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Background: Post-operative serum transaminases have been proposed as possible early predictors of morbidity after liver resection. This study aimed to verify the clinical value of post-operative serum transaminases. Methods: Clinical data from 2001 to 2016 in a single non-academic referral HPB center were collected from a prospectively held database. Post-operative day 1 serum aspartate transaminase (AST) and alanine transaminase (ALT) were tested for their relationship with post-operative major morbidity, defined by a Clavien-Dindo score 3 or higher, and mortality. Results: For this analysis, 371 patients were included, including 149 (40%) undergoing major liver resections. In total, 17% of the patients developed major morbidity. Stepwise logistic regression demonstrated that AST, and not ALT, is an independent predictor for major morbidity (p = 0.017). The probability of major morbidity significantly increased with increasing AST values. A threshold value of 242 U/L was found to be predictive for one or more major complications. Conclusions: In this study, post-operative serum AST on day 1 was a predictive factor for major morbidity after liver resection. For patients with low AST value, early discharge could be considered. However, because of the substantial inter-individual variability of AST values, more studies are needed to translate these results into clinical practice. [ABSTRACT FROM AUTHOR]

There were 186 treatment related adverse events (TRAEs) among 25 of 30 participants; 5 participants did not experience a TRAE; 163 of these occurred during combination therapy; 23 during monotherapy in 7 of 17 participants, where 10 participants did not experience a TRAE. B Conclusions: b Bendamustine, rituximab and acalabrutinib front-line therapy for WM is safe and well tolerated and initial clinical results show that this treatment induces a high percentage of VGPRs. Seventeen patients completed combination therapy, 9 completed monotherapy and 2 were followed-up at 18 months (6 months post therapy). [Extracted from the article]

Introduction: Unplanned readmission is a common event after liver resection, and it is a burden for both patients and healthcare policy makers. This study evaluates the incidence of and reasons for unplanned readmission after liver resection, in order to identify possible preventable causes. Methods: In this single-center cohort study, data from patients who underwent liver resection for both malignant and benign indications from 2001 to 2016 at our institute were collected from a database with prospective data. Readmissions were analyzed for their reasons and risk factors. Patients with general complaints with no specific complications were categorized as failure to thrive. Results: In 406 patients, the readmission rate was 11.6%. Most patients were readmitted because of failure to thrive (35%), deep and superficial surgical site infection (28%), or cardiopulmonary complications (15%). A multivariate analysis revealed that unplanned readmission was associated with the occurrence of complications during index admission—with an odds ratio of 4.69 (CI 2.41–9.12, p < 0.001). Conclusion: Readmission occurs in more than 1 in 10 patients after liver resection, and it is associated with a complicated course during index admission. One-third of readmissions occur because of failure to thrive and might be preventable. Future research in strategies to reduce readmission rates should focus on both the prevention of complications during index admission and programs at the interface between primary and secondary care. [ABSTRACT FROM AUTHOR]

Large rivers often bisect geopolitical boundaries where management goals may be at odds for a shared fishery, creating fragmented management zones. Fragmentation due to physical barriers may further impact the fishery by reducing fish passage. Our goal was to estimate basinwide parameters (i.e. movement, survival and capture probabilities) of a large-river species known to move throughout watersheds. We tagged13 892 Channel Catfish in the Red River of the North (Red River) and Lake Winnipeg in Manitoba, Canada, and collected 553 recaptures. We estimated 2.2% of catfish are moving from the Red River to Lake Winnipeg each month and 9.4%, primarily large (>600 mm) individuals, moved upstream through a dam (monthly). Approximately 5.6% of catfish moved to the USA each month, and only one fish returned. Our results suggest the lower reaches of the Red River may be a source population for the USA, where survival is lower, and Lake Winnipeg. The complex movements of Channel Catfish throughout the Red River, across barriers and international boundaries, suggest conservation and management of fish populations should be watershed wide. [ABSTRACT FROM AUTHOR]

Microbiological contaminations and other food safety hazards are omnipresent within the European Union ( EU) and a considerable risk for consumers, particularly in imported meat and meat products. The number of rejections at external EU borders has been increasing in recent years. Official authorities in each member state are therefore obliged to notify border rejections of food and animal feed due to a direct or indirect risk to human or animal health. This study explored the trends and temporal and spatial distribution of notifications on food safety hazards between January 2008 and December 2013 with a special emphasis on microbiological zoonoses in meat and meat products including poultry at border checks resulting from the rapid alert system for food and feed ( RASFF). Results indicated that border rejection notifications are increasing exponentially, frequently due to Salmonella in poultry and shiga-toxin-producing E. coli in meat and meat products. [ABSTRACT FROM AUTHOR]

