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Sample records for prevents acute sunburn

  1. Topical grape seed proanthocyandin extract reduces sunburn cells and mutant p53 positive epidermal cell formation, and prevents depletion of Langerhans cells in an acute sunburn model.

    PubMed

    Yuan, Xiao-Ying; Liu, Wei; Hao, Jian-Chun; Gu, Wei-Jie; Zhao, Yan-Shuang

    2012-01-01

    The purpose of this study was to investigate whether grape seed proanthocyanidin extract (GSPE) can provide photoprotection against ultraviolet (UV) irradiation. Study has shown that GSPE is a natural oxidant, and is used in many fields such as ischemia-reperfusion injury, chronic pancreatitis, and even cancer. However, the effect of GSPE on UV irradiation is as yet unknown. Cutaneous areas on the backs of normal volunteers were untreated or treated with GSPE solutions or vehicles 30 min before exposure to two minimal erythema doses (MED) of solar simulated radiation. Cutaneous areas at different sites were examined histologically for the number of sunburn cells, or immunohistochemically for Langerhans cells and mutant p53 epidermal cells. On histological and immunohistochemical examination, skin treated with GSPE before UV radiation showed fewer sunburn cells and mutant p53-positive epidermal cells and more Langerhans cells compared with skin treated with 2-MED UV radiation only (p<0.001, p<0.001, and p<0.01, respectively). GSPE may be a possible preventive agent for photoprotection.

  2. Sunburn

    MedlinePlus

    If you do get a sunburn: Take a cool shower or bath or place clean wet, cool wash cloths on the burn. DO NOT use ... urine output, or sunken eyes Pale, clammy, or cool skin Nausea , fever , chills, or rash Your eyes ...

  3. A novel mechanism of filaggrin induction and sunburn prevention by β-damascenone in Skh-1 mice

    SciTech Connect

    Uddin, Ahmed N.; Labuda, Ivica; Burns, Fredric J.

    2012-12-15

    Understanding how oral administration of aroma terpenes can prevent sunburn or skin cancer in mice could lead to more effective and safer ways of blocking sun damage to human skin. To establish sunburn preventive activity, female Skh-1 mice were given oral β-damascenone followed by irradiation with UVR from fluorescent ‘sunlamps’. The following endpoints were evaluated versus controls at various times between 1 and 12 days after the terpene: whole genome gene expression and in situ immunohistochemistry of PCNA, keratin10, filaggrin and caspase 14, and sunburn was evaluated at 5 days. UVR-induced sunburn was prevented by a single oral β-damascenone dose as low as 20 μL (0.95 mg/g body weight). Microarray analysis showed sunburn prevention doses of β-damascenone up-regulated several types of cornification genes, including keratins 1 and 10, filaggrin, caspase 14, loricrin, hornerin and 6 late cornified envelope genes. Immunohistochemical studies of PCNA labeling showed that β-damascenone increased the proliferation rates of the following cell types: epidermal basal cells, follicular outer root sheath cells and sebaceous gland cells. Keratin 10 was not affected by β-damascenone in epidermis, and filaggrin and caspase 14 were increased in enlarged sebaceous glands. The thickness of the cornified envelope plus sebum layer nearly doubled within 1 day after administration of the β-damascenone and remained at or above double thickness for at least 12 days. β-Damascenone protected against sunburn by activating a sebaceous gland-based pathway that fortified and thickened the cornified envelope plus sebum layer in a way that previously has been observed to occur only in keratinocytes. -- Highlights: ► Orally administered β-damascenone prevented UVB-induced sunburn in Skh-1 mice. ► Filaggrin and caspase 14 genes were induced in sebaceous gland cells. ► Numerous cornification genes were up-regulated by β-damascenone. ► β-Damascenone stimulated cell

  4. Treating Sunburn

    MedlinePlus

    ... Treating sunburn Warts: Not just for witches and frogs What is a scar? About hair: Not just ... dermatologist. Next: Warts: Not just for witches and frogs . Learn more Skin cancer: How the sun can ...

  5. Polyphenols and Sunburn

    PubMed Central

    Saric, Suzana; Sivamani, Raja K.

