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In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation.

By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery.

Pathway consensus is outspread (internal fixation for un-displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective judgement. Appearing neither exhaustive nor exclusive, most of the pathways seem difficult to evaluate scientifically, which might explain why only very few have been evaluated for compliance, reliability and complications after implementation in an actual clinical setting. We therefore introduce a model for step-wise pathway implementation including proper scientific evaluation.

Surgical treatment pathways for proximal femoral fractures are available in literature and nationally with somewhat evidence based treatment consensus, but the scientific evaluation of the pathways them selves needs to be optimised.

Surgical treatment pathways for proximal femoral fractures are available in literature and nationally with somewhat evidence based treatment consensus, but the scientific evaluation of the pathways them selves needs to be optimised.

CISD2 is known to have roles in calcium metabolism, anti-apoptosis, and longevity. However, whether CISD2 is involved in the inflammatory response associated with injuries of the central nervous system (CNS) remains unclear. This issue is particularly relevant for traumatic spinal cord injuries (SCIs), which lack therapeutic targeting and often cause long-term disability in patients. The authors previously demonstrated the neuroprotective effects of curcumin against RANTES-mediated neuroinflammation. In this study, we investigated (1) the role of CISD2 in injury-induced inflammation and (2) whether curcumin influences CISD2 expression in acute SCI.

The efficacy of curcumin treatment (40 mg/kg i.p.) was evaluated in an animal model of SCI. In a neural cell culture model, lipopolysaccharide (LPS) was administrated to induce inflammation with the aim of mimicking the situation commonly encountered in SCI. Additionally, knockdown of CISD2 expression by siRNA (siCISD2) in LPS-challenged neural cells was perforS-treated astrocytes.Column experiments were performed under various ionic strengths (0.0-0.9 mM) using 10 mg L(-1) of Cd(2+) without kaolinite colloids and 10 mg L(-1) Cd(2+) mixed with 100 mg L(-1) kaolinite colloids. The nonequilibrium two-site model (TSM) described the behavior of both Cd(2+) transport and Cd(2+) co-transported with kaolinite colloids better than the equilibrium model (CD(eq)) (R(2)=0.978-0.996). The results showed that an increase in ionic strength negatively impacted the retardation factors (R) of both Cd(2+) and Cd(2+) mixed with kaolinite colloids. The presence of kaolinite colloids increased the retardation factors of Cd(2+) from 7.23 to 7.89, 6.76 to 6.61 and 3.79 to 6.99 for ionic strengths of 0.225, 0.45 and 0.9 mM, respectively. On the other hand, the presence of kaolinite colloids decreased the retardation factor of Cd(2+) from 8.13 to 7.83 for ionic strength of 0.0 mM. The fraction of instantaneous sorption sites (f) parameters, kinetic constant for sorption sites (α) and Freundlich constant (K(f)) were estimated from HYDRUS-1D of TSM for Cd(2+) transport. The fraction of instantaneous sorption sites was found to increase for an increase in ionic strength. K(f) values of Cd(2+) transport without kaolinite colloids for 0.0, 0.225 and 0.45 mM were found to be higher than those of Cd(2+) transport with kaolinite colloids, except for ionic strength of 0.9 mM. Hence, the presence of kaolinite colloids probably retarded the mobility of Cd(2+) in porous media for higher ionic strengths. Furthermore, retardation factors and K(f) values of both Cd(2+) transport and Cd(2+) co-transport were shown to decrease when ionic strength increased. Interestingly, according to TSM, the fraction of instantaneous sorption sites tends to increase for an increase in ionic strength, which imply that the mechanism of Cd(2+) sorption onto quartz sand can be better described using equilibrium sorption rather than nonequilibrium sorption for an increase in ionic strength.In this study, a groundwater flow cycling in a karst springshed and an interaction between two springs, Spring Creek Springs and Wakulla Springs, through a subground conduit network are numerically simulated using CFPv2, the latest research version of MODFLOW-CFP (Conduit Flow Process). The Spring Creek Springs and Wakulla Springs, located in a marine estuary and 11 miles inland, respectively, are two major groundwater discharge spots in the Woodville Karst Plain (WKP), North Florida, USA. A three-phase conceptual model of groundwater flow cycling between the two springs and surface water recharge from a major surface creek (Lost Creek) was proposed in various rainfall conditions. A high permeable subground karst conduit network connecting the two springs was found by tracer tests and cave diving. Flow rate of discharge, salinity, sea level and tide height at Spring Creek Springs could significantly affect groundwater discharge and water stage at Wakulla Springs simultaneously. Based on the conceptual model, a numerical hybrid discrete-continuum groundwater flow model is developed using CFPv2 and calibrated by field measurements. Non-laminar flows in conduits and flow exchange between conduits and porous medium are implemented in the hybrid coupling numerical model. Time-variable salinity and equivalent freshwater head boundary conditions at the submarine spring as well as changing recharges have significant impacts on seawater/freshwater interaction and springs' discharges. The developed numerical model is used to simulate the dynamic hydrological process and quantitatively represent the three-phase conceptual model from June 2007 to June 2010. Simulated results of two springs' discharges match reasonably well to measurements with correlation coefficients 0.891 and 0.866 at Spring Creeks Springs and Wakulla Springs, respectively. The impacts of sea level rise on regional groundwater flow field and relationship between the inland springs and submarine springs are evaluated as well in this study.For decades, no cancer therapy had been shown to improve average survival in metastatic melanoma. Two critical events have occurred, the discovery of melanoma driver mutation subsets and the discovery of immune checkpoint inhibitors, which have allowed for the development of modern, effective therapies. These findings have facilitated a rapid emergence of novel therapeutics for the disease with multiple FDA approvals in the last several years. The drugs vemurafenib, trametinib, and dabrafenib, which inhibit the commonly mutated BRAF pathway, have been approved based on improvements in survival outcomes. Agents that block immune checkpoints on lymphocytes allowing for immune cell activity against melanoma have also been approved based on improved survival outcomes such as ipilimumab and nivolumab. Pembrolizumab, another immune checkpoint inhibitor, has also been approved based on the response rate and duration of response in a phase 1 trial. Further agents and combinations of approved agents are positioned to possibly further increase this tally of approved drugs. This review will discuss recently approved novel agents and select drugs in development in advanced melanoma.

