Thyroid morphology in lethal non-thyroidal illness: a post-mortem study

OBJECTIVE: Non-thyroidal illness (NTI) is associated with alterations in thyroid hormone metabolism. Whether morphological changes of the thyroid gland accompany NTI is unknown. The aim of the present study was to describe thyroid morphology in patients with lethal non-thyroidal disease. DESIGN: In an autopsy study 267 cases have been examined. METHODS: Clinical data were obtained from medical records. Subjects were patients with chronic disease (group A), intensive care patients (group B) or persons who had died suddenly without pre-existing illnesses (group C). Patients (n = 93) who did not fit into one of these categories and subjects with pre-existing thyroid disorders were excluded. Thyroid histology was assessed semi-quantitatively: grade I <25%, grade II 25--50% or grade III >75% occupation of the thyroid gland by follicles with a diameter <200 microm. RESULTS: Mean thyroid weight was 19.9 g in group A (n=75, age 19--96 (median 75) years, 48 males); 25.7 g in group B (n=64, age 24--93 (median 69) years, 43 males); and 26.0 g in group C (n=35, age 31--89 (median 69) years, 22 males) (P<0.0005, A vs B/C). Grade I thyroid histology was present in 6 out of 75 patients with chronic illness, in 3 out of 64 intensive care patients and in 33 out of 35 sudden-death subjects. Grade III thyroid histology occurred in 30 out of 75 chronically ill patients, in 17 out of 64 intensive care patients and in 0 out of 35 sudden-death subjects (P<0.0005, C vs A/B). CONCLUSIONS: NTI is associated with reduced thyroid follicular size that is accompanied by lower thyroid weight in chronically ill patients but not significantly in intensive care patients

Neutrophil-guided dosing of anthracycline-cyclophosphamide-containing chemotherapy in patients with breast cancer: a feasibility study

The aim of this study was to investigate whether neutrophil-guided dose escalation of anthracycline–cyclophosphamide-containing chemotherapy (ACC) for breast cancer is feasible, in order to optimize outcome. Breast cancer patients planned for 3-weekly ACC were enrolled in this study. The first treatment cycle was administered in a standard BSA-adjusted dose. The absolute neutrophil count was measured at baseline and at day 8, 11 and 15 after administration of ACC. For patients with none or mild (CTC grade 0–2) neutropenia and no other dose-limiting toxicity, we performed a 10–25 % dose escalation of the second cycle with the opportunity to a further 10–25 % dose escalation of the third cycle. Thirty patients were treated in the adjuvant setting with either FE100C (n = 23) or AC (n = 4), or in the palliative setting with FAC (n = 3). Two out of 23 patients (9 %) treated with FEC did not develop grade 3–4 neutropenia after the first treatment cycle. Dose escalation was performed in these two patients (30 % in one and 15 % in the other patient). During dose escalation, there were no complications like febrile neutropenia. No patients treated with FAC or AC could be escalated, since all of them developed grade 3–4 neutropenia. We conclude that asymptomatic grade 3–4 neutropenia is likely to be achieved in the majority of patients with breast cancer treated with ACC according to presently advocated BSA-based dose levels. Escalation of currently advocated ACC doses without G-CSF, with a target of grade 3–4 neutropenia, is feasible, but only possible in a small proportion of patients. EudraCT 2010-020309-33

Incidence and type of complications in non-operated patients at a surgical ward

<p>Abstract</p> <p>Background</p> <p>This study was designed to analyze a group of non-operated patients admitted to our surgical ward for incidence and type of documented complication. We classified and categorised these complications according to the definition of the Association of Surgeons of the Netherlands (ASN). Our main interest was to identify adverse events for non-operated patients that are caused by medical management and thus preventable.</p> <p>Methods</p> <p>Complications were prospectively collected in our registry, which is part of an electronic medical patient file, and in retrospective analysed. All non-operated patients admitted to our surgical ward between January 2003 and January 2006 have been analysed for type and incidence of complications.</p> <p>Results</p> <p>We recorded 437 complications in 364 (8%) of 4602 non-operated patients and we categorised 196 (45%) of these events in the Hospital - Provider group. In this last category 161 (82%) events were related to medical management and appeared to be preventable. Numerous different types of complications were recorded (n = 69) among the 437 events. Of all the complications, 75 (17%) were found to be a negative effect/failure of therapy.</p> <p>Conclusion</p> <p>The incidence of complications in non-operated patients at our surgical ward was 8%, with a great variety in types of events documented. Almost half of all complications (45%) were recorded in the Hospital-Provider category and appeared to be preventable, which needs further investigation.</p

Hip fractures in elderly people:Surgery or no surgery? A systematic review and meta-analysis