Clinical research is on the threshold of a new era in which electronic health records ( EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4 CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources. [ABSTRACT FROM AUTHOR]

Anadromous Arctic charr, Salvelinus alpinus (L.), was introduced to a sub- Arctic river-lake system near the village of Kujjuuaq, Nunavik, and the stable isotope values and diets of key resident fish species were used to assess changes in feeding patterns. Stable isotope values for most species did not differ significantly between the pre- and post-introduction periods, with observed shifts being within the bounds of expected natural variation. Lake chub, Couesius plumbeus ( Agassiz), were the single species to show a difference between study periods, with a small but significant increase in δ15N. No significant post-introduction changes were seen in lake trout, Salvelinus namaycush ( Walbaum), omnivory or in any of the assessed quantitative food web metrics. Gut contents of major fish species similarly showed significant temporal overlap between the pre- and post-introduction periods, and there was no significant change in species' weight-length relationships. The minor ecological impact was interpreted in relation to the availability of open niches exploitable by ecological generalists such as Arctic charr. The explanation accords with the known habitat and feeding flexibility of Arctic charr and the ecological immaturity of sub- Arctic lakes known to have driven adaptive variation among Arctic charr. Findings suggest that anadromous Arctic charr may be introduced at moderate densities to other sub- Arctic watersheds without major negative food web consequences for other resident fish species. [ABSTRACT FROM AUTHOR]

Aims: The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment. Methods Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink 'on' vs. 'off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power.Conclusion: The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014. [ABSTRACT FROM AUTHOR]

Screening of broiler flocks for their Campylobacter carriage on farm level and consequently the spread of Campylobacter spp. during slaughtering can help to identify hygiene control points. Therefore, between December 2001 and August 2002 in total 51 broiler flocks from three farms of different geographical regions in Germany were analysed for thermophilic Campylobacter. Campylobacter spp. were isolated from 45% of the broiler flocks examined. Subsequently, 1101 samples were taken from 22 flocks during different stages of processing. Samples were collected from: transport crates before and after cleaning/disinfection, evisceration, post-scalded and post-chilled carcasses and endproducts. Additionally, 45 selected Campylobacter isolates of droppings were genotyped by pulsed-field gel electrophoresis (PFGE). Campylobacter carriage of flocks showed seasonal variation, with the highest contamination rate during the period of June to August. No evidence was found for a horizontal transmission from one broiler flock to the next via a persistent house-contamination. In each positive flock, one to three different genotypes were found. One or two clones dominated isolations obtained from the farm level. The fact that in different flocks indistinguishable isolates of clonal origin were detected during the same rearing period suggested a transmission between the broiler flocks or an intermittent common external source. In one case, isolates of clonal origin were detected in various farms during different rearing periods. Sampling during processing confirmed that the entrance of a positive flock resulted in contamination of the abattoir environment. Campylobacter spp. were isolated from all sampling stages along the processing line, with a percentage of 91.1-100 of isolates at different stages of slaughtering. [ABSTRACT FROM AUTHOR]

Background and purpose: About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. Methods: Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. Results: When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis ≥50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. Conclusions: We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. BACKGROUND: The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. DESIGN: A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. METHODS: The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. RESULTS: Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. CONCLUSIONS: Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless communications. RELEVANCE TO CLINICAL PRACTICE: Nurses in this study support integrating wireless mobile computing technologies into their practice to improve client care. [ABSTRACT FROM AUTHOR]

Despite progress made in the therapy of solid tumors such as breast cancer, the prognosis of patients even with small primary tumors is still limited by metastatic relapse often long after removal of the primary tumor. Therefore, it has been hypothesized that primary tumors shed tumor cells already at an early stage into the blood circulation. A subset of these disseminated tumor cells may persist in a state of so-called “dormancy”. Based on cell culture and animal models, dormancy can occur at two different stages. Single dormant cells are defined as cells with a lack of proliferation and apoptosis with the cells undergoing cell cycle arrest. The micrometastasis model defines tumor cell dormancy as a state of balanced apoptosis and proliferation of micrometastasis resulting in no net increase of tumor mass. Mechanisms leading to a growth activation of dormant tumor cells and the outgrowth of manifest metastases are not completely understood. Genetic predisposition of the dormant cells as well as immunological and angiogenetic influences of the surrounding environment may contribute to this phenomenon. In this review, we summarize findings on different factors for tumor cell dormancy and potential therapeutic implications that should help to reduce metastatic relapse in cancer patients. [ABSTRACT FROM AUTHOR]