    2016-01-01

    Polyphenols are antioxidant molecules found in many foods such as green tea, chocolate, grape seeds, and wine. Polyphenols have antioxidant, anti-inflammatory, and antineoplastic properties. Growing evidence suggests that polyphenols may be used for the prevention of sunburns as polyphenols decrease the damaging effects of ultraviolet A (UVA) and ultraviolet B (UVB) radiation on the skin. This review was conducted to examine the evidence for use of topically and orally ingested polyphenols in prevention of sunburns. The PubMed database was searched for studies that examined polyphenols and its effects on sunburns. Of the 27 studies found, 15 met the inclusion criteria. Seven studies were conducted on human subjects and eight on animals (mice and rats). Eleven studies evaluated the effects of topical polyphenols, two studies examined ingested polyphenols, and two studies examined both topical and ingested polyphenols. Polyphenol sources included the following plant origins: green tea, white tea, cocoa, Romanian propolis (RP), Calluna vulgaris (Cv), grape seeds, honeybush, and Lepidium meyenii (maca). Eight studies examined green tea. Overall, based on the studies, there is evidence that polyphenols in both oral and topical form may provide protection from UV damage and sunburn, and thus are beneficial to skin health. However, current studies are limited and further research is necessary to evaluate the efficacy, mechanism of action, and potential side effects of various forms and concentrations of polyphenols. PMID:27618035

  6. Incidence and public health burden of sunburn among ...

    EPA Pesticide Factsheets

    Sunburn, a preventable skin condition, is a major risk factor for skin cancer. Severe burns can result in emergency department visits and in some cases hospitalization. Many people spend hours in direct sunlight while at the beach, which could lead to sunburn. We pooled data from 13 prospective cohorts of beachgoers in the United States (n=84,411) to describe incidence of sunburn, risk factors associated with an increased risk of sunburn, and the health burden resulting from time lost from work or school, visits to the doctor, and medication use. The incidence of sunburn in this population in the 10-12 days after the beach visit was 14% (n=9,882), excluding those with sunburn at enrollment. Sunburn incidence increased with greater time spent in the sun. Approximately 8% of beachgoers only exposed for <1 hour reported sunburn, whereas almost 20% spending ≥5 hours in the sun reported sunburn (p<0.001). Those with any water contact were also more likely to report sunburn (15% versus 11%, p<0.001). Among all participants, 66% applied sunblock. When skin type was considered, the highest incidence was noted among those who report repeated sunburns (17%) or freckles when in the sun (13%) compared to 11% who typically get dark tans. The incidence of sunburn varied considerably by age group. Children ages <1 year had the lowest incidence of sunburn (2%) whereas adults between the ages of 19-35 had the highest incidence of sunburn (18%). Preliminary analyses indicate t

  7. Sunburn: Treatment and Prevention

    MedlinePlus

    ... some medications can cause a skin reaction to sunlight, and some medical conditions may make people more ... of age should be kept out of direct sunlight. If adequate clothing and shade are not available, ...

  8. Measuring self-reported sunburn: challenges and recommendations.

    PubMed

    Shoveller, J A; Lovato, C Y

    2001-01-01

    Sunburn is a major preventable risk associated with the development of malignant melanoma and basal cell carcinoma. Thus, it is considered a key epidemiological concept to assess in prevention research and a core component of routine behavioural surveillance and program evaluation efforts. This review examined 38 English- language survey instruments and research reports published between 1990 and 1999 that used self-report data or parent-proxy reports of sunburn outcome. A qualitative review of the instruments and reports identified several methodological issues: the conceptual and operation definitions of sunburn; the recall period, and the use of self-reports and parent-proxy reports. As there was little consistency in definitional issues or recall periods across the studies, it is difficult to meaningfully compare their findings. Key issues that program evaluators and researchers should consider in determining the strengths and limitations of various definitions, measures and approaches are examined. Recommendations for measurement of sunburn and for further research are included.

  9. Sunburn risk factors at Galveston beaches.

    PubMed

    Shoss-Glaich, Adrienne B; Uchida, Tatsuo; Wagner, Richard F

    2004-07-01

    Although the beach is a well-recognized environment for sunburn injury, specific risk factors for sunburn and their interactions are poorly understood. In this epidemiologic study, variables related to sunburn injury at the beach were analyzed. Beachgoers exposed to more than 4 hours of sun at the beach were significantly more likely to sunburn compared with those with less exposure. Other significant sunburn risk factors were lack of sunscreen use or use of sunscreen with a Sun Protection Factor of 15 or less and Fitzpatrick Skin Types I and II. Reasonable sunburn avoidance strategies should include limiting duration of sun exposure to fewer than 4 hours per day.

  10. When Might Sunburn Require Medical Attention?

    MedlinePlus

    ... When might sunburn require medical attention? Answers from Lawrence E. Gibson, M.D. Consult a doctor for ... not required unless you develop an infection. With Lawrence E. Gibson, M.D. References AskMayoExpert. Sunburn. Rochester, ...

