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6% of GBPs was NP polyps. If the risk score was ≥4, 63.2% of GBPs were NP polyps.
Our risk scoring system can prevent unnecessary choelcystectomy. Because the incidence of NP polyps in low-risk patients (risk score <4) is extremely rare.
Our risk scoring system can prevent unnecessary choelcystectomy. Because the incidence of NP polyps in low-risk patients (risk score less then 4) is extremely rare.
Retroperitoneal tumours arising from the inferior vena cava (IVC) are rare tumours often requiring large vessel resection for complete surgical excision. Limited exposure to such tumours often discourages surgeons from offering surgical resection to these patients, depriving them of the only potentially curative modality. We present here the surgical technique for resection of a large IVC sarcoma without IVC reconstruction.
A 53-year-old lady presented with a large retroperitoneal sarcoma encasing the infra-hepatic IVC with tumour thrombus extension into the hepatic cloaca as well as the left renal vein. Surgical resection was planned as the disease remained stable after 2 cycles of neoadjuvant chemotherapy with adriamycin and ifosfamide.
Complete surgical excision of the tumour was achieved by performing a resection of the entire length of infra-hepatic IVC and right kidney, without IVC reconstruction. Left renal vein was divided after careful preservation of a draining collateral. Tumour thrombus was extracted from the hepatic cloaca, and proximal IVC stump closure was achieved with preservation of right hepatic vein insertion. Total blood loss during the procedure was 2300mL, and the patient recovered without compromise of renal function or development of lower limb oedema.
IVC resection without reconstruction can be safely performed for large retroperitoneal sarcomas involving major vascular structures. Familiarity with the retroperitoneal, retro-hepatic and supra-hepatic anatomy is paramount to achieving good surgical outcomes.
IVC resection without reconstruction can be safely performed for large retroperitoneal sarcomas involving major vascular structures. Familiarity with the retroperitoneal, retro-hepatic and supra-hepatic anatomy is paramount to achieving good surgical outcomes.
The heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. Central solid collections at the root of the mesentery are difficult to access with traditional techniques. Here we describe a case series of laparoscopic infracolic necrosectomy (ICN) and open or laparoscopic infracolic necrosectomy with Roux-en Y cystjejunostomy (ICN-RYCJ) for the management of complicated SAP.
A retrospective analysis of a prospectively maintained database identified all patients treated with infracolic necrosectomy or drainage of pancreatic collections for complicated SAP between 2012 and 2021 inclusive at a single institution.
Forty patients were identified (median age 53years)-ICN group 9 patients (median time to intervention-22days) and ICN-RYCJ group 31 patients (median time to intervention-99days). Two patients in ICN group underwent interval fistula-tract jejunostomy. Thirty-one patients had laparoscopic surgery and 9 patients underwent an open approach. Four patients required intervention post-operatively. Nineteen patients were discharged from follow-up at two years.
Infracolic approach with selective Roux-en Y cystjejunostomy, as a single or staged intervention, is an effective and safe operative option to add to the armamentarium of the pancreatic surgeon when dealing with complicated SAP not amenable to drainage/debridement by traditional techniques.
Infracolic approach with selective Roux-en Y cystjejunostomy, as a single or staged intervention, is an effective and safe operative option to add to the armamentarium of the pancreatic surgeon when dealing with complicated SAP not amenable to drainage/debridement by traditional techniques.In this article, we argue that physicians have normative authority over patients. First we elaborate on the nature of normative authority. Selleck PHA-665752 We then examine and critique Arthur Isak Applbaum's view that physicians lack authority over patients. Our argument appeals to four cases that demonstrate physicians' authority.
The end-of-life (EOL) experience in the intensive care unit (ICU) is emotionally challenging, and there are opportunities for improvement. The 3 Wishes Program (3WP) promotes the dignity of dying patients and their families by eliciting and implementing wishes at the EOL.
To assess whether the 3WP is associated with improved ratings of EOL care.
In the 3WP, clinicians elicit and fulfill simple wishes for dying patients and their families.
2-hospital academic healthcare system.
Dying patients in the ICU and their families.
A modified Bereaved Family Survey (BFS), a validated tool for measuring EOL care quality, was completed by families of ICU decedents approximately 3 months after death. We compared patients whose care involved the 3WP to those who did not using three BFS-derived measures Respectful Care and Communication (5 questions), Emotional and Spiritual Support (3 questions), and the BFS-Performance Measure (BFS-PM, a single-item global measure of care).
Of 314 completed surveys, 117 were for patients whose care included the 3WP. Bereaved families of 3WP patients rated the Emotional and Spiritual Support factor significantly higher (7.5 vs. 6.0, p = 0.003, adjusted p = 0.001) than those who did not receive the 3WP. The Respectful Care and Communication factor and BFS-PM were no different between groups.
The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.
The 3WP is a low-cost intervention that may be a feasible strategy for improving the EOL experience.
