scholarly journals 903 React! – An Aide Memoire to Guide Management of Extravasation Injuries

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Muscat ◽  
R Manton ◽  
P Goon
Keyword(s):  
Initial Treatment ◽  
Simple Algorithm ◽  
Treatment Result ◽  
Instructional Video ◽  
Portable Devices ◽  
Loss Of Function ◽  
Initial Management ◽  
Complex Reconstruction ◽  
Poor Outcomes ◽  
Key Steps

Abstract Introduction Intravenous infusions are common practice but come with the risk of extravasation injury. Although overall incidence is low, in those undergoing chemotherapy and in children the risk is much greater (4.7% and 11-58% respectively). These injuries can have severe consequences ranging from skin necrosis to loss of function, some necessitating complex reconstruction. Prompt recognition and treatment reduces the chance of these outcomes. Whilst classically managed by plastic surgeons, many hospitals do not have such services locally. Time-delays introduced by remote referral or inadequate initial treatment result in poor outcomes. We describe a simple algorithm with accompanying video designed to enable confident immediate management. Method We devised a simple acronym describing the basic steps, based on the technique described by Gault. Accompanied by an instructional video demonstrating the technique they form a simple to follow guide. Results The initial treatment of an extravasation injury can be split into the following key steps: These steps, detailed in a simple poster, sit alongside a descriptive video which could be accessed through hospital intranets and video publishing platforms, such as Youtube and Vimeo, can allow potential users access on their portable devices. Conclusions The combination of the REACT! acronym and video provides an example of an easy-to-use teaching tool, when combined with local training, could improve the initial management of extravasation injuries in hospitals where plastic surgery input is not immediately available, reducing poor outcomes.

scholarly journals GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway

Open Medicine ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 024-032
Author(s):  
Jian Wang ◽  
Min Xu ◽  
Dan-Dan Li ◽  
Wujikenayi Abudukelimu ◽  
Xiu-Hong Zhou
Keyword(s):  
Lung Adenocarcinoma ◽  
Biological Function ◽  
Migration And Invasion ◽  
Loss Of Function ◽  
Malignant Phenotype ◽  
Smad Pathway ◽  
Smad3 Phosphorylation ◽  
Poor Outcomes ◽  
Tgf Β1

AbstractThis paper aimed to research the function and in-depth mechanism of GPR37 in lung adenocarcinoma (LUAD). Herein, based on TCGA and Oncomine databases, we revealed that GPR37 was expressed at high levels in LUAD, and upregulation of GPR37 was related to the poor outcomes. Furthermore, biological function experiments in vitro were utilized to assess whether GPR37 impacts malignant phenotype of LUAD cells. Gain- or loss-of-function assays indicated that the upregulation of GPR37 contributed to improving the proliferation, migration, and invasion of LUAD cells in vitro, while knockdown of GPR37 can inhibit the malignant biological behaviors. Then, we found that depletion of GPR37 resulted in a decrease in the expression of TGF-β1 as well as the extents of Smad2 and Smad3 phosphorylation, while overexpression of GPR37 presented opposite outcomes. Altogether, our findings indicated that GPR37 is a potential oncogene of LUAD, and its promoting effects on the malignant progression of LUAD may be realized via TGF-β/Smad pathway.

Treatment Patterns and Outcomes in Bleb-Related Endophthalmitis: A 9-Year Analysis at a Tertiary Eye Center

2020 ◽  
pp. 247412642095396
Author(s):  
Cason B. Robbins ◽  
Henry L. Feng ◽  
Divakar Gupta ◽  
Sharon Fekrat
Keyword(s):  
Initial Treatment ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Light Perception ◽  
Initial Management ◽  
Pars Plana ◽  
Line Loss

Purpose: Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described. Methods: A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA). Results: Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, P = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; P = .044). Conclusions: BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.

scholarly journals Telomere Length Recovery: A Strong Predictor of Overall Survival in Acute Promyelocytic Leukemia