Iintroduction:  Increasing numbers of patients with hip fractures also have advanced comorbidities. A majority are treated surgically. However, a significantly increasing percentage of medically unfit patients with unacceptably high risk of perioperative death are treated nonoperatively. Important questions about patients' prefracture quality of life (QOL) and future perspectives should be asked before considering different treatment options to assess what kind of treatment is advisable in frail elderly high-risk patients with a hip fracture. Objective:  The aim of this review was to provide an overview of differences in mortality, health-related QOL [(HR)QOL], functional outcome, and costs between nonoperative management (NOM) and operative management (OM) of hip fractures in patients above 65 years. Methods:  A systematic literature search was performed in EMBASE, OvidSP, PubMed, Cochrane Central, and Web of Science for observational studies and trials. Observational studies and randomized controlled trials comparing NOM with OM in hip fracture patients were selected. The methodological quality of the selected studies was assessed according to the Methodological Index for Nonrandomized Studies (MINORS) or Furlan checklist. Results:  Seven observational studies were included with a total of 1189 patients, of whom 242 (20.3%) were treated conservatively. The methodological quality of the studies was moderate (mean: 14.7, standard deviation [SD]: 1.5). The 30-day and 1-year mortalities were higher in the nonoperative group (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 1.43-10.96; OR: 3.84, 95% CI: 1.57-9.41). None of the included studies compared QOL, functional outcome, or health-care costs between the 2 groups. Conclusion:  This systematic review and meta-analysis demonstrated that only a few studies with small number of patients comparing NOM with OM were published. A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients. No data were found examining (HR)QOL and costs. Further work is needed to enable shared decision-making and to initiate NOM in frail elderly patients with advanced comorbidity and limited life expectancy

Unraveling the spontaneous zwitterionic copolymerization mechanism of cyclic imino ethers and acrylic acid

We report a high-resolution electrospray ionization mass spectrometric (HR ESI MS) access route leading to in-depths insight into the spontaneous zwitterionic copolymerization mechanism between cyclic imino ethers (i.e. 2-methyl-2-oxazoline (MeOx), 2-ethyl-2-oxazoline (EtOx) or 2-ethyl-2-oxazine (EtOz)) with acrylic acid (AA), exploiting the characteristic species accumulating during the copolymerization as well as tandem mass spectrometry (MS/MS). We demonstrate preferences in α,ω-end group formation by screening various feed ratios of cyclic imino ethers and acrylic acid (e.g. MeOx:AA = 1:1; MeOx:AA = 2:1; MeOx:AA = 1:2). Critically, a calibration curve – based on AA-MeOx-AA dimer – was established allowing for semi-quantitative determination of the end group ratios with different feed ratios of acrylic acid. The formation of, previously suggested, alternating copolymers was confirmed by MS/MS experiments. Deviations from an ideal alternating composition were found to decrease from MeOx to EtOx to EtOz. The results of (semi-quantitative) HR ESI MS and MS/MS measurements suggest, for the first time presented in such precision, a polymerization mechanism for the spontaneous zwitterionic (alternating) copolymerization indicating optimal monomer ratios and pairings

Particle Size Effects in the Selective Hydrogenation of Alkadienes over Supported Cu Nanoparticles

Copper is considered an excellent alternative to noble-metal selective hydrogenation catalysts. Herein, we systematically studied the effect of Cu nanoparticle size (2–10 nm) in the selective hydrogenation of 1,3-butadiene in excess of propene. The catalysts exhibited particle size-dependent activity, with particles above 4 nm being 3 to 4 times more active than the 2 nm ones, and at the same time more selective (up to 99 % at almost full butadiene conversion for 7–10 nm particles). The higher activity of larger particles was ascribed to a higher fraction of kinks and step sites, essential to activate hydrogen. The high selectivity of nanoparticulate Cu catalysts was explained by a very strong preferential adsorption of 1,3-butadiene compared to mono-olefin adsorption on the Cu surface (in particular on larger particles), as proven via adsorption measurements. These findings may guide both testing and catalyst design for reactions where hydrogen surface availability and selectivity play a key role

Ligand-Free Silver Nanoparticles for CO2 Electrocatalytic Reduction to CO

Silver-based catalysts are attractive for electroreduction of CO2 to CO. To understand the electrocatalyst properties, a good control over the nanoparticle size is necessary. Herein, we report a strategy to synthesize highly dispersed, ligand-free silver Ag nanoparticles supported on carbon. We demonstrate that the heat treatment atmosphere and carbon surface chemistry are crucial to control the Ag particle size in the 10–30 nm range. Even at low silver loadings (0.099 m2Ag m−2), Ag nanoparticles outperforms the bulk silver at low overpotentials, leading to a 23.5 % CO Faradaic efficiency at −1.2 V vs RHE. The Ag weight-based activity of the catalysts scales with the inverse particle size, while the Ag surface-specific activity is independent of the particle size in this range. The supported silver nanoparticles can produce a H2 to CO ratio of 2.9 to 1, interesting for further exploration of this type of catalysts for syngas synthesis

Easy Wireless: broadband ad-hoc networking for emergency services

Wireless ad-hoc networks will enable emergency services to continuously overview and act upon the actual status of the situation by retrieving and exchanging detailed up-to-date information between the rescue workers. Deployment of high-bandwidth, robust, self-organising ad-hoc networks will enable quicker response to typical what/where/when questions, than the more vulnerable low-bandwidth communication networks currently in use. This paper addresses a number of results of the Easy Wireless project that enable high bandwidth robust ad-hoc networking. Most of the concepts presented here have been experimentally verified and/or prototyped