Use of infrared thermography in the detection of superficial phlebitis in adult intensive care unit patients:A prospective single-center observational study

Common methods to detect phlebitis may not be sufficient for patients in the intensive care unit (ICU). The goal of this study was to investigate the feasibility of infrared (IR) thermography to objectively detect phlebitis in adult ICU patients. We included a total of 128 adult ICU-patients in a pilot and subsequent validation study. Median [interquartile range] age was 62 [54-71] years and 88 (69%) patients were male. Severity of phlebitis was scored using the visual infusion phlebitis (VIP)-score, ranging from 0 (no phlebitis) to 5 (thrombophlebitis). The temperature difference (ΔT) between the insertion site and a proximal reference point was measured with IR thermography. In 78 (34%) catheters early phlebitis and onset of moderate phlebitis was observed (VIP-score of 1-3). In both the pilot and the validation study groups ΔT was significantly higher when the VIP-score was ≥1 compared to a VIP-score of 0 (p<0.01 and p<0.001, respectively). Multivariate analysis identified ΔT (p<0.001) and peripheral venous catheter (PVC) dwell time (p = 0.001) as significantly associated with phlebitis. IR thermography may be a promising technique to identify phlebitis in the ICU. An increased ΔT as determined with thermography may be a risk factor for phlebitis

Heme and menaquinone induced electron transport in lactic acid bacteria

<p>Abstract</p> <p>Background</p> <p>For some lactic acid bacteria higher biomass production as a result of aerobic respiration has been reported upon supplementation with heme and menaquinone. In this report, we have studied a large number of species among lactic acid bacteria for the existence of this trait.</p> <p>Results</p> <p>Heme- (and menaquinone) stimulated aerobic growth was observed for several species and genera of lactic acid bacteria. These include <it>Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacilllus brevis, Lactobacillus paralimentarius, Streptococcus entericus </it>and <it>Lactococcus garviae</it>. The increased biomass production without further acidification, which are respiration associated traits, are suitable for high-throughput screening as demonstrated by the screening of 8000 <it>Lactococcus lactis </it>insertion mutants. Respiration-negative insertion-mutants were found with <it>noxA</it>, <it>bd</it>-type cytochrome and menaquinol biosynthesis gene-disruptions. Phenotypic screening and <it>in silico </it>genome analysis suggest that respiration can be considered characteristic for certain species.</p> <p>Conclusion</p> <p>We propose that the <it>cyd</it>-genes were present in the common ancestor of lactic acid bacteria, and that multiple gene-loss events best explains the observed distribution of these genes among the species.</p

Classification and occurrence of clinically significant drug interactions with irinotecan and oxaliplatin in patients with metastatic colorectal cancer

Background: Pharmacokinetic and pharmacodynamic drug interactions with cytotoxic drugs may significantly influence the efficacy and toxicity of chemotherapy. Objective: The purpose of this study was to identify drug interactions with irinotecan and oxaliplatin reported in the literature, to assess their clinical significance, and to examine the occurrence of these interactions in patients with metastatic colorectal cancer treated with either irinotecan or oxaliplatin or both. Methods: To obtain data on drug-drug interactions with irinotecan and oxaliplatin, a literature search of PubMed and EMBASE was conducted using the search terms irinotecan, oxaliplatin, and interactions (English-language studies only published between 1980 and August 2004). The interactions found were subsequently classified for documentation evidence and severity of clinical effect, according to a 5-level classification system of a standard reference text, by a study panel of medical oncologists and clinical pharmacists. Comedication of patients who were treated with irinotecan or oxaliplatin, or both, was then examined to determine the occurrence of clinically significant interactions. Results: Ninety-eight patients (50 women, 48 men; mean age, 60 years) were included in the study. Seventeen interactions with irinotecan were found in the literature, and 11 were classified as clinically significant. Only 1 nonspecific, clinically significant interaction was identified for oxaliplatin. Irinotecan-treated patients received a mean of 8 different comedications and oxaliplatin-treated patients received a mean of 6. Apart from antiemetic and antidiarrheal drugs that were prescribed for treatment-related toxicities, only 1 patient appeared to be exposed to a possible clinically significant interaction (between irinotecan and phenytoin). Conclusions: Eleven of the 17 interactions with irinotecan that were found in the literature were classified as clinically significant versus 1 clinically significant interaction with oxaliplatin. The occurrence of these interactions in the study patients with metastatic colorectal cancer was low. For medication surveillance purposes, however, the significant interactions should be considered in clinical practice. Copyright (c) 2005 Excerpta Medica, Inc