  11. Predictors of sun protection behaviours and sunburn among Australian adolescents.

    PubMed

    Pettigrew, Simone; Jongenelis, Michelle; Strickland, Mark; Minto, Carolyn; Slevin, Terry; Jalleh, Geoffrey; Lin, Chad

    2016-07-13

    Excessive sun exposure and sunburn increase individuals' risk of skin cancer. It is especially important to prevent sunburn in childhood due to the higher relative risk of skin cancer across the life span compared to risk associated with sunburn episodes experienced later in life. This study examined demographic and attitudinal factors associated with engagement in a range of sun protection behaviours (wearing a hat, wearing protective clothing, staying in the shade, and staying indoors during the middle of the day) and the frequency of sunburn among Western Australian adolescents to provide insights of relevance for future sun protection campaigns. Cross-sectional telephone surveys were conducted annually with Western Australians between 2005/06 and 2014/15. The results from 4150 adolescents aged 14-17 years were used to conduct a path analysis of factors predicting various sun protection behaviours and sunburn. Significant primary predictors of the sun protection behaviours included in the study were skin type (sun sensitivity), gender, tanning-related attitudes and behaviours, and perceived relevance of public service advertisements that advocate sun protection. Of the four sun protection behaviours investigated, staying in the shade and staying indoors during the middle of the day were associated with a lower frequency of sunburn. There is a particular need to target sun protection messages at adolescent males who are less likely to engage in the most effective sun protection behaviours and demonstrate an increased propensity to experience sunburn. The results suggest that such future sun protection messages should include a focus on the importance of staying in the shade or indoors during periods of high UV radiation to increase awareness of the efficacy of these methods of avoiding skin cancer.

  12. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis.

    PubMed

    Dennis, Leslie K; Vanbeek, Marta J; Beane Freeman, Laura E; Smith, Brian J; Dawson, Deborah V; Coughlin, Julie A

    2008-08-01

    Sunburns are an important risk factor for melanoma and those occurring in childhood are often cited as posing the greatest risk. We conducted a meta-analysis to quantify the magnitude of association for melanoma and sunburns during childhood, adolescence, adulthood and over a lifetime. After reviewing over 1300 article titles and evaluating 270 articles in detail, we pooled odds ratios from 51 independent study populations for "ever" sunburned and risk of cutaneous melanoma. Among these, 26 studies reported results from dose-response analyses. Dose-response analyses were examined using both fixed-effects models and Bayesian random-effects models. An increased risk of melanoma was seen with increasing number of sunburns for all time-periods (childhood, adolescence, adulthood, and lifetime). In an attempt to understand how risk between life-periods compares, we also report these same linear models on a scale of five sunburns per decade for each life-period. The magnitude of risk for five sunburns per decade is highest for adult and lifetime sunburns. Overall, these results show an increased risk of melanoma with increasing number of sunburns during all life-periods, not just childhood. Prevention efforts should focus on reducing sunburns during all life-periods.

  13. Sunburns and risk of cutaneous melanoma, does age matter: a comprehensive meta-analysis

    PubMed Central

    Dennis, Leslie K.; VanBeek, Marta J.; Beane Freeman, Laura E.; Smith, Brian J.; Dawson, Deborah V.; Coughlin, Julie A.

    2010-01-01

    Purpose Sunburns are an important risk factor for melanoma and those occurring in childhood are often cited as posing the greatest risk. We conducted a meta-analysis to quantify the magnitude of association for melanoma and sunburns during childhood, adolescence, adulthood and over a lifetime. Methods After reviewing over 1300 article titles and evaluating 270 articles in detail, we pooled ORs from 51 independent study populations for “ever” sunburned and risk of cutaneous melanoma. Among these, 26 studies reported results from dose-response analyses. Dose-response analyses were examined using both fixed-effects models and Bayesian random-effects models. Results An increased risk of melanoma was seen with increasing number of sunburns for all time-periods (childhood, adolescence, adulthood and lifetime). In an attempt to understand how risk between life-periods compares, we also report these same linear models on a scale of 5 sunburns per decade for each life-period. The magnitude of risk for 5 sunburns per decade is highest for adult and lifetime sunburns. Conclusions Overall, these results show an increased risk of melanoma with increasing number of sunburns during all life-periods, not just childhood. Prevention efforts should focus on reducing sunburns during all life-periods. PMID:18652979

  14. 7 CFR 51.900 - Sunburn.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Sunburn. 51.900 Section 51.900 Agriculture Regulations... Definitions § 51.900 Sunburn. Sunburn means injury to the berry caused by exposure to the sun, including “sulphur burn,” usually occurring as a sunken and discolored or dried area on the exposed surface. ...