2016 ◽  
Vol 136 (4) ◽  
pp. 210-218 ◽  
Author(s):  
Muhamed Baljevic ◽  
Bogdan Dumitriu ◽  
Ju-Whei Lee ◽  
Elisabeth M. Paietta ◽  
Peter H. Wiernik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Telomere Length ◽  
Acute Promyelocytic Leukemia ◽  
Mononuclear Cells ◽  
Strong Predictor ◽  
Genetic Material ◽  
Promyelocytic Leukemia ◽  
Loss Of Function ◽  
High Risk Disease ◽  
Poor Outcomes

Telomeres are the capping ends of chromosomes that protect the loss of genetic material and prevent chromosomal instability. In human tissue-specific stem/progenitor cells, telomere length (TL) is maintained by the telomerase complex, which consists of a reverse transcriptase catalytic subunit (TERT) and an RNA template (TERC). Very short telomeres and loss-of-function mutations in the TERT and TERC genes have been reported in acute myeloid leukemia, but the role of telomeres in acute promyelocytic leukemia (APL) has not been well established. We report the results for a large cohort of 187 PML/RARα-positive APL patients. No germline mutations in the TERT or TERC genes were identified. Codon 279 and 1062 TERT polymorphisms were present at a frequency similar to that in the general population. TL measured in blood or marrow mononuclear cells at diagnosis was significantly shorter in the APL patients than in healthy volunteers, and shorter telomeres at diagnosis were significantly associated with high-risk disease. For patients who achieved complete remission, the median increase in TL from diagnosis to remission (delta TL) was 2.0 kilobase (kb), and we found delta TL to be the most powerful predictor of overall survival when compared with well-established risk factors for poor outcomes in APL.

Review of the current status of KRAS mutation testing in France in 2011: The Flash-KRAS study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14129-e14129 ◽  
Author(s):  
Pascal Artru ◽  
Michel Ducreux ◽  
Astrid Lièvre ◽  
Michel Guiu ◽  
Jean-Louis Merlin ◽  
...  
Keyword(s):  
Therapeutic Management ◽  
Current Status ◽  
Treatment Result ◽  
National Study ◽  
Wild Type ◽  
First Line ◽  
Initial Management ◽  
Mean Delay ◽  
Kras Status ◽  
Multidisciplinary Group

e14129 Background: KRAS testing is required before treatment initiation of cetuximab in the management of metastatic colorectal cancer (mCRC). The objective of the study was to examine the current situation in 2011 regarding KRAS testing in the initial management of mCRC. Methods: This observational, retrospective, national study was carried out between March 28th and April 8th 2011. During this period 538 patients with mCRC were included across 160 french hospitals. The main objective was to assess the rate of KRAS testing in patients who had started first line (L1) treatment for mCRC. The secondary objectives were to describe the time taken and techniques used for KRAS testing, the possible reasons this test was not requested, to describe and analyse the clinical characteristics of the patients and the planned L1 treatments and those finally received. Results: KRAS testing was carried out for 433 patients (81.1%) and not carried out for 101 patients (18.9%). The main reasons for not requesting the KRAS status were (several answers possible): anti-EGFR not prescribed (n=58), candidate for surgery (n=8), samples not useable (n=5), age of the patient (n=3), other (n=24), data missing (n=13). The genotyping results were available after a mean delay of 23.6 ± 28.2 days. The KRAS testing was requested by an oncologist (45.5%), a gastroenterologist (31%), a surgeon (11.2%), a pathologist (7.2%) or a multidisciplinary group (5.1%) approximately 15 days (-66.5;33.6) median (min ; max) after the diagnosis of metastases, and 15 days (-66.9;3.7) median (min ; max) before the start of L1 treatment. Result of KRAS status had not been received before the L1 treatment was chosen in 56.6% of the patients. For patients with wild-type KRAS status whose therapeutic management was modified after the result of KRAS testing (n=108), this change was a prescription of an anti-EGFR in 77.8% of the cases. Conclusions: The Flash-KRAS study is the first one to assess the current modalities of KRAS genotyping in France. It shows that in 2011 the KRAS test is an integral part of the management of patients with mCRC. Nonetheless, it shows disparities between regions in terms of time to obtain results, which need to be improved to be compatible with the therapeutic management.