The aim of this study was to evaluate the effectiveness of a digital health intervention plus community health worker (CHW) support on self-monitoring of blood glucose and glycosylated hemoglobin (HbA1c) among adult Medicaid beneficiaries with diabetes.
Randomized controlled trial.
Urban outpatient clinic.
Adult Medicaid beneficiaries living with diabetes and treated with insulin and who had a HbA1c ≥ 9%.
Participants were randomly assigned to one of three arms. Participants in the usual-care arm received a wireless glucometer if needed. Those in the digital arm received a lottery incentive for daily glucose monitoring. Those in the hybrid arm received the lottery plus support from a CHW if they had low adherence or high blood glucose levels.
The primary outcome was the difference in adherence to daily glucose self-monitoring at 3 months between the hybrid and usual-care arms. The secondary outcome was difference in HbA1c from baseline at 6 months.
A total of 150 participants were enrolled in the study. A total of 102 participants (68%) completed the study. At 3 months, glucose self-monitoring rates in the hybrid versus usual-care arms were 0.72 vs 0.65, p = 0.23. At 6 months, change in HbA1c in the hybrid versus usual-care arms was - 0.74% vs - 0.49%, p = 0.69.
There were no statistically significant differences between the hybrid and usual care in glucose self-monitoring adherence or improvements in HbA1C.
This trial is registered with clinicaltrials.gov identifier NCT03939793.
This trial is registered with clinicaltrials.gov identifier NCT03939793.
Clinical trials are needed to study topics relevant to older adults with serious illness. Investigators conducting clinical trials with this population are challenged by how to appropriately define, classify, report, and monitor serious and non-serious adverse events (SAEs/AEs), given that some traditionally reported AEs (pressure ulcers, delirium) and SAEs (death, hospitalization) are common in persons with serious illness, and may be consistent with their goals of care.
A multi-stakeholder group convened to establish greater clarity on and new approaches to address this critical issue.
Thirty-two study investigators, members of regulatory and sponsor agencies, and patient stakeholders took part.
The group met virtually four times and, using a collaborative approach, conducted a survey, select interviews, and reviewed regulatory guidance to collectively define the problem and identify a new approach.
SAE/AE challenges fell into two areas (1) definitions and classifications, including (a) implausiblllness and other vulnerable populations.
Adoption of the proposed approach-and supporting it with education and better alignment with regulatory guidance and procedures-could improve the quality and efficiency of clinical trials' safety involving older adults with serious illness and other vulnerable populations.Major clinical trials with sodium glucose co-transporter-2 inhibitors (SGLT-2i) exhibit protective effects against heart failure events, whereas inconsistencies regarding the cardiovascular death outcomes are observed. Therefore, we aimed to compare the selective SGLT-2i empagliflozin (EMPA), dapagliflozin (DAPA) and ertugliflozin (ERTU) in terms of infarct size (IS) reduction and to reveal the cardioprotective mechanism in healthy non-diabetic mice. C57BL/6 mice randomly received vehicle, EMPA (10 mg/kg/day) and DAPA or ERTU orally at the stoichiometrically equivalent dose (SED) for 7 days. 24 h-glucose urinary excretion was determined to verify SGLT-2 inhibition. IS of the region at risk was measured after 30 min ischemia (I), and 120 min reperfusion (R). In a second series, the ischemic myocardium was collected (10th min of R) for shotgun proteomics and evaluation of the cardioprotective signaling. In a third series, we evaluated the oxidative phosphorylation capacity (OXPHOS) and the mitochondrial fatty ais not correlated to SGLT-2 inhibition, is STAT-3 and PI3K dependent and associated with increased FGF-2 and Cav-3 expression.
Chronic kidney disease (CKD) patients have high levels of inflammatory mediators. These inflammatory mediators contribute to the increased risk of cardiovascular events and all-cause mortality. Platelet-lymphocyte ratio (PLR) has recently been recognized as a novel inflammatory marker and has been shown to be associated with the prognosis in CKD patients. However, the quality of these studies varies and their results are controversial. The purpose of this meta-analysis was to investigate the relationship between PLR and all-cause mortality in CKD patients.
A systematic literature search of PubMed, EMBASE, CENTRAL and ISI Web of Science was conducted. The databases were searched from their inception dates up to the latest issue (31 October 2021). Two reviewers independently searched the databases and screened studies. Data were extracted using a standardized collection form. Meta-analysis was performed to compare PLR values between CKD and non-CKD patients, and to investigate the association between PLR an CKD.Research devoted to characterizing phenomena is underappreciated in philosophical accounts of scientific inquiry. This paper develops a diachronic analysis of research over 100 years that led to the recognition of two related electrophysiological phenomena, the membrane potential and the action potential. A diachronic perspective allows for reconciliation of two threads in philosophical discussions of phenomena-Hacking's treatment of phenomena as manifest in laboratory settings and Bogen and Woodward's construal of phenomena as regularities in the world. The diachronic analysis also reveals the epistemic tasks that contribute to establishing phenomena, including the development of appropriate investigative techniques and concepts for characterizing them.