  15. 7 CFR 51.900 - Sunburn.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Sunburn. 51.900 Section 51.900 Agriculture Regulations... Standards for Grades of Table Grapes (European or Vinifera Type) 1 Definitions § 51.900 Sunburn. Sunburn... a sunken and discolored or dried area on the exposed surface. [36 FR 9126, May 20, 1971...

  16. Incidence and public health burden of sunburn among beachgoers in the United States

    EPA Science Inventory

    Sunburn, a preventable skin condition, is a major risk factor for skin cancer. Severe burns can result in emergency department visits and in some cases hospitalization. Many people spend hours in direct sunlight while at the beach, which could lead to sunburn. We pooled data fro...

  17. Incidence and public health burden of sunburn among beachgoers in the United States

    EPA Science Inventory

    Sunburn, a preventable skin condition, is a major risk factor for skin cancer. Severe burns can result in emergency department visits and in some cases hospitalization. Many people spend hours in direct sunlight while at the beach, which could lead to sunburn. We pooled data fro...

  18. Can Acute Myeloid Leukemia Be Prevented?

    MedlinePlus

    ... Causes, Risk Factors, and Prevention Can Acute Myeloid Leukemia Be Prevented? It’s not clear what causes most ... Myeloid Leukemia Be Prevented? More In Acute Myeloid Leukemia About Acute Myeloid Leukemia Causes, Risk Factors, and ...

  19. A possible cause of sunburn in fish

    USGS Publications Warehouse

    1958-01-01

    A LESION DESCRIBED AS A GRAY ΡATCH GENERALLY LOCATED ΑΝΤΕRIOR TO THE DORSAL FIN has been associated with high mortality of fish on numerous occasions in production hatcheries throughout the United States. This lesion has been called "sunburn" or "backpeel." No bacteria or other pathogens have been found in fish with these symptoms. For example, at a Montana hatchery in April 1956, mortality of 10 to 15 percent occurred daily and this lesion was the only syndrome found.  On occasion, shade has prevented this condition and even restored affected fish to an apparent normal condition; thus there has seemed to be a correlation between sunshine and the condition in fish. To our knowledge, this has been the only therapy attempted.

  20. Prevalence and determinants of sunburn in Queensland.

    PubMed

    Rogers, Carla; Kvaskoff, Marina; DiSipio, Tracey; Youlden, Danny; Whiteman, David; Eakin, Elizabeth; Youl, Philippa H; Aitken, Joanne; Fritschi, Lyn

    2009-08-01

    Australia records the highest incidence of skin cancer in the world. In response to this, public education campaigns have incorporated messages about reducing sun exposure and avoiding sunburn. This study sought to describe the prevalence of and factors associated with sunburn in Queensland residents. The Queensland Cancer Risk Study was a population-based, cross-sectional survey of 9,298 respondents conducted via computer-assisted telephone interview during 2004. Sunburn prevalence and its association with socio-demographics and skin cancer risk variables were examined. More than two-thirds (70.4%) of respondents reported at least one episode of sunburn in the past 12 months, and one in 10 respondents reported at least one episode of severe sunburn in the past 12 months. Experiences of sunburn on two or more occasions were reported more frequently by males than females (57.6% versus 46.5%, p<0.001), and by nearly two-thirds (65.8%) of those aged 20-39 years compared to 48.0% of 40-59 year olds, and 26.7% of 60-75 year olds (p<0.001). Episodes of sunburn were strongly associated with being male (OR=2.20 95%CI 1.84-2.63) and being aged 20 to 39 years compared to 60 to 75 years (OR=9.79, 95%CI=7.66-12.50). Sunburn remains highly prevalent among Queensland residents particularly among men and in the younger age groups.