Stratification of tumors based on mTOR-pathway biomarkers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23097-e23097
Author(s):  
Jean-Francois Laes ◽  
S Bastien Sauvage ◽  
Gregori Ghitti
Keyword(s):  
Mtor Pathway ◽  
Loss Of Function ◽  
Pathway Activity ◽  
Pten Loss ◽  
Pathway Activation ◽  
Activating Mutation ◽  
Ffpe Samples ◽  
Cancer Types ◽  
Poor Outcomes ◽  
The Relationship

e23097 Background: The mTOR pathway is often activated in human cancers. In this study, a total of 538 samples representing 40 different cancer types were analysed to evaluate the relationship between mTOR pathway activity and mutations in the upstream genes PIK3CA and PTEN. Methods: FFPE samples were analysed both by NGS (PIK3CA, PTEN, mTOR, TSC1, TSC2) and IHC (PTEN, 4pEBP1). Results: Overall, mTOR-pathway activation was identified in 83% of the samples, functional mutations were found in either or both PIK3CA and PTEN genes in 32% of the samples but there was no signification association between them. However when separating samples by cancer types, potential associations were identified. One example is the combination of PIK3CA activating mutation and PTEN loss of function which was associated with mTOR-pathway activation, most notably in the breast-cancer samples. Such combination has been associated with poor outcomes to some treatments (trastuzumab). Conclusions: In conclusion, our results show that stratification of tumors using the combination of mTOR-pathway biomarkers (and combined NGS and IHC technologies in their assessment) is potentially more informative than using a single biomarker to select the best treatment.

Impact of Treatment on Cessation of Air Leakage and Recurrence of Spontaneous Pneumothorax: A Case Control Study

2021 ◽  
Author(s):  
Takahito Nakano ◽  
Hiroyuki Kaneda ◽  
Kento Fukumoto ◽  
Hiroshi Matsui ◽  
Yohei Taniguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Initial Treatment ◽  
Spontaneous Pneumothorax ◽  
Significant Risk ◽  
Lung Collapse ◽  
Air Leak ◽  
Initial Management ◽  
High Degree ◽  
Persistent Air Leak

Abstract Background: Conservative observation with/without oxygen supplementation, aspiration, or tube drainage is selected as an initial treatment for spontaneous pneumothorax. In this study, we have examined the efficacy of initial management for cessation of air leak and prevention of recurrence separately, with consideration of the degree of lung collapse.Methods: Spontaneous pneumothorax in patients who underwent initial management in our institute between January 2006 and December 2015 were included in this retrospective, single-institutional study. Multivariate analyses were conducted to identify risk factors related to the persistent air leak after initial treatment and those related to ipsilateral recurrence after last treatment.Results: In the multivariate analysis for predicting persistent air leak after first treatment, repeated episode of ipsilateral pneumothorax (p = 0.0022), high degree of lung collapse (p = 0.032), and bulla formation (p < 0.0001) were the statistically significant risk factors for treatment failure. Recurrence of ipsilateral pneumothorax was observed in 126 cases. In the multivariate analysis for predicting the recurrence, repeated episode of ipsilateral pneumothorax was the significant risk factor (p = 0.0032).Conclusions: Predicting factors for persistent air leak after initial treatment were recurrence of ipsilateral pneumothorax, high degree of lung collapse, and radiological evidence of bullae. The predictive factor for recurrence after the last treatment was recurrence of ipsilateral pneumothorax. Selection of either observational or interventional approach at initial management did not affect the outcomes evaluated. Therefore, because of treatment invasiveness, observation is recommended to be attempted first in cases sans risk factors.Trial Registration: retrospectively registeredDate of IRB approval: May 28, 2018Number of IRB approval: 2017320

