Concept: Harshad number
Background Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. Methods In a trial conducted at 37 children’s hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. Results The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups. Conclusions Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).
The most common technique used to detect ochratoxin A (OTA) in food matrices is based on extraction, clean-up, and chromatography detection. Different clean-up cartridges, such as immunoaffinity columns (IAC), molecular imprinting polymers (MIP), Mycosep™ 229, Mycospin™, and Oasis® HLB (Hydrophilic Lipophilic balance) as solid phase extraction were tested to optimize the purification for red wine, beer, roasted coffee and chili. Recovery, reproducibility, reproducibility, limit of detection (LOD) and limit of quantification (LOQ) were calculated for each clean-up method. IAC demonstrated to be suitable for OTA analysis in wine and beer with recovery rate >90%, as well as Mycosep™ for wine and chili. On the contrary, MIP columns were the most appropriate to clean up coffee. A total of 120 samples (30 wines, 30 beers, 30 roasted coffee, 30 chili) marketed in Italy were analyzed, by applying the developed clean-up methods. Twenty-seven out of 120 samples analyzed (22.7%: two wines, five beers, eight coffees, and 12 chili) resulted positive to OTA. A higher incidence of OTA was found in chili (40.0%) more than wine (6.6%), beers (16.6%) and coffee (26.6%). Moreover, OTA concentration in chili was the highest detected, reaching 47.8 µg/kg. Furthermore, three samples (2.5%), two wines and one chili, exceeded the European threshold.
The discovery and identification of Ovis aries (sheep) miRNAs will further promote the study of miRNA functions and gene regulatory mechanisms. To explore the microRNAome (miRNAome) of sheep in depth, samples were collected that included eight developmental stages: the longissimus dorsi muscles of Texel fetuses at 70, 85, 100, 120, and 135 days, and the longissimus dorsi muscles of Ujumqin fetuses at 70, 85, 100, 120, and 135 d, and lambs at 0 (birth), 35, and 70 d. These samples covered all of the representative periods of Ovis aries growth and development throughout gestation (about 150 d) and 70 d after birth. Texel and Ujumqin libraries were separately subjected to Solexa deep sequencing; 35,700,772 raw reads were obtained overall. We used ACGT101-miR v4.2 to analyze the sequence data. Following meticulous comparisons with mammalian mature miRNAs, precursor hairpins (pre-miRNAs), and the latest sheep genome, we substantially extended the Ovis aries miRNAome. The list of pre-miRNAs was extended to 2,319, expressing 2,914 mature miRNAs. Among those, 1,879 were genome mapped to unique miRNAs, representing 2,436 genome locations, and 1,754 pre-miRNAs were mapped to chromosomes. Furthermore, the Ovis aries miRNAome was processed using an elaborate bioinformatic analysis that examined multiple end sequence variation in miRNAs, precursors, chromosomal localizations, species-specific expressions, and conservative properties. Taken together, this study provides the most comprehensive and accurate exploration of the sheep miRNAome, and draws conclusions about numerous characteristics of Ovis aries miRNAs, including miRNAs and isomiRs.
Background: Dentin hypersensitivity (DH) is a painful, exaggerated response to normal stimuli, such as cold, sweetness, and brushing. The aim of the present controlled, randomized, double-masked, non-inferiority clinical trial is to evaluate the effectiveness of cyanoacrylate in the treatment of DH when compared to the application of low-intensity laser. Methods: The study includes 434 sensitive teeth from 62 patients. A total of 216 teeth were treated with laser and 218 with cyanoacrylate. A numeric rating scale was used to record the parameters of pain related to the stimuli at baseline and after the treatment at intervals of 24 hours and 30, 90, and 180 days. Results: Both groups had significant reductions in DH. However, there was no significant difference between the two groups ≤6 months. Intragroup analysis showed that the effect of cyanoacrylate obtained at 24 hours remained for 90 days in response to air-jet test and 30 days for cold-spray test. There was a statistically significant difference between all other intragroup comparisons at the time intervals (P <0.001). Conclusions: It was concluded that cyanoacrylate is as effective as low-intensity laser in reducing DH. In addition, it is a more accessible and low-cost procedure and can be safely used in the treatment of DH.
Objective: This post-hoc analysis of a prospective open-label study investigated patients with restless legs syndrome (RLS) taking approved dosages (1, 2 or 3 mg/24 h) of rotigotine transdermal patch for up to 5 years. Research design and methods: Following 6 weeks' double-blind treatment, patients with moderate-to-severe RLS received open-label rotigotine titrated to optimal dosage. Main outcome measures: Safety was assessed by adverse events (AEs) and efficacy was assessed by the International Restless Legs Syndrome Study Group Rating Scale (IRLS). Results: Of 295 patients who entered the open-label study, 198 (67%) began the maintenance period taking rotigotine dosages of 1 - 3 mg/24 h, or increased their dosage from 0.5 mg in the first 3 months of the maintenance period. Of the 198 patients, 45 patients (23%) completed 5 years of follow-up within this dosage range, 79 patients (40%) had their dosage adjusted outside this range during follow-up and 74 patients (37%) withdrew (including 49 [25%] due to AEs and 6 [3%)] for lack of efficacy). Application site reactions were the most common AEs (102 of 198 patients [52%]), with an incidence of 35% (69 of 198) in year 1, 19% (19 of 102) in year 2, and 4 - 6% during each of years 3 - 5. Mean IRLS total score decreased from 27.1 ± 6.0 at double-blind baseline to 6.5 ± 6.5 at the beginning of maintenance, and to 7.4 ± 8.4 after 5 years' treatment on 1 - 3 mg/24 h (n = 45); 21 patients (47%) were classified as symptom-free (IRLS = 0). Conclusions: Consistent with the results for the overall population, rotigotine transdermal patch at approved dosages of 1 - 3 mg/24 h was generally well tolerated after the first year, with sustained efficacy in patients who completed 5 years of treatment at dosages of 1 - 3 mg/24 h.
