Myocardial necrosis in ICU patients with acute non-cardiac disease: a prospective study

Objective: To ascertain if, after an episode of hypotension, unnoticed myocardial necrosis could occur in critical care patients with acute non-cardiac illness and to search for signs of cardiac necrosis. ¶Design: A prospective observational study.¶Setting: General intensive care unit (ICU) at a tertiary level hospital.¶Patients: Thirty-one patients in two groups. Group 1 included 19 patients with severe sepsis/septic shock (ACCP/SCCM Consensus Conference). Group 2 included 12 patients with hypovolemic shock.¶Interventions: Biochemical markers of myocardial necrosis (cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase MB mass (CKMB) and myoglobin) were measured at 12 h (T1), 24 h (T2) and 48 h (T3) after enrollment.¶A standard 12-lead ECG was recorded upon enrollment (T0) and at T2. Anomalous Q-waves or ST segment depression or elevation was considered diagnostic for acute myocardial infarction (AMI). A hypotensive episode (arterial systolic pressure < 90 mmHg at heart rate > 100 bpm) was considered moderate if it lasted 30–60 min or severe if longer than 60 min.¶Measurements and results: At T0 none of the patients had AMI on ECG. At T2 a non-Q AMI developed in five patients. Increased levels of troponin I, myoglobin, CK and CKMB were found in 74.2 %, 96.8 %, 74.2 % and 67.7 % of the patients, respectively. Cardiac troponin I increased in 11 out of 19 septic patients and in all hypovolemic patients. There was a significant difference between the groups (p < 0.05). All biochemical markers increased in relationship to the degree of hypotension with cTnI again showing a significant difference. The longer the hypotensive episode was, the greater was the increase (moderate hypotension: median 1.16; quartiles 0.55–3.44 ng/ml, severe hypotension: median 8.53; quartiles 1.1–20.7 ng/ml; p < 0.05). Abnormal levels of cTnI were more frequent in non-survivors than in survivors (p < 0.05).¶Conclusions: Hypotension may cause cardiac damage in critically ill patients with acute non-cardiac diseases as shown by abnormal levels of cTnI. It is likely that a high number of these myocardial necroses may go unnoticed on the ECG.     

Severe neurodevelopmental disability and healthcare needs among survivors of medical and surgical necrotizing enterocolitis: A prospective cohort study

Purpose

This study characterizes neurodevelopmental outcomes and healthcare needs of extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to ELBW infants without NEC.

Morbidity and mortality among “big” babies who develop necrotizing enterocolitis: A prospective multicenter cohort analysis

Background

Necrotizing enterocolitis (NEC) is classically a disease of prematurity, with less reported regarding morbidity and mortality of this disease among other infants.

Sensor technology implementation for research,treatment, and assessment of eating disorders

Sensor technology has made huge technological advances in the past decade. Many sensor technologies (e.g., wearable wristbands) have been integrated into health research with the ability to substantially improve health outcomes and reduce health care costs. Despite the rapid technological developments in sensor technology, little research has examined sensor technology in eating disorders (EDs). The overarching aim of the current article is to briefly review the literature on sensor technology and health outcomes, including EDs, and discuss several potential ideas for the application of sensor technology in the treatment, assessment, and diagnosis of EDs. We will also present data from a feasibility case study with an ED participant and healthy control providing a brief example of how wearable sensor technology might be implemented in ED research. Overall, we will discuss how sensor technology could be used to improve treatment and assessment of EDs and represents an idea in need of more research in the ED field.     

Barriers experienced by nurses providing smoking cessation support to disadvantaged,young women during and after pregnancy

In Europe, smoking during and after pregnancy is still highly prevalent among socioeconomically disadvantaged women. Nurses caring for these women can play a key role in smoking cessation, but encounter many problems when providing support. This research aims to identify barriers in providing smoking cessation support, experienced by nurses working within a Dutch preventive care programme for disadvantaged young women (VoorZorg), and to understand the underlying reasons of these barriers. Sixteen semi‐structured interviews with nurses were performed. All interviews were recorded, transcribed and analysed deductively and inductively. We found that the VoorZorg programme provided nurses with training, resources and time to deliver smoking cessation support. Yet, nurses experienced important barriers, such as unmotivated clients and support methods that do not fit clients’ needs. Underlying reasons are competing care demands, unsatisfactory training for cessation support, lack of self‐efficacy in attending their clients, and conflicts with own professional attitudes. The results emphasise that nurses’ ability to provide smoking cessation support could be improved by proper training in interventions that fit their clients’ needs, and by time schedules and task definitions that help them to prioritise smoking cessation support over other matters.     