Background: Poor ejection fraction (EF) comprises a critical risk factor in cardiac bypass surgery (CABG). It has been unclear, whether biventricular or four-chamber pacing confers benefit upon patients with intact atrioventricular and interventricular conduction especially following surgery. Methods: Twenty-one consecutive patients with an EF <= 35% underwent hemodynamic evaluation (continuous pressures and thermodilution) 3, 6, and 18 hours post-CABG and biatrial (AA), biatrial-right ventricular (AAV), and biatrial-biventricular (AAVV) pacing were compared. Results: Patients (65 ± 9 years) presented with an average EF of 29.5% (15-35%). 514 measurements of cardiac index (CI) were taken. Nineteen patients (91%) showed highly significant increases in CI with AAVV as compared to AA pacing (P < 0,001) at all times post surgery. The increase in CI with pacing mode varied from 6% to 25% and decreased with time following surgery. No consistent difference in CI was seen between four-chamber (AAVV) and biventricular pacing (AVV). The QRS-widths prior to surgery never exceeded 120 ms; postoperatively QRS-complexes widened in all patients on average by 15.9 ms ±6 and returned to starting values by 48 hours. Conclusions: Biventricular pacing improves CI in patients with poor EF following cardiac surgery in the absence of preoperative atrioventricular- or interventricular conduction block. This benefit decreases with time after surgery as the QRS width returns to preoperative values. Four-chamber pacing did not confer additional benefit as compared to biventricular pacing in this series. Biventricular pacing should be considered as an adjunct in patients with critically low EF undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

The author reflects on the various approach in protection against tumor developments. He stated DNA repair serves a dominating role in safeguarding against tumor growth but mismatch repair deficiencies and the consequent microsatellite instability may lead to multi-cancer syndromes. He said that intercellular surveillance is another powerful defense mechanism against tumor, which is based on the interaction between tumor cells and their host environment.

