Aggressive Soft Tissue Infections Garcia, Nicole M; Cai, Jenny
The Surgical clinics of North America,
10/2018, Volume:
98, Issue:
5
Journal Article
Peer reviewed
Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is ...essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. There are no adjunct laboratory values or imaging that have high sensitivity and specificity in the diagnosis of NSTI. The treatment involves emergent, radical surgical debridement of involved tissues and broad spectrum antibiotics. Follow-up should include close monitoring of the wound and repeat debridements in the operating room.
Abstract Background The incidence of colorectal cancer (CRC) in the adolescent and young adult population (AYA: ages 15-39 years) is rising. Materials and Methods We used the Surveillance, ...Epidemiology, and End Results (SEER) Database to study CRC in the AYA population. We studied clinical and socioeconomic factors associated with survival. Results Of the 11,071 cases of CRC, the most common site of the primary tumor was the rectum (25%) while 66.6% of the diseases were left sided. The majority of the patients (72%) presented with regional or metastatic disease. However, the disease specific-survival (DSS) and the overall survival (OS) of the AYA population were comparable to that of the general population (DSS; 5 and 10-year- 64.8%, 57.3%; OS; 5, and 10-year 61.5% and 52.4%). On multivariate analysis, disease stage at the time of the diagnosis was the strongest predictor of mortality. After controlling for disease stage; male gender, Black race, and higher-grade tumors were associated with worse survival. Conclusions The AYA population presents with advanced distal CRC but have similar survival compared to the general population.
Abstract An effort to prevent PJI has led to the development of antimicrobial dressings that support wound healing. We sought to determine whether Aquacel Surgical dressing independently reduces the ...rate of acute PJI following TJA. A single institution retrospective chart review of 903 consecutive cases who received the Aquacel Surgical dressing and 875 consecutive cases who received standard gauze dressing was conducted to determine the incidence of acute PJI (within 3 months). The incidence of acute PJI is 0.44% in the Aquacel dressing group compared to 1.7% in the standard gauze dressing group ( P = 0.005). Multivariate analysis revealed that use of Aquacel dressing was an independent risk factor for reduction of PJI (odds ratio of 0.165, 95% confidence interval: 0.051–0.533). Aquacel Surgical dressing significantly reduces the incidence of acute PJI.
Sulfur-impregnated activated carbons (SIACs) produced from oil-sands fluid coke by KOH−SO2 activation were applied to remove mercury ions from aqueous solutions. A pseudo-first-order rate expression ...can describe the Hg2+ adsorption behavior of SIACs produced in this study. The rate constants were found to be 0.01−0.102 min−1. The Hg2+ adsorption capacities of the examined SIACs ranged from 43 to 72 mg/g, which were comparable to those reported in the literature (35−100 mg/g) and that of a commercial SIAC (41 mg/g). The adsorption capacity increased with increasing specific surface area (S BET) of the SIACs, and a positive correlation was found between the S BET-normalized adsorption capacity and the total sulfur content of the SIACs. Elemental sulfur, disulfide, and thiophene seemed particularly effective in Hg2+ adsorption, as SIACs with these sulfur compounds showed higher adsorption capacities in general.
Abstract
Purpose
Although hyperglycemic crises can lead to a hypercoagulable state, few instances of associated mesenteric venous thrombosis (MVT) have been reported. Worsening abdominal pain in the ...context of shock requiring vasopressor support should prompt urgent further investigation.
Summary
A 44-year-old Hispanic male arrived at an emergency department with chief complaints of lethargy, polydipsia, and polyuria. His past medical history included type 2 diabetes, epilepsy, obesity, tobacco smoking, and noncompliance with his medications. On arrival the patient had a serum glucose concentration of >1,600 mg/dL, and hyperosmolar hyperglycemic syndrome (HHS) was diagnosed. The patient was admitted to the intensive care unit with respiratory failure and subsequently developed shock refractory to fluid resuscitation, necessitating vasopressor support. On hospital day 4, a computerized tomogram obtained for investigation of increasing abdominal tenderness revealed superior MVT and pneumatosis intestinalis. Despite an emergency laparotomy and enterectomy, the patient ultimately succumbed on hospital day 41 due to recurrent pneumonia complicated by acute respiratory distress syndrome and septic shock.
Conclusion
Shock that is refractory to aggressive fluid resuscitation, necessitating pressor support, in the setting of HHS or diabetic ketoacidosis should prompt investigation for the underlying source of shock. Other etiologies, including hypovolemic, cardiogenic, and obstructive shock, should be considered; however, infection is the leading trigger of hyperglycemic crises. Although rarely reported, MVT should be considered in the diagnostic algorithm in the absence of an identified infectious source. Prompt investigation should include use of diagnostic modalities such as computed tomography to assess for MVT.
Background
Introduction of new tobacco products in the United States, including those that may be lower on the risk continuum than traditional combustible cigarettes, requires premarket authorization ...by the US Food and Drug Administration and information on the potential impact of the products on consumer behaviors. Efficient recruitment and data capture processes are needed to collect relevant information in a near-to-real-world environment.
Objective
The aim of this pilot study was to develop and test a protocol for an actual use study of a new tobacco product. The product included in this study was a commercially available oral nicotine pouch. Through the process of study design and execution, learnings were garnered to inform the design, execution, analysis, and report writing of future full-scale actual use studies with tobacco products.
Methods
A small sample (n=100) of healthy adult daily smokers of 7 or more cigarettes per day were recruited to participate in an 8-week prospective observational study conducted at 4 geographically dispersed sites in the United States. A smartphone-based customized electronic diary (eDiary) was employed to capture daily tobacco product use, including 1 week of baseline smoking and 6 weeks during which participants were provided with oral nicotine pouches for use as desired.