Abstract P701: Depression, OSA, and Anxiety (DOA) Related Healthcare Burden Amongst Stroke Survivors- A National Estimate

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nikhila Veluri ◽  
Batool Sheikh ◽  
Jayasudha Gude ◽  
Rashmi Subhedar ◽  
Pratik Jain ◽  
...  
Keyword(s):  
Native American ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Loss Of Function ◽  
Chi Square ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Discharge Disposition ◽  
Prevalence Of Depression ◽  
Poor Outcomes

Background: Evaluation of mental health of acute ischemic stroke (AIS) patients is crucial to reduce health care burden. Objective: Aim of this study was to evaluate the prevalence and outcomes [morbidity, disability (APRDRG loss of function) and discharge disposition] of DOA amongst AIS patients. Methods: A cross-sectional study was conducted on Nationwide Inpatient Sample from 2003-2017. Adult primary hospitalizations with AIS were extracted and concurrent DOA were identified using ICD-9/10-CM codes. Weighted analysis using Chi-square test and mixed-effect multivariable survey logistic regression was performed to evaluate prevalence and role of DOA to predict the outcomes. Definitions of outcomes were mentioned in Table 1 . Results: Out of a total 5,690,773 AIS hospitalizations, 2.65%, 3.1% and 4.37% had depression, OSA, and anxiety, respectively. In AIS patients, females had higher prevalence of depression [3.43 vs 2.25%] and anxiety [5.92 vs 3.04%] and lower prevalence of OSA [2.21 vs 4.40%] in comparison to males. (p<0.0001) Caucasians had a higher prevalence of depression [3.11 vs 2.12 vs 2.84 vs 1.81 vs 2.54%], OSA [3.43 vs 3.27 vs 2.42 vs 1.60 vs 3.24%], and anxiety [5.26 vs 2.48 vs 3.75 vs 2.13 vs 3.59%] in comparison to AA, Hispanic, Asian, and Native American, respectively. (p<0.0001) Depressed patients had a higher prevalence of morbidity (9 vs 8 vs 5 vs 7%), disability [46 vs 46 vs 35 vs 37%], transfer to non-home [69 vs 58 vs 61 vs 63%] in comparison with OSA, anxiety and non-DOA patients, respectively. (p<0.0001) Depression was associated with 40% higher chance of severe disability (aOR 1.4; 95%CI 1.38-41), morbidity (1.36; 1.33-1.38) and discharge to non-home (1.54; 1.52-1.56). OSA and anxiety had higher odds of non-home discharge amongst post-AIS hospitalizations. (Table 1) Conclusion: DOA is associated with poor outcomes amongst post-AIS patients. Prompt recognition by screening and timely management of DOA may mitigate the adverse outcomes.

Blood Glucose Management in the Neurosurgical Patient

2019 ◽  
pp. 175-189
Author(s):  
Kevin Furlong ◽  
Satya Villuri
Keyword(s):  
Blood Glucose ◽  
Adverse Outcomes ◽  
Treatment Result ◽  
Glucose Levels ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Inpatient Settings ◽  
Poor Outcomes ◽  
Glucose Management

It is well established that both hyperglycemia and hypoglycemia are important markers for poor outcomes and increased inpatient mortality in both critically ill and general floor patients. Similar, hyperglycemia and hypoglycemia are associated with adverse outcomes in neurosurgical patients. However, the presence of central nervous system injury and its treatment result in significant differences in various aspects of blood glucose management in these patients compared to the general patient population. The purpose of this chapter is to give a brief overview of blood glucose management before, during, and after neurosurgery. Particular emphasis is placed on blood glucose goals in the different inpatient settings, management of blood glucose levels in patients taking glucocorticoids, and the role of nutrition in blood glucose management.

