Does the revised cardiac risk index predict cardiac complications following elective lung resection?

Background: Revised Cardiac Risk Index (RCRI) score and Thoracic Revised Cardiac Risk Index (ThRCRI) score were developed to predict the risks of postoperative major cardiac complications in generic surgical population and thoracic surgery respectively. This study aims to determine the accuracy of these scores in predicting the risk of developing cardiac complications including atrial arrhythmias after lung resection surgery in adults. Methods: We studied 703 patients undergoing lung resection surgery in a tertiary thoracic surgery centre. Observed outcome measures of postoperative cardiac morbidity and mortality were compared against those predicted by risk. Results: Postoperative major cardiac complications and supraventricular arrhythmias occurred in 4.8% of patients. Both index scores had poor discriminative ability for predicting postoperative cardiac complications with an area under receiver operating characteristic (ROC) curve of 0.59 (95% CI 0.51-0.67) for the RCRI score and 0.57 (95% CI 0.49-0.66) for the ThRCRI score. Conclusions: In our cohort, RCRI and ThRCRI scores failed to accurately predict the risk of cardiac complications in patients undergoing elective resection of lung cancer. The British Thoracic Society (BTS) recommendation to seek a cardiology referral for all asymptomatic pre-operative lung resection patients with > 3 RCRI risk factors is thus unlikely to be of clinical benefit

Evolution of Fermi surface and normal-state gap in chemically substituted cuprates Bi2_{2}Sr2−x_{2-x}Bix_{x}CuO6+δ_{6+\delta}

We have performed a systematic angle-resolved photoemission study of chemically substituted cuprates Bi$_{2}$Sr$_{2-x}$Bi$_{x}$CuO$_{6+\delta}$. We observed that the Fermi surface area shrinks linearly with Bi substitution content $x$, reflecting the electron doping nature of this chemical substitution. In addition, the spectral linewidth broadens rapidly with increasing $x$, and becomes completely incoherent at the superconducting-insulating boundary. The d-wave-like normal-state gap observed in the lightly underdoped region gradually evolves into a large soft gap, which suppresses antinodal spectral weight linearly in both the excitation energy and temperature. Combining with the bulk resistivity data obtained on the same samples, we establish the emergence of the Coulomb gap behavior in the very underdoped regime. Our results reveal the dual roles, doping and disorder, of off-plane chemical substitutions in high-$T_c$ cuprates and elucidate the nature of the quantum electronic states due to strong correlation and disorder.Comment: 4 pages, 4 figure

Increased Expression of Cannabinoid CB1 Receptors in Achilles Tendinosis

BACKGROUND: The endogenous cannabinoid system is involved in the control of pain. However, little is known as to the integrity of the cannabinoid system in human pain syndromes. Here we investigate the expression of the cannabinoid receptor 1 (CB₁) in human Achilles tendons from healthy volunteers and from patients with Achilles tendinosis. METHODOLOGY: Cannabinoid CB₁ receptor immunoreactivity (CB₁IR) was evaluated in formalin-fixed biopsies from individuals suffering from painful Achilles tendinosis in comparison with healthy human Achilles tendons. PRINCIPAL FINDINGS: CB₁IR was seen as a granular pattern in the tenocytes. CB₁IR was also observed in the blood vessel wall and in the perineurium of the nerve. Quantification of the immunoreactivity in tenocytes showed an increase of CB₁ receptor expression in tendinosis tissue compared to control tissue. CONCLUSION: Expression of cannabinoid receptor 1 is increased in human Achilles tendinosis suggesting that the cannabinoid system may be dysregulated in this disorder

Additive Antinociceptive Effects of a Combination of Vitamin C and Vitamin E after Peripheral Nerve Injury

Accumulating evidence indicates that increased generation of reactive oxygen species (ROS) contributes to the development of exaggerated pain hypersensitivity during persistent pain. In the present study, we investigated the antinociceptive efficacy of the antioxidants vitamin C and vitamin E in mouse models of inflammatory and neuropathic pain. We show that systemic administration of a combination of vitamins C and E inhibited the early behavioral responses to formalin injection and the neuropathic pain behavior after peripheral nerve injury, but not the inflammatory pain behavior induced by Complete Freund's Adjuvant. In contrast, vitamin C or vitamin E given alone failed to affect the nociceptive behavior in all tested models. The attenuated neuropathic pain behavior induced by the vitamin C and E combination was paralleled by a reduced p38 phosphorylation in the spinal cord and in dorsal root ganglia, and was also observed after intrathecal injection of the vitamins. Moreover, the vitamin C and E combination ameliorated the allodynia induced by an intrathecally delivered ROS donor. Our results suggest that administration of vitamins C and E in combination may exert synergistic antinociceptive effects, and further indicate that ROS essentially contribute to nociceptive processing in special pain states