20 jaar semencryopreservatie: haalbaarheid en verwijspatronen

Treatment of cancer can affect spermatogenesis resulting in infertility. Semen cryopreservation prior to gonadotoxic treatment can be offered to secure future fertility in male cancer patients. During 20 years 1,018 patients referred for semen cryopreservation in fertile age with Hodgkin disease (n = 194), non-Hodgkin lymphoma (n = 110), leukemia (n = 126) and testicular germ cell tumor (n = 588) were followed up. Incidence of these cancers and incidence of regional semen cryopreservation was used to calculate a referral rate. Semen cryopreservation was successful in 856 of 1,018 patients (84.1%). Median yearly referral rate was respectively 17% and 31% in hematological malignancies and testicular germ cell tumor. Regional referral rate in hematological malignancies dropped dramatically after 2005 to a minimum of 2% in 2009. The incidence of TGCT and referral rate for fertility preservation in these patients increased over time. Our result show that referral of for semen cryopreservation in patients with hematological malignancies in fertile age is suboptimal.Behandeling van kanker kan de spermatogenese aantasten, met infertiliteit tot gevolg. Semencryopreservatie voorafgaand aan gonadotoxische behandeling kan de vruchtbaarheid van mannelijke kankerpatiënten veiligstellen. Gedurende 20 jaar zijn 1.018 patiënten tussen 12 en 50 jaar oud, met Hodgkin-lymfoom (n= 194), non-Hodgkin lymfoom (n=110), leukemie (n= 126) of testiculaire kiemceltumoren (n= 588) verwezen naar één centrum voor semencryopreservatie. De incidentie van deze kankertypen in het adherentiegebied en de incidentie van regionale semencryopreservatie werd gebruikt om een verwijsratio te berekenen. Semencryopreservatie was succesvol bij 856 van de 1.018 patiënten (84,1%). De mediane jaarlijkse verwijsratio bij hematologische maligniteiten en testiculaire stamceltumoren was respectievelijk 17% en 31%. De regionale verwijzing bij hematologische maligniteiten daalde na 2005 fors, tot een minimum van 2% in 2009, terwijl deze toenam bij testiculaire kiemceltumoren. Onze resultaten tonen aan dat verwijzing voor semencryopreservatie bij patiënten met een hematologische maligniteit in de fertiele leeftijd suboptimaal is

Microcystin-LR equivalent concentrations in fish tissue during a postbloom Microcystis exposure in Loskop Dam, South Africa

The effects of a decomposing cyanobacteria bloom on water quality and the accumulation of microcystin-LR equivalent toxin in fish at Loskop Dam were studied in May 2012. Enzyme-linked immunosorbent assay [ELISA] was used to confirm the presence of microcystin-LR equivalent in the water and to determine the microcystin (MCYST) concentration in the liver and muscle of fish. The lowest concentration of extracellular MCYST-LR equivalent was recorded in the lacustrine zone, where no cyanobacterial cells were observed, while the highest concentration (3.25 μg l−1), 3.25 higher than World Health Organization standard, was observed in the riverine zone. Extremely high MCYST-LR equivalent concentrations of 1.72 μg MCYST-LReq kg−1 in the liver and 0.19 μg kg−1 in muscles of Labeo rosae, and 2.14 μg MCYST-LReq kg−1 in the liver and 0.17 μg kg−1 in muscles of Oreochromis mossambicus, indicate that the consumption of sufficient fish biomass might cause severe adverse effects in humans. Microscopic analyses of the stomach content of both fish species revealed low numbers of cyanobacterial Microcystis aeruginosa cells in comparison to other phytoplankton. The extracellular MCYST-LR equivalent of the decomposing bloom may have played a major role in the high levels observed in the livers of the two fish species. These findings are important for all downstream water users.The National Research Foundation (NRF; TTK2006062100013); Council for Scientific and Industrial Research; Department of Genetics, University of Stellenbosch; and the Department of Biodiversity, University of Limpopo as well as the Belgian Vlaamse Interuniversitaire Raad University Development Cooperation funding programme.http://www.tandfonline.com/loi/taas20hb2016Paraclinical Science

Salvage surgery for local failures after stereotactic ablative radiotherapy for early stage non-small cell lung cancer

markdownabstract__Introduction:__ The literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited. We describe our experience with salvage surgery in nine patients who developed a local recurrence following SABR for early stage non-small cell lung cancer (NSCLC). __Methods:__ Patients who underwent surgical salvage for a local recurrence following SABR for NSCLC were identified from two Dutch institutional databases. Complications were scored using the Dindo-Clavien-classification. __Results:__ Nine patients who underwent surgery for a local recurrence were identified. Median time to local recurrence was 22 months. Recurrences were diagnosed with CT- and/or 18FDG-PET-imaging, with four patients also having a pre-surgical pathological diagnosis. Extensive adhesions were observed during two resections, requiring conversion from a thoracoscopic procedure to thoracotomy during one of these procedures. Three patients experienced complications post-surgery; grade 2 (N = 2) and grade 3a (N = 1), respectively. All resection specimens showed viable tumor cells. Median length of hospital stay was 8 days (range 5-15 days) and 30-day mortality was 0 %. Lymph node dissection revealed mediastinal metastases in 3 patients, all of whom received adjuvant therapy. __Conclusions:__ Our experience with nine surgical procedures for local recurrences post-SABR revealed two grade IIIa complications, and a 30-day mortality of 0 %, suggesting that salvage surgery can be safely performed after SABR