  1. Changes in sunburn and tanning attitudes among lifeguards over a summer season.

    PubMed

    Hiemstra, Marieke; Glanz, Karen; Nehl, Eric

    2012-03-01

    Skin cancer is one of the most common cancers in the United States. Lifeguards are at increased risk of excessive sun exposure and sunburn. We sought to examine changes in: (1) sunburn frequency over a summer while controlling for sun exposure, sun protection habits, and participation in a skin cancer prevention program; and (2) tanning attitudes while controlling for participation in the program. Participants in this study were lifeguards (n = 3014) at swimming pools participating in the Pool Cool program in 2005. Lifeguards completed surveys at the beginning and end of the summer. Sequential regression analyses were used to assess changes in sunburn frequency and tanning attitudes. Sunburn frequency decreased between baseline and follow-up. Having a sunburn over the summer was significantly predicted by baseline sunburn history, ethnicity, skin cancer risk, and sun exposure. The tanning attitude, "People are more attractive if they have a tan," was significantly predicted from baseline tanning attitude and ethnicity. The second tanning attitude, "It helps to have a good base suntan," was significantly predicted by baseline tanning attitude, ethnicity, basic/enhanced group, and moderate skin cancer risk. Self-reported data and limited generalizability to lifeguards at other outdoor pools are limitations. The findings showed that previous sunburn history is an important predictor of sunburn prospectively. In addition, a more risky tanning attitude is an important predictor of future attitudes toward tanning. Active involvement in targeted prevention programs may help to increase preventive behavior and health risk reduction. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  2. Towards Prevention of Acute Syndromes

    PubMed Central

    Ahmed, A.; Thongprayoon, C.; Pickering, B.W.; Akhoundi, A.; Wilson, G.; Pieczkiewicz, D.; Herasevich, V.

    2014-01-01

    Summary Background Identifying patients at risk for acute respiratory distress syndrome (ARDS) before their admission to intensive care is crucial to prevention and treatment. The objective of this study is to determine the performance of an automated algorithm for identifying selected ARDS predisposing conditions at the time of hospital admission. Methods This secondary analysis of a prospective cohort study included 3,005 patients admitted to hospital between January 1 and December 31, 2010. The automated algorithm for five ARDS predisposing conditions (sepsis, pneumonia, aspiration, acute pancreatitis, and shock) was developed through a series of queries applied to institutional electronic medical record databases. The automated algorithm was derived and refined in a derivation cohort of 1,562 patients and subsequently validated in an independent cohort of 1,443 patients. The sensitivity, specificity, and positive and negative predictive values of an automated algorithm to identify ARDS risk factors were compared with another two independent data extraction strategies, including manual data extraction and ICD-9 code search. The reference standard was defined as the agreement between the ICD-9 code, automated and manual data extraction. Results Compared to the reference standard, the automated algorithm had higher sensitivity than manual data extraction for identifying a case of sepsis (95% vs. 56%), aspiration (63% vs. 42%), acute pancreatitis (100% vs. 70%), pneumonia (93% vs. 62%) and shock (77% vs. 41%) with similar specificity except for sepsis and pneumonia (90% vs. 98% for sepsis and 95% vs. 99% for pneumonia). The PPV for identifying these five acute conditions using the automated algorithm ranged from 65% for pneumonia to 91 % for acute pancreatitis, whereas the NPV for the automated algorithm ranged from 99% to 100%. Conclusion A rule-based electronic data extraction can reliably and accurately identify patients at risk of ARDS at the time of hospital

  3. Sunburn and Lyme Disease: Two Preventable Injuries.

    ERIC Educational Resources Information Center

    Pavlicin, Karen M.

    1995-01-01

    Stresses the importance of educating campers and staff about the dangers of overexposure to the sun and the transmission of Lyme disease. Discusses the importance of using an appropriate sunscreen and avoiding outdoor activities during peak hours of sunlight. Discusses how Lyme disease is transmitted, the life cycle of a tick, and how to remove…

  4. Sunburn and Lyme Disease: Two Preventable Injuries.

    ERIC Educational Resources Information Center

    Pavlicin, Karen M.

    1995-01-01

    Stresses the importance of educating campers and staff about the dangers of overexposure to the sun and the transmission of Lyme disease. Discusses the importance of using an appropriate sunscreen and avoiding outdoor activities during peak hours of sunlight. Discusses how Lyme disease is transmitted, the life cycle of a tick, and how to remove…

