Drifting away in the Atlantic Sampaio, Eduardo
Science (American Association for the Advancement of Science),
04/2022, Letnik:
376, Številka:
6589
Journal Article
Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and ...internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty.
BACKGROUND: Pain is a multidimensional experience that should be evaluated beyond an estimate of intensity. A multidimensional pain measure has not been developed for older persons undergoing ...comprehensive geriatric assessment.
OBJECTIVE: To develop and evaluate validity and reliability of a multidimensional pain assessment instrument for older persons.
RESEARCH DESIGN: A series of steps in instrument development and evaluation.
SUBJECTS: A total of 176 subjects (mean age 84 ± 6.0 years) in ambulatory geriatric clinics; 64% were women, and 73% had a history of chronic pain.
MEASUREMENTS: Measurements included the Geriatric Pain Measure (GPM), the McGill Pain Questionnaire, Yesavage GDS, Katz ADLs, Lawton IADLs, Tinetti Gait and Balance, Folstein MMSE, and other demographic and clinical characteristics from interview and chart review.
RESULTS: The GPM demonstrated a standardized alpha = 0.9445, homogeneity ratio =0.457, and average inter‐item correlation =0.415. A subgroup of 50 subjects demonstrated concurrent validity of the GPM in comparison with the McGill Pain Questionnaire (Pearson's r correlation 0.6269 (P < .0000). Test‐retest reliability was demonstrated in another subgroup of 50 subjects who repeated the GPM within 48 to 72 hours (Pearson's r = 0.9018; P < .0000). Factor analysis revealed five clusters of components: Pain Intensity, Disengagement, Pain with Ambulation, Pain with Strenuous Activities, and Pain with Other Activities.
CONCLUSIONS: The GPM is a 24‐item questionnaire that is easy to administer and has significant validity and reliability in older persons with multiple medical problems. The GPM may be a useful addition to the multidimensional geriatric assessment process.
Abstract Recurrent pregnancy loss (RPL) is defined by two or more failed pregnancies and accounts for only 1–5% of pregnancy failures. Treatment options for unexplained RPL (uRPL) are limited. ...Previous studies suggest a link between delayed implantation and pregnancy loss. Based on this, a timely signal for rescue of the corpus luteum (CL) using human chorionic gonadotrophin (HCG) could improve outcomes in women with uRPL. This retrospective cohort study included 98 subjects with uRPL: 45 underwent 135 monitored cycles without HCG support; and 53 underwent 142 cycles with a single mid-luteal HCG injection. Based on Log-rank Mantel-Cox survival curves, miscarriage rate and time to pregnancy decreased in the HCG group ( P = 0.0005). Women receiving luteal HCG support had an increased chance of an ongoing pregnancy compared with those not receiving it (RR = 2.4; 95% CI 1.4–3.6; number need to treat (NNT) = 7; 95% CI 4–18). Subjects receiving HCG support had a significant absolute risk reduction (ARR) of miscarriage ( P < 0.001; ARR = 11.5%; 95% CI 3.6–19.5; NNT = 9(5–27). These data suggest restoration of synchrony and CL support improves outcomes in women with RPL. Further randomized controlled trials of luteal-phase HCG in women with RPL appears warranted.
Lactate elevation is a well-characterized biomarker of mitochondrial dysfunction, but its role in diabetic kidney disease (DKD) is not well defined. Urine lactate was measured in patients with type 2 ...diabetes (T2D) in 3 cohorts (HUNT3, SMART2D, CRIC). Urine and plasma lactate were measured during euglycemic and hyperglycemic clamps in participants with type 1 diabetes (T1D). Patients in the HUNT3 cohort with DKD had elevated urine lactate levels compared with age- and sex-matched controls. In patients in the SMART2D and CRIC cohorts, the third tertile of urine lactate/creatinine was associated with more rapid estimated glomerular filtration rate decline, relative to first tertile. Patients with T1D demonstrated a strong association between glucose and lactate in both plasma and urine. Glucose-stimulated lactate likely derives in part from proximal tubular cells, since lactate production was attenuated with sodium-glucose cotransporter-2 (SGLT2) inhibition in kidney sections and in SGLT2-deficient mice. Several glycolytic genes were elevated in human diabetic proximal tubules. Lactate levels above 2.5 mM potently inhibited mitochondrial oxidative phosphorylation in human proximal tubule (HK2) cells. We conclude that increased lactate production under diabetic conditions can contribute to mitochondrial dysfunction and become a feed-forward component to DKD pathogenesis.
Towards patient-based cancer therapeutics Schreiber, Stuart L; Shamji, Alykhan F; Clemons, Paul A ...
Nature biotechnology,
201009, 2010-Sep, 2010-9-00, 20100901, Letnik:
28, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Orienting cancer drug discovery to the patient requires relating the genetic features of tumors to acquired gene and pathway dependencies and identifying small-molecule therapeutics that target them. ...PUBLICATION ABSTRACT
Value of the IUCN Red List Lamoreux, John; Resit Akçakaya, H; Bennun, Leon ...
Trends in ecology & evolution (Amsterdam),
05/2003, Letnik:
18, Številka:
5
Journal Article
Tumor necrosis factor-alpha (TNF-alpha) is an important cytokine involved in the pathogenesis of inflammatory bowel disease. The monoclonal antibody to TNF-alpha, infliximab, is effective in treating ...Crohn's disease. Preclinical studies suggest the importance of TNF-alpha in treating ulcerative colitis (UC). We report the effectiveness of infliximab for UC and examine factors predictive of response to medication.
Data from all UC patients receiving infliximab at four institutions were analyzed. Disease activity was determined by the Disease Activity Index.
A total of 27 patients with active UC received inpatient (37%) and outpatient (63%) infliximab as single (52%) or multiple (two to 15) infusions (48%). Twelve patients (44%) achieved remission and six patients (22%) had partial response. Nine patients had no response; five subsequently underwent total colectomy. The median time to achieve response and remission was 4 days and the median duration 8 wk. Nine of the 18 patients who responded experienced 19 relapses; 18 of these relapses (95%) were successfully treated with repeat infusions. Steroid-refractory patients were less likely to respond to infliximab therapy than were steroid-responsive patients (33% vs 83%; p = 0.026). No other factors were predictive of response to infliximab. Two patients developed serious adverse events, including death in one case.
Preliminary evidence suggest effectiveness of infliximab in the treatment of UC, including medically refractory severe disease. Individuals who are refractory to corticosteroids, however, may be unlikely to respond to infliximab. A randomized controlled trial is necessary to further investigate the efficacy of infliximab in patients with UC.
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