As a β-adrenoceptor antagonist (β-blocker), esmolol can reduce cardiac output and the phosphodiesterase III inhibitor milrinone has been shown to improve heart contractility in patients with septic shock. This study was performed to assess the effects of esmolol combined with milrinone in patients with severe sepsis.

This prospective randomized study was conducted in patients with severe sepsis in the intensive care unit of the Jiangxi Provincial People's Hospital (Nanchang, Jiangsu, China) between June 2013 and June 2014. Patients were randomly divided into control (C), milrinone (M), and milrinone-esmolol (ME) groups. The primary outcome was the rate of controlling the heart rate (HR) to achieve target levels. Secondary outcomes included the 28-day survival rate and changes in hemodynamic variables, organ function variables, myocardial injury markers, and the serum levels of proinflammatory factors.

A total of 90 patients with severe sepsis were included in this study (30 per group). The HR in the ME group was lower than in the M and C groups after 12 h. The rate of successful HR control during the first 96 h was significantly higher in the ME group (60.0 vs. 33.3 % in the M group, vs. 26.7 % in the C group). this website Also, patients in the ME group had higher 28-day overall survival compared with the M (Log rank statistic = 5.452; P = 0.020) and C groups (Log rank statistic = 10.206; P = 0.001). Additionally, several variables showed significant improvement in the ME group 96 h after treatment compared with the M and C groups (P < 0.05).

Combination therapy with milrinone and esmolol could improve cardiac function and the 28-day survival rate in patients with severe sepsis.

Combination therapy with milrinone and esmolol could improve cardiac function and the 28-day survival rate in patients with severe sepsis.

This study aimed to describe the prescription pattern of selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) in an Italian setting, focusing on therapy duration, switching and adherence.

Historic cohort study, based on administrative databases of three Italian local health-units, was conducted. Patients with a prescription of antidepressants (ADs) in 2009 were enrolled and grouped into (1) naïve, (2) already in treatment with the same drug and (3) already in treatment with a different drug. Therapy duration, switching and adherence [as medication possession ratio-(MPR)] were evaluated. A logistic regression model was performed to identify predictors of adherence.

There were 88,755 subjects recruited 37 % naïve, 58 % already in treatment with the same drug and 4 % with different drug. A treatment duration of ≤3 months was found in 41 % of naïve patients, whereas the majority of patients already in treatment had a duration of ≥6 months. Switches occshort duration and a low adherence of AD therapies, especially at the initiation of treatment. Physicians should carefully balance the need to prescribe these drugs, considering the great likelihood of a short duration of treatment and a very low level of adherence.