Initial Treatment of Closed Metacarpal Fractures

1994 ◽  
Vol 19 (5) ◽  
pp. 597-600 ◽  
Author(s):  
P. J. McMAHON ◽  
D. A. WOODS ◽  
P. D. BURGE
Keyword(s):  
Early Mobilization ◽  
Loss Of Function ◽  
Range Of Movement ◽  
Initial Management ◽  
The Third ◽  
Active Flexion ◽  
Relieve Pain ◽  
Pip Joint ◽  
Hand Volume ◽  
The Mean

A prospective clinical trial compared two forms of initial management for closed stable fractures of the shaft of the finger metacarpals. Patients were randomized to treatment with a compression glove and early mobilization (21 patients) or to immobilization in a plaster splint (21 patients). The mean loss of total active flexion (MP+PIP+DIP) in the second week after injury was 56° in the glove group and 84° in the splint group ( P=0.0036). In the third week, the mean loss of flexion was 23° and 46° respectively ( P=0.0010). Hand volume and PIP joint circumference were significantly smaller in the glove group in the second week but not in the third and fourth weeks. Within each group, however, there was no correlation between range of motion and swelling, suggesting that these were independent variables in this study. The support of the glove helped to relieve pain. Use of a compression glove avoided the loss of function imposed by splintage and was associated with a greater range of movement during the second and third weeks.

scholarly journals Clinical Characteristics and Risk Factors Analysis for the Recurrence of Pelvic Endodermal Sinus Tumors

2021 ◽  
Author(s):  
Yanglong Guo ◽  
Xi Chen ◽  
Qingqing Lin ◽  
Tao Zhu ◽  
Ying-Li Zhang
Keyword(s):  
Initial Treatment ◽  
Embryonal Carcinoma ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Endodermal Sinus Tumor ◽  
Initial Management ◽  
Free Survival ◽  
Platinum Based Chemotherapy ◽  
Sinus Tumor

Abstract Background: This study investigated the clinicopathological characteristics and factors influencing the recurrence of pelvic endodermal sinus tumor. Methods: Fifty-four cases were retrospectively analyzed from at the Zhejiang Cancer Hospital. Imaging and serological indicators were used to determine whether disease recurred, to evaluate progression-free survival, and to compare the influence of related factors on disease recurrence. SPSS 19.0 software was used for statistical analysis. Statistical significance was defined as p < 0.05. Results: The median age at initial treatment was 21 years (range, 11–52 years). Six patients had extragonadal endodermal sinus tumor, and four had histological features of endodermal sinus tumor combined with embryonal carcinoma. Thirty-nine patients underwent fertility-preserving surgery, 18 patients had a childbearing history, and eight patients had residual tumor after initial treatment. Twenty-six patients had a tumor diameter of more than 15 cm, and 30 patients had a serum α‑fetoprotein level greater than 10,000 ng/mL before initial management. The median follow-up time was 47.5 months (range, 14–212 months). During follow-up, 15 patients experience recurrence, with a recurrence rate of 27.8% and a 5-year PFS rate of 61.1%. In univariate analysis, the International Federation of Gynecology and Obstetrics stage (stage III-IV VS. I-II; HR= 10.054 p<0.001), residual tumor (yes VS. no for the first surgery; HR=5.014 p=0.001), histological features (endodermal sinus tumor combined with embryonal carcinoma VS. endodermal sinus tumor; HR=4.130 p=0.018), and use of platinum-based chemotherapy (courses≥3 VS. courses<3; HR= 0.188 p=0.004) were independent factors influencing recurrence; age, childbearing history, tumor site, tumor size, and serum α-fetoprotein level before initial management did not affect recurrence. In multivariate analysis, only stage was an independent risk factor for progression-free survival（stage III-IV VS. I-II; HR=6.923 p=0.019）. Conclusions: Stage is a prognostic factor for recurrence of pelvic endodermal sinus tumor. The first surgery should remove the tumor as completely as possible, and initial treatment should require a sufficient dose and full course of platinum-based chemotherapy, which may reduce the recurrence rate. Patients with endodermal sinus tumor and embryonal carcinoma may have increased susceptibility of recurrence.

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