midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP). We sought to confirm whether MR-proADM added to Pneumonia Severity Index (PSI) ...improves the potential prognostic value of PSI alone, and tested to what extent this combination could be useful in predicting poor outcome of patients with CAP in an Emergency Department (ED).
Consecutive patients diagnosed with CAP were enrolled in this prospective, single-centre, observational study. We analyzed the ability of MR-proADM added to PSI to predict poor outcome using receiver operating characteristic (ROC) curves, logistic regression and risk reclassification and comparing it with the ability of PSI alone. The primary outcome was "poor outcome", defined as the incidence of an adverse event (ICU admission, hospital readmission, or mortality at 30 days after CAP diagnosis).
226 patients were included; 33 patients (14.6%) reached primary outcome. To predict primary outcome the highest area under curve (AUC) was found for PSI (0.74 0.64-0.85), which was not significantly higher than for MR-proADM (AUC 0.72 0.63-0.81, p > 0.05). The combination of PSI and MR-proADM failed to improve the predictive potential of PSI alone (AUC 0.75 0.65-0.85, p=0.56). Ten patients were appropriately reclassified when the combined PSI and MR-proADM model was used as compared with the model of PSI alone. Net reclassification improvement (NRI) index was statistically significant (7.69%, p = 0.03) with an improvement percentage of 3.03% (p = 0.32) for adverse event, and 4.66% (P = 0.02) for no adverse event.
MR-proADM in combination with PSI may be helpful in individual risk stratification for short-term poor outcome of CAP patients, allowing a better reclassification of patients compared with PSI alone.
To describe the outcome of patients after noninvasive ventilation in a high dependency unit (HDU) of an emergency department (ED). Secondary aims were to define the role of intensive care ...consultation and to identify variables associated with mortality.
Observational, prospective 6-month study.
Two hundred and nine cases were analysed. Thirty-four patients were initially rejected by the intensive care unit (ICU). Physicians in the ED did not request ICU consultation in the remaining 175 (83%) because of 'belief of improvable medical condition in the ED in patients without therapeutic limits' in 93 (group 1) and to 'preset therapeutic limits' or 'comfort measures only' in 82 (groups 2 and 3). Ten out of these 175 were subsequently admitted to the ICU. The global in-hospital mortality rate was 22% (3.3% in the high dependency unit), but only 10% in group 1. Place of referral for ventilation (P<0.001), absence of subsequent ventilation on the general ward (P<0.001), group of assignation (P=0.004), intensive care initial rejection (P=0.022), no previous home ventilation (P=0.028), older age (P=0.03) and longer duration on ventilation (P=0.047) were significantly associated with mortality. In the multivariate regression model, ventilating patients from general wards (odds ratio=7.1; 2.3-25, 95% confidence interval) and ventilation under preset limits (odds ratio=3.57; 1.42-8.98, 95% confidence interval) remained significantly associated with mortality.
Noninvasive ventilation is a relatively safe and effective treatment in the ED when performed in carefully controlled settings. ICU consultation may be securely deferred in this setting.
Introduction
The serum rise of alpha-fetoprotein (AFP) has been relationed to hepatic tumors. Other than these, such as gastric adenocarcinoma, can present with high levels of this glycoprotein. One ...rare kind of gastric adenocarcinoma, called hepatoid subtype, has two essential features: hepatoid differentiation in histology and high levels of AFP in serum.
Discussions
We report a Spanish female who consulted because of fatigue, anorexia, and weight loss. In laboratory data, she presented anemia and markedly elevation of AFP. On CT scan, a gastric mass resulted without hepatic dissemination, and subsequently, gastroduodenoscopy was performed for histological diagnosis. Then, an ulcerated mass was detected and sample was taken, resulting in poorly-differentiated adenocarcinoma of stomach with hepatoid tissue foci, with intense positivity for AFP-immunohistochemical staining. This rare cancer has poor prognosis even with early gastrectomy and chemotherapy.
Tumour-induced Osteomalacia Secondary to a Sarcoma Rodriguez-Velver, Karla Victoria; Zapata-Rivera, María Azucena; Montes-Villarreal, Juan ...