Abstract Background: Levocetirizine and desloratadine are mostly used H1-antihistamines in the treatment of allergic disease in 5 mg and 10 mg doses. Objective: In this study, the efficacy of single oral dosages of 5 mg and 10 mg desloratadine and levocetirizine were compared by using histamine-induced wheal and flare reactions. Methods: Eighty healthy volunteers were randomized for 4 double blinded treatment with desloratadine 5 mg-10 mg, levocetirizine 5 mg-10 mg. Wheal and flare responses were produced by histamine. Measurements were performed just before the ingestion of antihistamines (baseline) and afterwards at 30, 60, 240 minutes and 24 hours. The values obtained for each antihistamine were compared with baseline values. Results: It was found that, except the flare reactions at 30th minute, levocetirizine 5 mg and 10 mg suppressed histamine-induced wheal-flare reactions more than desloratadine 5 mg and 10 mg did. There were not any significant differences between desloratadine 5 mg and 10 mg in all periods. Levocetirizine 10 mg suppressed wheal-flare reactions significantly more than levocetirizine 5 mg only at 24th hour. Conclusion: In this study it was observed that levocetirizin 5 mg and 10 mg has a higher activity than desloratadine’s.
BACKGROUND: Disability and pain were assessed in patients with venous leg ulcers treated with split-thickness skin grafts to evaluate to what extent skin grafting improves functional status in this population. METHODS: A prospective, nonrandomized, multicenter case-control study was conducted from July 2008 to December 2010 in two hospitals in Brazil. One hundred patients with venous leg ulcers were divided into two treatment groups of 50 patients each: the control group (conservative treatment) and the surgery group (skin grafting). Patients were assessed at baseline (day 0) and on days 30, 90, and 180. Disability was measured with the Disability Index of the Health Assessment Questionnaire (HAQ-DI). The visual analog scale (VAS) and McGill Pain Questionnaire (MPQ) were used to assess pain. RESULTS: Surgery group patients reported significantly lower (p = 0.0001) overall HAQ-DI scores (lower disability levels) 180 days postoperatively (HAQ-DI = 0.18) compared with baseline (HAQ-DI = 2.65); mean overall HAQ-DI scores for control patients was 1.70 on day 180, with a significant difference between groups (p = 0.0001). The surgery group showed significant improvement on all HAQ-DI categories and reported significantly lower pain intensity (VAS pain scores) on days 30, 90, and 180 compared with controls (p = 0.0001). The MPQ was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in the two groups; there were significant differences between groups on days 30, 90, and 180 (p = 0.0001). CONCLUSIONS: Patients with venous leg ulcers treated with split-thickness skin grafts showed improvement in functional status compared with controls.
Little is known about the effect of serving temperature on saltiness perception in food products such as soups that are typically consumed at high temperature. This study focused on determining whether serving temperature modulates saltiness perception in soup-base products. Eight trained panelists and 62 untrained consumers were asked to rate saltiness intensities in salt water, chicken broth, and miso soup, with serving temperatures of 40, 50, 60, 70, and 80 °C. Neither trained nor untrained panelists were able to find significant difference in the saltiness intensity among salt water samples served at these five different temperatures. However, untrained consumers (but not trained panelists) rated chicken broth and miso soup to be significantly saltier when served at 70 and/or 80 °C compared to when served at 40 to 60 °C. There was an interaction between temperature-related perceived saltiness and preference; for example, consumers who preferred soups served at lower temperatures found soups served at higher temperatures to be less salty. Consumers who frequently consumed hot dishes rated soup samples served at 60 °C as saltier than consumers who consumed hot dishes less frequently. This study demonstrates that soup serving temperature and consumer dietary habits are influential factors affecting saltiness perception of soup.
Deep sequencing of the gut microbiomes of 1135 participants from a Dutch population-based cohort shows relations between the microbiome and 126 exogenous and intrinsic host factors, including 31 intrinsic factors, 12 diseases, 19 drug groups, 4 smoking categories, and 60 dietary factors. These factors collectively explain 18.7% of the variation seen in the interindividual distance of microbial composition. We could associate 110 factors to 125 species and observed that fecal chromogranin A (CgA), a protein secreted by enteroendocrine cells, was exclusively associated with 61 microbial species whose abundance collectively accounted for 53% of microbial composition. Low CgA concentrations were seen in individuals with a more diverse microbiome. These results are an important step toward a better understanding of environment-diet-microbe-host interactions.
Patients more likely to engage in treatment at 30 days when given buprenorphine in the ED, referred for follow-up
- ED management : the monthly update on emergency department management
- Published about 3 years ago
A new randomized trial shows patients who present to the ED with opioid dependence are much more likely to engage in treatment when they receive buprenorphine along with coordinated follow-up than when they just receive a brief intervention and a facilitated referral for treatment or just screening and referral. However, barriers to prescribing are robust, and many ED leaders are not persuaded they should be in the business of providing treatment for addiction. In the trial, at 30 days 78% of patients in the buprenorphine group (89 of 114 patients) were engaged in addiction treatment, compared with just 45% of the patients in the brief intervention group (50 of 111 patients) and 37% of patients in the referral group (38 of 102 patients). To prescribe buprenorphine for addiction disease, providers must undergo training and pass a test to obtain a DEA waiver; they are limited to treating 100 patients. While experts note there are not enough providers to prescribe buprenorphine and provide the follow-up needed to patients with addiction disease, they also acknowledge concerns about drug diversion as well as potential problems with capacity if EDs take a larger role in treating addiction.