Exercise-induced alterations in phospholipid hydrolysis, airway surfactant, and eicosanoids and their role in airway hyperresponsiveness in asthma

The mechanisms responsible for driving endogenous airway hyperresponsiveness (AHR) in the form of exercise-induced bronchoconstriction (EIB) are not fully understood. We examined alterations in airway phospholipid hydrolysis, surfactant degradation, and lipid mediator release in relation to AHR severity and changes induced by exercise challenge. Paired induced sputum

Double-blind randomized proof-of-concept trial of canakinumab in patients with COVID-19 associated cardiac injury and heightened inflammation

AIMS: In coronavirus disease 2019 (COVID-19), myocardial injury is associated with systemic inflammation and higher mortality. Our aim was to perform a proof of concept trial with canakinumab, a monoclonal antibody to interleukin-1β, in patients with COVID-19, myocardial injury, and heightened inflammation. METHODS AND RESULTS: This trial required hospitalization due to COVID-19, elevated troponin, and a C-reactive protein concentration more than 50 mg/L. The primary endpoint was time to clinical improvement at Day 14, defined as either an improvement of two points on a seven-category ordinal scale or discharge from the hospital. The secondary endpoint was mortality at Day 28. Forty-five patients were randomly assigned to canakinumab 600 mg ( CONCLUSION: There was no difference in time to clinical improvement at Day 14 in patients treated with canakinumab, and no safety concerns were identified. Future studies could focus on high dose canakinumab in the treatment arm and assess efficacy outcomes at Day 28

A review of 89 revision stapes surgeries for otosclerosis

SummaryObjectivesThe aim of this study was to identify the causes and the audiometric results of revision surgery following stapedotomies and stapedectomies.Patients and methodsWe retrospectively reviewed a series of 89 revisions after surgery for otosclerosis between 1993 and 2008. Intraoperative findings, causes of failure, and pre- and postoperative audiometric results were noted retrospectively.ResultsThe leading causes of failure found intraoperatively included dislocated prosthesis and necrosis of the long process of the incus. The average postoperative air–bone gap was 13dB. Closure of the air–bone gap to within 10dB was achieved in 52% of patients.ConclusionStapes revisions had less satisfactory results compared with primary procedures in this series. However, certain precautions during initial surgery should decrease the number of stapes surgery revisions

Age-adjusted D-dimer cut-off in the diagnostic strategy for deep vein thrombosis: a systematic review

BACKGROUND: Studies have indicated that use of an age-adjusted D-dimer cut-off value for patients above 50 years increases utility of the diagnostic strategy for pulmonary embolism. Evidence for the same approach regarding diagnosis of deep vein thrombosis (DVT) is, however, unclear.MATERIALS AND METHODS: A systematic literature review was conducted following the PRISMA Statement guideline to gather the existing knowledge on the use of an age-adjusted D-dimer cut-off in the diagnostic strategy for DVT. Studies were extracted from Medline and the Cochrane Library. The search period ended in November 2016.RESULTS: Out of 73 articles retrieved, only eight studies addressed DVT either specifically or along with PE. None of these were randomized controlled trials, but were either prospective studies of consecutive outpatients or retrospective studies. Despite differences in study design, DVT prevalence, and D-dimer assay used, all studies were in favour of the age-adjusted D-dimer cut-off with negative predictive values (NPV) ranging from 91.8-100% compared to 89.7-100% for the standard D-dimer cut-off. All the studies concluded that use of an age-adjusted D-dimer cut-off resulted in an improved utility, although the results due to heterogeneity in reporting did not allow a direct comparison.CONCLUSION: Use of an age-adjusted D-dimer cut-off for patients above 50 years of age for ruling out DVT seems as safe as using a standard D-dimer cut-off. The recommended (and most used) adjustment is by the formula (patient's age ×10) μg/L.</p

Combined local anesthesia and monitored anesthesia care for cochlear implantation

AbstractIntroductionCochlear implantation has become a routine procedure for patients with hearing loss. In some patients, general anesthesia might be contraindicated due to multiple co-morbidities. We describe a successful protocol for cochlear implantation under local anesthesia with light sedation.Case reportAn 81-year-old patient presented with profound sensorineural hearing loss. Her past medical history revealed ischemic coronaropathy, managed by stenting. After multidisciplinary evaluation and clear adapted information to the patient, surgery was performed under local anesthesia with light sedation and monitored anesthesia care. The procedure lasted 70min, and was without incident and under good conditions for the surgeon. During the intervention, the patient was comfortable. No nausea or vomiting was noted. The postoperative period was smooth and uneventful.ConclusionWe find local anesthesia with light sedation a good alternative to general anesthesia for patients where general anesthesia is contraindicated. An experienced surgical and anesthesiology team is essential to shorten the duration of the procedure