OBJECTIVES: This study evaluated the impact of catheter ablation of the coronary sinus (CS) region during paroxysmal and persistent atrial fibrillation (AF). BACKGROUND: The CS musculature and connections have been implicated in the genesis of atrial arrhythmias. METHODS: Forty-five patients undergoing catheter ablation of AF were studied. The CS was targeted if AF persisted after ablation of pulmonary veins and selected left atrial tissue. CS ablation was commenced endocardially by dragging along the inferior paramitral left atrium. Ablation was continued from within the vessel (epicardial) if CS electrograms had cycle lengths shorter than that of the left atrial appendage. RF energy was limited to 35 W endocardially and 25 W epicardially. The impact of ablation was evaluated on CS electrogram cycle length (CSCL) and activation sequence, atrial fibrillatory cycle length measured in the left atrial appendage (AFCL) and on perpetuation of AF. RESULTS: Endocardial ablation significantly prolonged CSCL by 17 +/- 5 msec and organized the CS activation sequence (from 13% of patients before to 51% after ablation); subsequent epicardial ablation further increased local CSCL by 32 +/- 27 msec (P < 0.001). AFCL prolonged significantly both during endocardial and epicardial ablation (median: 152 to 167 msec P = 0.03) and was associated with AF termination in 16 (35%) patients (46% of paroxysmal and 30% of persistent AF). AFCL prolongation > or =5 msec and/or AF termination was associated with more rapid activity in the CS region originally: P < or = 0.04. CONCLUSION: Catheter ablation targeting both the endocardial and epicardial aspects of the CS region significantly prolongs fibrillatory cycle length and terminates AF persisting after PV isolation in 35% of patients. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with heart failure are characterized by impaired nitric oxide-dependent endothelial vasodilation and, in addition, by reduced renal perfusion. Design We assessed blood concentrations of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) as well as renal haemodynamics to compare normotensive patients with mild heart failure (n = 12, seven males, 70 ± 1 years, 72·0 ± 2·7 kg, 92 ± 2 mmHg, NYHA I/II) and healthy subjects matched with respect to gender, age and body weight (n = 12, seven males, 69 ± 2 years, 72·7 ± 2·5 kg, 88 ± 2 mmHg). Results Plasma ADMA concentration and renovascular resistance (RVR) were significantly higher (P < 0·01) and effective renal plasma flow (ERPF) significantly lower (P < 0·01) in the patients with heart failure (ADMA 4·18 ± 0·42 µmol L-1 , RVR 159 ± 12 mmHg mL-1 min-1 , ERPF 381 ± 26 mL min-1 1·73 m-2 ) as compared with the healthy controls (ADMA 2·38 ± 0·11 µmol L-1 , RVR 117 ± 8 mmHg mL-1 min-1 , ERPF 496 ± 19 mL min-1 1·73 m-2 ). In contrast, plasma concentrations of l-arginine, homocysteine, symmetric dimethylarginine (i.e. the biologically inactive stereoisomer of ADMA) and plasma renin activity were not significantly different in both groups studied. In the multiple regression analysis, only plasma ADMA concentrations independently predicted reduced ERPF (r = -0·57; P < 0·003). Conclusions In normotensive patients with heart failure plasma ADMA concentrations are markedly increased and related to reduced renal perfusion. Thus accumulation of this endogenous nitric oxide inhibitor may play a role in renal pathology in these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: To validate a self-administered 20-item short questionnaire (SQ) for classifying individuals according to their intake of total fat, saturated (SFA), monounsaturated (MUFA), and polyunsaturated fatty acids (PUFA), as well as cholesterol. METHODS: The SQ was sent to a randomly selected subsample of 300 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) in Heidelberg. The SQ was sent back by 244 participants (52.5% women, 47.5% men). Intake of total fat, SFA, MUFA, PUFA, and cholesterol was calculated from a 148-item food frequency questionnaire (FFQ). The intake was compared with the scores computed from the SQ. RESULTS: Spearman's correlation coefficient between the intake estimated from the FFQ and the score from the SQ ranged from r = 0.29 (PUFA) to r = 0.56 (cholesterol). When the participants were assigned to quartiles of intake according to both methods 29-42% were classified into the same quartile, 1-7% of the participants were grossly misclassified. CONCLUSIONS: The SQ demonstrated a good validity with respect to SFA and cholesterol and an acceptable validity with respect to total fat and MUFA, while the results are less good for PUFA. The SQ can be used to classify persons according to their intake into categories of intake. [ABSTRACT FROM AUTHOR]

Background and Purpose: This study was carried out to determine whether high-resolution 3-dimensional prospective-volume-rendered computed tomographic (CT) angiography can replace conventional intra-arterial digital subtractional angiography in the diagnostic evaluation of patients with an acute subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm.Methods: Both techniques were performed in 30 consecutive patients within 2 to 12 hours after their admission to the hospital.Results: In this group of 30 patients, CT angiography with 3-dimensional volume-rendered reconstruction detected 31 aneurysms in 25 patients. Two aneurysms were missed on CT angiography. Conventional angiography detected 33 aneurysms in 27 patients. The authors considered angiograms in 3 patients presenting with SAH as normal. In all cases where an aneurysm was detected on CT angiography, the finding was confirmed by conventional angiography.Conclusions: CT angiography with 3-dimensional post-processing is a sensitive, noninvasive method that provides a 3-dimensional view of intracranial vessels and the aneurysm. It is also very useful in planning either surgical or endovascular treatment. [ABSTRACT FROM AUTHOR]

Arrhythmias associated with preexcitation syndromes and ventricular tachycardia, may both be treated surgically with high efficacy and low mortality when patients are appropriately selected. Intraoperative techniques which rapidly localize critical portions of arrhythmia circuits, and sites of arrhythmogenesis, have improved the efficacy of surgical therapy for cardiac arrhythmias. These techniques include mapping of the cardiac activation sequence, pace mapping, and ice mapping. The success of the procedure is dependent not only on the skill of the surgeon, but also on good communication between the team members, and biomedical engineering backup to maintain the mapping equipment. These mapping techniques, when used to direct the surgeon to perform ablation, resection, or exclusion of the appropriate sites, can lead to effective therapy of cardiac arrhythmias in selected patients. [ABSTRACT FROM AUTHOR]

Discusses the concepts of the nodoventricular accessory pathway from a historical viewpoint. Extensions of the atriooventricular conducting systems within the central fibrous body; Inconsistent findings with the hypotheses on the electrocardiographic and electrophysiological manifestations of the pathways; Overview of studies and formation of an alternate hypotheses; Mechanisms for tachycardia.