Hypoxia-Targeting Fluorescent Nanobodies for Optical Molecular Imaging of Pre-Invasive Breast Cancer

Purpose

The aim of this work was to develop a CAIX-specific nanobody conjugated to IRDye800CW for molecular imaging of pre-invasive breast cancer.

Procedures

CAIX-specific nanobodies were selected using a modified phage display technology, conjugated site-specifically to IRDye800CW and evaluated in a xenograft breast cancer mouse model using ductal carcinoma in situ cells (DCIS).

Results

Specific anti-CAIX nanobodies were obtained. Administration of a CAIX-specific nanobody into mice with DCIS xenografts overexpressing CAIX showed after 2 h a mean tumor-to-normal tissue ratio (TNR) of 4.3?±?0.6, compared to a TNR of 1.4?±?0.2 in mice injected with the negative control nanobody R2-IR. In DCIS mice, a TNR of 1.8?±?0.1 was obtained. Biodistribution studies demonstrated an uptake of 14.0?±?1.1 %I.D./g in DCIS?+?CAIX tumors, 4.6?±?0.8 %I.D./g in DCIS tumors, while 2.0?±?0.2 %I.D./g was obtained with R2-IR.

Conclusions

These results demonstrate the successful generation of a CAIX-specific nanobody-IRDye800CW conjugate that can be used for rapid imaging of (pre-)invasive breast cancer.

     

Evaluation and clinical validation of an alcohol-based transport medium for preservation and inactivation of respiratory viruses

The clinical and public health importance of influenza and other respiratory viruses has accelerated the development of highly sensitive molecular diagnostics, but data are limited regarding preanalytical stages of diagnostic testing. We evaluated CyMol, an alcohol-based transport medium, for its ability to maintain specimen integrity for up to 21 days of storage at various temperatures; for its ability to inactivate virus; and for its compatibility with antigen- or nucleic acid-based diagnostics for respiratory viruses in clinical samples. In mock-infected samples, both universal transport medium (UTM-RT) and CyMol maintained equivalent viral quantities for at least 14 days at room temperature or colder, whereas a dry swab collection maintained viral quantities only if refrigerated or frozen. CyMol inactivated influenza virus within 5 min of sample immersion. UTM-RT- and CyMol-collected nasal swab specimens from 73 symptomatic students attending a campus health clinic were positive for a respiratory virus in 56.2% of subjects by multiplex PCR testing, including influenza A and B viruses, rhinovirus/enteroviruses, coronaviruses, respiratory syncytial virus, parainfluenza viruses, metapneumovirus, and adenovirus. Detection by PCR was equivalent in UTM-RT- and CyMol-collected specimens and in self- and staff-collected swabs. Direct fluorescent antibody (DFA) testing was substantially less sensitive (23.3%) than multiplex PCR, and DFA testing from UTM-RT-collected swabs was more sensitive than that from CyMol-collected swabs. These data indicate that an alcohol-based transport medium such as CyMol preserves respiratory virus integrity, rapidly inactivates viruses, and is compatible with PCR-based respiratory diagnostics.     

The bidirectional relationship of depression and diabetes: a systematic review

Depression and diabetes are both serious chronic conditions common in Western cultures. These conditions impart a significant burden on the patients and society. Depression is often comorbid with chronic illness, and past research has found an increased prevalence of depressive symptoms in patients with Type 2 Diabetes Mellitus (T2DM). However, the exact nature and direction of this relationship are unknown. Depression is often thought to be a consequence of diabetes, perhaps due to the burden of chronic illness. Research has also suggested that depression may be a risk factor for development of diabetes, in part due to biochemical changes in depression and in part because of a reduction of health care behaviors in individuals with depression. This paper reviews the literature behind both lines of investigation and includes special diagnostic and clinical considerations for at risk populations. We discuss clinical implications, limitations of current research, and areas of interest for future research.