European endocrinology,
08/2016, Letnik:
12, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Tumour-induced osteomalacia (TIO), is a rare paraneoplasatic syndrome found in >95% of benign tumours that secrete fibroblast growth factor 23 - a phosphaturic circulating hormone. A rare case of a ...TIO secondary to a sarcoma, in a 21-year old man with history of bone fractures and distinctive physical and biochemical characteristics is presented and discussed.
This case report presents a lipofibromatous hamartoma of the median nerve in a 31-year-old man who presents local deformity and a sensory deficit in the nerve territory. The tumor was evaluated with ...magnetic resonance, computed tomography, and plain film radiography, studying the pathognomonic findings of this tumor. The patient did not want surgical treatment because of prior surgical sequelae. A prior surgical biopsy was reported as a peripheral nerve with normal axonal fascicles surrounded by abundant fibroadipose tissue. This tumor has a low incidence with less than 180 cases reported in the literature.
Sardine fisheries in the Iberian Atlantic shelf (36°N–44.5°N) show decadal‐scale cycles. In the late 1990s, a positive phase in sardine stock was expected; on the contrary, catches have declined ...until now. Regime shifts in climatic and oceanographic variables on different scales (as forcing factor) and shifts in sardine stock (as result) have been used with the aim of identifying the physical variables that explain most of the sardine population variance in the region. Circa 1998, when last sardine regime shift was detected, the main patterns of large‐scale atmospheric circulation in the Northern Hemisphere with influence in the study area namely Northern Atlantic Oscillation (NAO) and East Atlantic (EA) pattern changed and coupled in a combination that led to a rise in sea surface temperature and a decline in the coastal upwelling intensity. Several years with a downwelling situation in average in the main spawning and feeding Iberian sardine areas would have affected the stock abundance, averting the return to the projected positive regime. The sardine negative regime shift was detected first in the regions of the study located further north. The regional variable latent heat flux that groups a set of environmental processes related to the ocean–atmosphere heat exchanges and so with the turbulence manages to explain the 72% of sardine recruitment.
It is controversial whether mitochondrial dysfunction in skeletal muscle is the cause or consequence of metabolic disorders. Herein, we demonstrate that in vivo inhibition of mitochondrial ATP ...synthase in muscle alters whole‐body lipid homeostasis. Mice with restrained mitochondrial ATP synthase activity presented intrafiber lipid droplets, dysregulation of acyl‐glycerides, and higher visceral adipose tissue deposits, poising these animals to insulin resistance. This mitochondrial energy crisis increases lactate production, prevents fatty acid β‐oxidation, and forces the catabolism of branched‐chain amino acids (BCAA) to provide acetyl‐CoA for de novo lipid synthesis. In turn, muscle accumulation of acetyl‐CoA leads to acetylation‐dependent inhibition of mitochondrial respiratory complex II enhancing oxidative phosphorylation dysfunction which results in augmented ROS production. By screening 702 FDA‐approved drugs, we identified edaravone as a potent mitochondrial antioxidant and enhancer. Edaravone administration restored ROS and lipid homeostasis in skeletal muscle and reinstated insulin sensitivity. Our results suggest that muscular mitochondrial perturbations are causative of metabolic disorders and that edaravone is a potential treatment for these diseases.
Synopsis
Lipid homeostasis in skeletal muscle is dependent on mitochondrial activity. Inhibition of ATP synthase in the muscle alters whole‐body lipid metabolism and induces insulin resistance in mice, two phenotypes that can be reverted by edavarone treatment.
Inhibition of oxidative phosphorylation (OXPHOS) in skeletal muscle promotes branched‐chain amino acids (BCAA) catabolism and de novo lipogenesis.
Accumulation of Acetyl‐CoA feeds back onto OXPHOS dysfunction by inhibiting mitochondrial respiratory complex II and increasing ROS levels.
Mice with low OXPHOS show increased lipid deposits and insulin resistance.
Edaravone rescues mitochondrial activity, and lipid and glucose homeostasis in mice with low OXPHOS.
Inhibition of ATP synthase in the muscle alters whole‐body lipid metabolism and induces insulin resistance in mice, two phenotypes that can be reverted by edavarone treatment.
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