  5. Sun protective behaviour and sunburn prevalence in primary and secondary schoolchildren in western Switzerland.

    PubMed

    Ackermann, Simone; Vuadens, Anne; Levi, Fabio; Bulliard, Jean-Luc

    2016-01-01

    Although solar overexposure during childhood and adolescence increases the risk of melanoma, determinants of sunburn and sun protective behaviours of Swiss children have scarcely been explored. We investigated sunburn occurrence and sun protective behaviours of schoolchildren in western Switzerland, the region with the highest incidence of melanoma in Europe. Self-reported questionnaires were administered during regular classes to pupils in 5th (primary school, n = 431), 8th and 11th grades (secondary school, n = 837) in the 18 public schools of La Chaux-de-Fonds. Descriptive statistics and multivariate logistic regression analyses were performed to assess predictors of sunburns and of three sun protective behaviours (sunscreen, shade, wear of covering clothes). Response rate was 91%. Sunburn prevalence over the preceding year was high (60% at least one sunburn, 30% at least two, 43% at least one severe sunburn). Younger age, fair skin, regular sunscreen use, higher sun-related knowledge and preference for a tanned skin were predictors of sunburn. Sunscreen was the most used protective measure (69%), followed by seeking shade (33%) and wearing long-sleeved shirts (32%). Decline in all protective measures was observed in older pupils and those with pro-tan attitudes. The wear of covering clothes was significantly associated with sunscreen use and seeking shade. Parental encouragement favoured sunscreen use and wearing of protective clothes. Sunscreen use as a last protective barrier against ultraviolet radiation should be better emphasised in prevention campaigns targeting children and adolescents. Multi-faceted interventions, including role models, parents and peers should help to improve children's sun protective behaviours.

  6. Increase in sunburns and photosensitivity disorders at the edge of the Antarctic ozone hole, southern Chile, 1986-2000.

    PubMed

    Abarca, Jaime F; Casiccia, Claudio C; Zamorano, Felix D

    2002-02-01

    Over the past 15 years Punta Arenas, Chile, a medium-sized city located on the extreme southern tip of South America, has repeatedly been exposed to acute, sudden episodes of highly increased levels of ultraviolet B (UVB) 280-320 nm radiation because of the passage of the spring Antarctic "Ozone Hole" overhead, or nearby. Our purpose was to observe the relationship between episodes of ozone depletion, increased UVB radiation, and sunburns and photosensitivity disorders in Punta Arenas, Chile, during spring. Incidence of photosensitivity disorders and sunburns was registered by dermatologists during each of the past 15 springs. Local data of sudden, severe ozone depletions (<250 Dobson units) and the corresponding increase of UVB radiation were reviewed. Patients with sunburn increased significantly during the austral spring of 1999 (P <.01). This was especially noticeable (29/31 cases) on weekends with ozone depletion, and increased UVB radiation (P <.01) occurred on the Sundays Oct 31, Nov 21, and Dec 5, 1999. The incidence of photosensitivity disorders, although statistically not significant, increased 51% over the past 7 years. An acute impact on human health (sunburn) occurred because of abrupt ozone depletion and the accompanying increase in UVB during the mid and late austral spring of 1999. Most sunburns (93.5%) occurred on weekends. Ozone levels as well as seasonal and recreational factors played a mayor role in the increase in sunburns. The increase in radiation at 300 nm, the most carcinogenic wavelength, on days under the Antarctic ozone hole is a matter of special concern.

  7. Pressure sore prevention in acutely ill patients.

    PubMed

    James, H

    1997-03-01

    A wide range of factors affect the skin's ability to withstand pressure, friction and shear. Clinically validated pressure-relieving equipment is essential to prevent pressure sores in acutely ill patients. A successful pressure sore prevention strategy depends on sufficient resource allocation, appropriate levels and types of preventive equipment and evaluation.

  8. Predictors of sun protection behaviors and severe sunburn in an international online study.

    PubMed

    Bränström, Richard; Kasparian, Nadine A; Chang, Yu-mei; Affleck, Paul; Tibben, Aad; Aspinwall, Lisa G; Azizi, Esther; Baron-Epel, Orna; Battistuzzi, Linda; Bergman, Wilma; Bruno, William; Chan, May; Cuellar, Francisco; Debniak, Tadeusz; Pjanova, Dace; Ertmanski, Slawomir; Figl, Adina; Gonzalez, Melinda; Hayward, Nicholas K; Hocevar, Marko; Kanetsky, Peter A; Leachman, Sancy A; Heisele, Olita; Palmer, Jane; Peric, Barbara; Puig, Susana; Schadendorf, Dirk; Gruis, Nelleke A; Newton-Bishop, Julia; Brandberg, Yvonne

    2010-09-01

    The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behavior. The aim of this study was to examine the prevalence of self-reported sun protection behaviors and sunburn in users of the Internet, and to identify the demographic, clinical, and attitudinal/motivational correlates of sun protection behaviors. Self-report data were gathered on behalf of the GenoMEL consortium using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the United States, 2% from Israel, and 6% from other countries. Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behavior were perceived barriers to protection (beta = -0.44/beta = -0.37), and respondents who reported a positive attitude toward suntans were less likely to protect (beta = -0.16/beta = -0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviors resulting in severe sunburn. Future strategies to decrease sunburn should target the practical, social, and psychological barriers associated with nonuptake of sun protection. (c)2010 AACR.