Variant Guillain-Barré Syndrome in a Patient with Non-Hodgkin’s Lymphoma

We report a 72-year-old female patient with diffuse large B cell non-Hodgkin’s lymphoma (NHL) with previous treatment with standard chemotherapy presenting as an acute, ascending, sensorimotor polyneuropathy. Nerve conduction studies and lumbar puncture supported a rare, but ominous, axonal variant of Guillain-Barré Syndrome (GBS) known as acute motor and sensory axonal neuropathy (AMSAN), which is distinguished from the more common, acute demyelinating forms of GBS. Previous reports have largely focused on toxicities secondary to chemo- or radiotherapy as a major contributor to the development of acute neuropathies in malignancy. Clinicians should also be mindful of direct neoplastic invasion or, less commonly, paraneoplastic phenomenon, as alternative mechanisms, the latter possibly reflecting immune dysregulation in particularly aggressive lymphomas. At the time of writing, this is the first report in the literature of an axonal variant of GBS in a patient with diffuse large B cell NHL. A discussion regarding common and uncommon neuropathies in haematological malignancies is made, with a brief review of the anecdotal evidence supporting a paraneoplastic association with GBS or its variant forms in the setting of lymphoma

Inflammatory myofibroblastic tumours of the respiratory system and the impact of the varying patterns.

Inflammatory fibroblastic tumours are very rare. They are mostly located in the respiratory system. We present three cases of patients with fibroblastic tumours. The diversity of inflammatory fibroblastic tumours in the respiratory system and the surgical considerations are discussed. Our recommendation is that treatment should include a complete resection to prevent local recurrence and malignant transformation, and follow-up review should reflect the procedure carried out, especially in terms of the anatomical location and the extent of the surgical procedure performed

A 20-year review of pectus surgery: An analysis of factors predictive of recurrence and outcomes

Objectives: We aimed to audit outcomes of pectus surgery and investigate potential predictive factors of pectus recurrence. Methods: A retrospective review of 297 patients who underwent repair of pectus deformity between 1994 and 2014. Patients medical records were reviewed for demographics; type of surgical correction; length of hospital stay; postoperative complications; pectus recurrence and duration of bar stay. Survival analysis methods and repeated events analysis were performed to identify predictor factor for pectus recurrence. Results: A total of 297 patients were included (262 males; 35 females), with a mean age of 19.8 years (range 9 to 45). Mean length of hospital stay was 4.7 days (range 1 to 21). Hundred and sixty-seven patients had surgery for pectus excavatum; 116 for carinatum. Hundred and fifty-three patients received a modified Ravitch without bar insertion; 72 with insertion of bar. Fifty-three patients underwent Nuss repair. Eighty-five patients had their bars removed, on an average of 18.5 months after surgery. The main complications were wound infection (3%) and postoperation bleeding (2.3%). Pectus recurrence rate was 9.4% (28/297). Type of operation was a highly significant factor of pectus first recurrence (P = 0.0002). A repeated event analysis, confirmed that patients treated with a bar were 2.7 times more likely to have further recurrences (P = 0.0078; 95% CI 1.3-5.8). In those patient treated with a bar, time of bar removal was a statistically significant predictive factor of first recurrence (P = 0.0112; OR: 1.054; 95% CI 1.054-1.011). Presence of postoperative complications only marginally failed to yield statistically significant results (P = 0.064). Conclusions: Pectus surgery can be performed with low morbidity. Type of operation, bar insertion and length of bar stay are predictive factors of pectus recurrence

The Effect of Glutamine Supplementation on Microbial Invasion in Surgical Infants Requiring Parenteral Nutrition – Results of a Randomised Controlled Trial

Background: To determine whether parenteral plus enteral glutamine supplementation influences microbial invasion in surgical infants requiring parenteral nutrition. // Methods: An ethically-approved prospective double-blind randomised controlled trial studying surgical infants receiving parenteral nutrition for at least five days for congenital or acquired intestinal anomalies (July 2009 – March 2012). Infants were randomised to receive either glutamine supplementation (parenteral plus enteral; total 400mg/kg/day) or isonitrogenous control. The primary endpoint was microbial invasion evaluated after five days of supplementation and defined as either: i) positive conventional blood culture; ii) evidence of microbial DNA in blood (PCR); iii) plasma endotoxin level ≥50 pg/mL; or iv) plasma level of lipopolysaccharide-binding protein (LBP) ≥50 ng/mL. Data are given as median (range) and compared by binary logistic regression. // Results: Sixty infants were randomised and reached the primary endpoint. 25 patients had congenital/neonatal intestinal obstruction, 19 had anterior abdominal wall defects, 13 had necrotising enterocolitis. Thirty six infants showed some evidence of microbial invasion during the study: 17 of these were not detected by conventional blood culture. There was no significant difference between the two groups in the primary outcome: evidence of microbial invasion after five days was found in 9/31 in the control group and 8/29 in the glutamine group: odds ratio 0.83 (0.24 – 2.86; p=0.77). // Conclusion: More than half of surgical infants requiring parenteral nutrition showed evidence of microbial invasion. Approximately half of this was not detectable by conventional blood cultures. Parenteral plus enteral glutamine supplementation had no effect on the incidence of microbial invasion