Risk of recurrent venous thromboembolism in patients with HIV infection:A nationwide cohort study

Background Multiple studies have described a higher incidence of venous thromboembolism (VTE) in people living with an HIV infection (PWH). However, data on the risk of recurrent VTE in this population are lacking, although this question is more important for clinical practice. This study aims to estimate the risk of recurrent VTE in PWH compared to controls and to identify risk factors for recurrence within this population. Methods and findings PWH with a first VTE were derived from the AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort (2003-2015), a nationwide ongoing cohort following up PWH in care in the Netherlands. Uninfected controls were derived from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA) follow-up study (19992003), a cohort of patients with a first VTE who initially participated in a case-control study in the Netherlands who were followed up for recurrent VTE. Selection was limited to persons with an index VTE suffering from deep vein thrombosis in the lower limbs and/or pulmonary embolism (PE). Participants were followed from withdrawal of anticoagulation to VTE recurrence, loss to follow-up, death, or end of study. We estimated incidence rates, cumulative incidence (accounting for competing risk of death) and hazard ratios (HRs) using Cox proportional hazards regression, adjusting for age, sex, and whether the index event was provoked or unprovoked. When analyzing risk factors among PWH, the main focus of analysis was the role of immune markers (cluster of differentiation 4 [CD4]+ T-cell count). There were 153 PWH (82% men, median 48 years) and 4,005 uninfected controls (45% men, median 49 years) with a first VTE (71% unprovoked in PWH, 34% unprovoked in controls) available for analysis. With 40 VTE recurrences during 774 person-years of follow-up (PYFU) in PWH and 635 VTE recurrences during 20,215 PYFU in controls, the incidence rates were 5.2 and 3.1 per 100 PYFU (HR: 1.70, 95% CI 1.23-2.36, p = 0.003). VTE consistently recurred more frequently per 100 PYFU in PWH in all predefined subgroups of men (5.6 versus 4.8), women (3.6 versus 1.9), and unprovoked (6.0 versus 5.2) or provoked (3.1 versus 2.1) first VTE. After adjustment, the VTE recurrence risk was higher in PWH compared to controls in the first year after anticoagulant discontinuation (HR: 1.67, 95% CI 1.04-2.70, p = 0.03) with higher cumulative incidences in PWH at 1 year (12.5% versus 5.6%) and 5 years (23.4% versus 15.3%) of follow-up. VTE recurred less frequently in PWH who were more immunodeficient at the first VTE, marked by a better CD4+ T-cell recovery on antiretroviral therapy and during anticoagulant therapy for the first VTE (adjusted HR: 0.81 per 100 cells/mm3 increase, 95% CI 0.67-0.97, p = 0.02). Sensitivity analyses addressing potential sources of bias confirmed our principal analyses. The main study limitations are that VTEs were adjudicated differently in the cohorts and that diagnostic practices changed during the 20-year study period. Conclusions Overall, the risk of recurrent VTE was elevated in PWH compared to controls. Among PWH, recurrence risk appeared to decrease with greater CD4+ T-cell recovery after a first VTE. This is relevant when deciding to (dis)continue anticoagulant therapy in PWH with otherwise unprovoked first VTE. Author summary Why was this study done? The HIV pandemic affects approximately 40 million people and causes significant morbidity, including a markedly increased risk of a venous thromboembolism (VTE). The recurrence risk of VTE in people living with HIV (PWH) is unknown, although this risk drives the anticoagulant therapy duration after a first VTE. Our study determined the recurrent VTE risk in PWH compared to uninfected controls. What did the researchers do and find? We performed an observational cohort study using data from the national ATHENA PWH cohort (2003-2015) in the Netherlands and the Dutch Multiple Environmenta

Salvage surgery for local failures after stereotactic ablative radiotherapy for early stage non-small cell lung cancer