  9. Predictors of Sun Protection Behaviours and Severe Sunburn inan International on-line study

    PubMed Central

    Bränström, Richard; Kasparian, Nadine A.; Chang, Yu-mei; Affleck, Paul; Tibben, Aad; Aspinwall, Lisa G.; Azizi, Esther; Baron-Epel, Orna; Battistuzzi, Linda; Bergman, Wilma; Bruno, William; Chan, May; Cuellar, Francisco; Dębniak, Tadeusz; Pjanova, Dace; Ertmański, Sƚawomir; Figl, Adina; Gonzalez, Melinda; Hayward, Nicholas K.; Hocevar, Marko; Kanetsky, Peter A.; Leachman, Sancy A.; Heisele, Olita; Palmer, Jane; Peric, Barbara; Puig, Susana; Schadendorf, Dirk; Gruis, Nelleke A.; Newton-Bishop, Julia; Brandberg, Yvonne

    2013-01-01

    Background The incidence of melanoma continues to increase in many countries, and primary prevention of melanoma includes avoidance of sunburn as well as adequate sun protection behaviour. The aim of this study was to examine the prevalence of self-reported sun protection behaviours and sunburn in users of the Internet, and to identify the demographic, clinical and attitudinal/motivational correlates of sun protection behaviours. Methods Self-report data were gathered on behalf of GenoMEL (www.genomel.org) using an online survey available in 10 different languages, and 8,178 individuals successfully completed at least 80% of survey items, with 73% of respondents from Europe, 12% from Australia, 7% from the USA, 2% from Israel, and 6% from other countries. Results Half of all respondents and 27% of those with a previous melanoma reported at least one severe sunburn during the previous 12 months. The strongest factors associated with sun protection behaviour were perceived barriers to protection (β=−0.44/β=−0.37), and respondents who reported a positive attitude towards suntans were less likely to protect (β=−0.16/β=−0.14). Reported use of protective clothing and shade, as well as avoidance of midday sun exposure, were more strongly related to reduced risk of sunburn than sunscreen use. Conclusions Despite widespread dissemination of public health messages about the importance of sun protection, a substantial proportion of this international sample, including respondents with a previous melanoma, reported inadequate sun protection behaviours resulting in severe sunburn. Impact Future strategies to decrease sunburn should target the practical, social and psychological barriers associated with non-uptake of sun protection. PMID:20643826

  10. Severe Sunburn After a Hot Air Balloon Ride: A Case Report and Literature Review.

    PubMed

    Ozturk, Sinan; Karagoz, Huseyin

    2015-01-01

    Hot air balloon tours are very popular among travelers worldwide. Preventable burn injuries associated with hot air balloon rides have been reported during crashes into power lines, in propane burner explosions, and following contact with the propane burner tanks. We present a case of severe repeated sunburn, which poses another risk of preventable injury during hot air balloon rides, and briefly discuss the injury epidemiology of hot air balloon rides. © 2015 International Society of Travel Medicine.

  11. Exposure to indoor tanning without burning and melanoma risk by sunburn history.

    PubMed

    Vogel, Rachel Isaksson; Ahmed, Rehana L; Nelson, Heather H; Berwick, Marianne; Weinstock, Martin A; Lazovich, DeAnn

    2014-07-01

    Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.

  12. Exposure to indoor tanning without burning and melanoma risk by sunburn history.

    PubMed

    Vogel, Rachel Isaksson; Ahmed, Rehana L; Nelson, Heather H; Berwick, Marianne; Weinstock, Martin A; Lazovich, DeAnn

    2014-06-01

    Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.

  13. Prevalence and trends of sunscreen use and sunburn among Norwegian women.

    PubMed

    Ghiasvand, R; Lund, E; Edvardsen, K; Weiderpass, E; Veierød, M B

    2015-02-01

    Sunscreen is recommended to prevent sunburn and skin cancer. To investigate sunscreen use in relation to demographic and phenotypic characteristics among women in Norway, as well as solar UV exposure, sunburn experience in different decades of life, and temporal trends in sunscreen use. We used data from the Norwegian Women and Cancer Study, a large population-based prospective cohort study. Log-binomial regression was used to estimate the association between sunscreen use and personal characteristics. Results are presented as prevalence ratios (PRs) and 99% confidence intervals (CIs). The study sample consisted of 148,869 women, with a mean age, when answering the questionnaire, of 53 years (range 41-75). Sixty-five per cent of the women used sunscreen during the Easter holiday, 73% in northern latitudes and 87% in bathing vacations in southern latitudes. Sunscreen with sun protection factor (SPF) ≥ 15 was used by 25,156 (18%) at Easter, 18,118 (13%) in northern latitudes and 22,678 (30%) in southern latitudes. The prevalence of sunscreen use increased from 1997 to 2007, and this increase was associated with age. In 1997, 39% of women reported at least one sunburn per year in the recent decade, compared with 46% in 2007 (Ptrend = 0·001). Women who experienced at least four sunburns per year during adolescence reported more sunscreen use in adulthood (PREaster 1·54, 99% CI 1·30-1·83; PRnorthern latitudes 1·49, 99% CI 1·20-1·84; PRsouthern latitudes 1·37, 99% CI 1·14-1·65). The prevalence of sunscreen use increased from 1997 to 2007. However, this increase has not been accompanied by a decrease in sunburn. Moreover, use of sunscreen with the recommended SPF was not common among Norwegian women. © 2014 British Association of Dermatologists.