Results
Online screening procedures with follow-up telephone interviews and on-site enrollment were successfully implemented. Of 100 participants, 97 completed the study, with more than half (59/99, 60%) identifying as dual- or poly-users of cigarettes and other types of tobacco products at baseline. There was more than 90% (91-93/99, 92%-94%) compliance with daily eDiary reporting, and the majority (92/99, 93%) of participants expressed satisfaction with the study processes. Product use data from the eDiary indicated that after an initial period of trial use, pouches per day increased among those continuing to use the products, while per day average cigarette consumption decreased for 82% (79/97) of all study participants. At the end of the week 6, 16% (15/97) of participants had reduced their cigarette consumption by more than half.
Conclusions
The design of this study, including recruiting, enrollment, eDiary use, and oversight, was successfully implemented through the application of a detailed protocol, a user-friendly eDiary, electronically administered questionnaires, and remote monitoring procedures. High-resolution information was obtained on prospective changes in tobacco product use patterns in the context of availability of a new tobacco product. Future, larger actual use studies will provide important evidence supporting the role that alternatives to combustible cigarettes may play in smoking reduction and/or cessation and lowering the population health burden of tobacco and nicotine-containing products.
Cardiovascular disease (CVD) is the leading cause of death in China and worldwide. Whole grain oats can reduce risk of CVD by reducing total and LDL-cholesterol, major risk factors for CVD. While ...this association has been established in many populations, data from Asian populations is limited. Thus, this study investigated the impact of oat consumption on cholesterol levels in Chinese adults. Male and female data from this work were previously published separately in mandarin in two Chinese journals. The combined male and female data were reanalyzed and are presented here.
A randomized, controlled, parallel-arm study was conducted at Beijing Hospital, Beijing china. Subjects were adults (men and women) with mild to moderate hypercholesterolemia. The oat group (n=85) consumed 100 grams of instant oat cereal versus the control group (n=81) who consumed 100 grams of wheat flour-based noodles daily for 6 weeks. Laboratory and anthropometric measurements were conducted at baseline and at the end of the 6-week intervention.
Dietary fiber intake increased significantly in the oat group compared to the control group at the end of the 6-week intervention. Total-, LDL-cholesterol and waist circumference decreased significantly in the oat group compared to the control. HDL-cholesterol decreased significantly in the control group versus the oat group. There were no significant changes in blood pressure, other anthropometric or laboratory measures between the two groups at the end of the intervention.
Instant oatmeal consumed daily for 6 weeks significantly increased fiber intake and decreased major risk factors for CVD in Chinese adults with hypercholesterolemia. Increased consumption of whole grains, including oats, should continue to be encouraged.
Abstract Background Some manufacturers have introduced polyethylene (PE) inserts in 1-mm increment thickness options to allow for finer adjustments in total knee arthroplasty kinematics. Methods Two ...surgeons with extensive experience performed 88 total knee arthroplasties using implants with 1-mm PE inserts. After trial components were inserted and the optimal PE thickness was selected, the insert was removed and a trial insert size was randomly chosen from opaque envelopes (1-mm smaller, same size, and 1-mm larger). The knee was re-examined and the surgeon determined which size PE had been placed. Results Surgeons reliably determined insert thicknesses in 62.5% (55 of 88; P = .050) of trials. Surgeons were not able to accurately detect 1-mm incremental changes of trial PE implants on a consistent basis. Conclusion The potential clinical usefulness of this concept should be further evaluated.
The apoptosis process is crucial to various biological processes including embryo development and organism homeostasis. Inducing apoptosis of cancer cells has become a very attractive field for ...cancer therapy in the recent years. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL; also called Apo2L, TNFSF10, CD253, or TL2) is a member of tumor necrosis factor family. Preclinical studies showed that human TRAIL induced apoptosis of various tumor cell lines, whereas nontransformed normal cell lines were not affected. We have cloned both canine and feline TRAIL full-length genes by using Rapid Amplification of cDNA Ends-PCR technology. Truncated soluble versions of the canine and feline TRAIL genes were also constructed. The degree of identity between canine TRAIL protein and the human, mouse, chicken, porcine, and rat homologues is 81.3%, 61.7%, 54.3%, 82.9%, and 63.2%, respectively. The degree of identity between the feline TRAIL protein and the human, mouse, chicken, porcine, and rat homologues is 84.2%, 64.2%, 54.4%, 86.8% and 65.7%, respectively. The identity between the canine and feline TRAIL proteins is 93.2%. The canine and feline soluble TRAIL proteins were expressed in both mammalian and bacterial expression systems. Western immunoblot assays with TRAIL-specific antibody confirmed the identity of expressed protein. Both canine and feline TRAIL proteins were shown to specifically induce apoptosis and inhibit cell growth of cancer cells at a level comparable with their human counterpart.
Real-time PCR has become increasingly important in gene expression profiling research, and it is widely agreed that normalized data are required for accurate estimates of messenger RNA (mRNA) ...expression. With increased gene expression profiling in pre-clinical research and toxicogenomics, a need for reference genes in the rat has emerged, and the studies in this area have not yet been thoroughly evaluated. The purpose of our study was to evaluate a panel of rat reference genes for variation of gene expression in different tissue types. We selected 48 known target genes based on their putative invariability. The gene expression of all targets was examined in 11 types of rat tissues using TaqMan® low density array (LDA) technology. The variability of each gene was assessed using a two-step statistical model. The analysis of mean expression using multiple reference genes was shown to provide accurate and reliable normalized expression data. The least five variable genes from each specific tissue were recommended for future tissue-specific studies. Finally, a subset of investigated rat reference genes showing the least variation is recommended for further evaluation using the LDA platform. Our work should considerably enhance a researcher's ability to simply and efficiently identify appropriate reference genes for given experiments.
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