__Introduction:__ The literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited. We describe our experience with salvage surgery in nine patients who developed a local recurrence following SABR for early stage non-small cell lung cancer (NSCLC). __Methods:__ Patients who underwent surgical salvage for a local recurrence following SABR for NSCLC were identified from two Dutch institutional databases. Complications were scored using the Dindo-Clavien-classification. __Results:__ Nine patients who underwent surgery for a local recurrence were identified. Median time to local recurrence was 22 months. Recurrences were diagnosed with CT- and/or 18FDG-PET-imaging, with four patients also having a pre-surgical pathological diagnosis. Extensive adhesions were observed during two resections, requiring conversion from a thoracoscopic procedure to thoracotomy during one of these procedures. Three patients experienced complications post-surgery; grade 2 (N = 2) and grade 3a (N = 1), respectively. All resection specimens showed viable tumor cells. Median length of hospital stay was 8 days (range 5-15 days) and 30-day mortality was 0 %. Lymph node dissection revealed mediastinal metastases in 3 patients, all of whom received adjuvant therapy. __Conclusions:__ Our experience with nine surgical procedures for local recurrences post-SABR revealed two grade IIIa complications, and a 30-day mortality of 0 %, suggesting that salvage surgery can be safely performed after SABR

How central obesity influences intra-abdominal pressure:a prospective, observational study in cardiothoracic surgical patients

Background: Intra-abdominal hypertension (IAH) is frequently present in critically ill patients and is an independent predictor for mortality. Better recognition of clinically important thresholds is necessary. Increased intra-abdominal pressure (IAP) is associated with renal dysfunction, and renal failure is one of the most consistently described organ dysfunctions associated with IAH. Obesity is also associated with kidney injury. The underlying mechanisms are not yet fully understood. Increased IAP may be a link in this association. The aim of this study was firstly to find the range in values of intra-abdominal pressure (IAP) in cardiothoracic surgery patients a secondly to investigate the relationship between central obesity, body mass index (BMI) and IAP and thirdly to investigate the relationship between IAP, inflammation and renal function in this population. Methods: Consecutive adult patients admitted to the cardiothoracic unit of the intensive care unit (ICU) after undergoing elective cardiothoracic surgery were included in this prospective, observational study. C-reactive protein (CRP) as a marker of inflammation and serum creatinine as a marker of renal function were measured pre- and postoperatively. Estimated glomerular filtration rates were calculated pre-and postoperatively. BMI was calculated. Waist circumference (WC), hip circumference (HC) and transvesical IAP were measured once directly after admission to the ICU postoperatively. Waist/ hip ratio (WHR) was calculated (WC divided by HC). Three definitions of central obesity were used. Central obesity was defined according to WC, WHR or median WHR. Results: In total, 186 patients undergoing cardiothoracic surgery were included. Mean IAP was 9.1 mmHg (SD 4.4). IAP = 12 mmHg was observed in 50 patients (26.9 %). IAP > 20 mmHg was measured in 4 patients (2.2 %). There was a positive correlation between IAP and BMI (r(2) = 0.05, p = 0.003). Correlations between IAP and WC (r(2) = 0.02, p = 0.054) and between IAP and WHR (r(2) = 0.01, p = 0.173) were not significant. There were no correlations between pre-or postoperative CRP and IAP (r(2) = 2.3 x 10(-4), p = 0.839 and r(2) = 0.013, p = 0.117, respectively). In obese patients postoperative CRP was significantly higher than in non-obese patients (p = 0.034). There were no correlations between pre-operative serum creatinine and IAP (r(2) = 3.3 x 10(-5), p = 0.938) or postoperative serum creatinine and IAP (r(2) = 0.003, p = 0.491). Conclusions: The range in IAP in patients undergoing cardiothoracic surgery was wide. There was a positive correlation between IAP and BMI. Correlations between IAP and indices for central obesity were not significant. In a multiple regression model BMI was a better predictor of IAP than WHR in this population. There were no correlations between pre- or postoperative CRP and IAP. Furthermore, this study did not find evidence for a relation between IAP and pre- and postoperative serum creatinine

Puddle formation, persistent gaps, and non-mean-field breakdown of superconductivity in overdoped (Pb,Bi)2Sr2CuO6+{\delta}

The cuprate high-temperature superconductors exhibit many unexplained electronic phases, but it was often thought that the superconductivity at sufficiently high doping is governed by conventional mean-field Bardeen-Cooper-Schrieffer (BCS) theory[1]. However, recent measurements show that the number of paired electrons (the superfluid density) vanishes when the transition temperature Tc goes to zero[2], in contradiction to expectation from BCS theory. The origin of this anomalous vanishing is unknown. Our scanning tunneling spectroscopy measurements in the overdoped regime of the (Pb,Bi)2Sr2CuO6+{\delta} high-temperature superconductor show that it is due to the emergence of puddled superconductivity, featuring nanoscale superconducting islands in a metallic matrix[3,4]. Our measurements further reveal that this puddling is driven by gap filling, while the gap itself persists beyond the breakdown of superconductivity. The important implication is that it is not a diminishing pairing interaction that causes the breakdown of superconductivity. Unexpectedly, the measured gap-to-filling correlation also reveals that pair-breaking by disorder does not play a dominant role and that the mechanism of superconductivity in overdoped cuprate superconductors is qualitatively different from conventional mean-field theory