed reduced expression of
RNA and protein.
A dominantly inherited deep intronic GAA repeat expansion in
was found to be associated with LOCA. (Funded by Fondation Groupe Monaco and others.).
: This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 "low risk" ...cases, and may serve as reference to assess outcome of single or any groups of patients.
To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups.
Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative.
Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff.
Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values.
Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.
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