  14. [Acute heart failure: precipitating factors and prevention].

    PubMed

    Aramburu Bodas, Oscar; Conde Martel, Alicia; Salamanca Bautista, Prado

    2014-03-01

    Acute heart failure episodes, whether onset or decompensation of a chronic form, are most often precipitated by a concurrent process or disease, described as precipitating factors of heart failure. In this article, we review these precipitating factors, their proportions and clinical relevance in general and in subgroups of patients, their relationship with prognosis, and their possible prevention. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  15. Prevention of Acute Exacerbations of COPD

    PubMed Central

    Bourbeau, Jean; Diekemper, Rebecca L.; Ouellette, Daniel R.; Goodridge, Donna; Hernandez, Paul; Curren, Kristen; Balter, Meyer S.; Bhutani, Mohit; Camp, Pat G.; Celli, Bartolome R.; Dechman, Gail; Dransfield, Mark T.; Fiel, Stanley B.; Foreman, Marilyn G.; Hanania, Nicola A.; Ireland, Belinda K.; Marchetti, Nathaniel; Marciniuk, Darcy D.; Mularski, Richard A.; Ornelas, Joseph; Stickland, Michael K.

    2015-01-01

    BACKGROUND: COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS: In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS: The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in

  16. The likelihood of sunburn in sunscreen users is disproportionate to the SPF.

    PubMed

    Pissavini, Marc; Diffey, Brian

    2013-06-01

    Sunburn is a common feature in sunscreen users. The purpose of this paper is to estimate the expected frequency and magnitude of sunburn resulting from typical use of sunscreens labelled SPF15 and SPF30 by people spending long periods outdoors in strong summer sunshine. By combining the probability distribution of the measured sun protection factor (SPF) in vivo with those for the average application thickness and the uniformity of application over the skin surface, a simulation model was developed to estimate the variation in delivered protection over the exposed skin surface from consumer use of sunscreens. While either sunscreen, if delivering the nominal SPF over the entire exposed skin, would be sufficient to prevent any erythema, the simulation indicates that the combination of the average quantity applied with the variability in thickness over the skin surface will lead to erythema, especially in SPF15 sunscreen users. People who intend spending long periods outside in strong sunshine would be better advised to use SPF30 labelled sunscreens than SPF15 sunscreens, and to apply the product carefully over exposed skin if they wish to minimize their risk of sunburn and, by implication, skin cancer. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Sun exposure, sun protection and sunburn among Canadian adults.

    PubMed

    Pinault, Lauren; Fioletov, Vitali

    2017-05-17

    Ultraviolet radiation (UVR) exposure and a history of sunburn are important risk factors for skin cancer. Sunburn is more common among men, younger age groups, and people in higher income households. Sun protection measures also vary by sex, age, and socioeconomic characteristics. Associations between ambient UVR and sunburn and sun safety measures have not been quantified. A total of 53,130 respondents aged 18 or older answered a Canadian Community Health Survey (CCHS) module on sun safety, which was administered in six provinces from 2005 to 2014. The module contained questions about sunburn, time in the sun, and sun protection. These respondents were linked to an ambient erythemal UVR dataset representing the June-to-August mean. Descriptive statistics and logistic regression were used to examine associations between population characteristics, sunburn, sun safety, time in the sun, and ambient UVR. Sunburn was reported by 33% of respondents and was more common among men, younger age groups, people who were not members of visible minorities, residents of higher income households, and individuals who were employed. On a typical summer day, a larger percentage of women than men sought shade and wore sunscreen, whereas a larger percentage of men wore a hat or long pants. As ambient summer UVR increased, women were more likely to apply sunscreen to their face, seek shade, or wear a hat (OR~1.02 to 1.09 per increase of 187 J/m² of erythemally-weighted UVR, or 5.4% of the mean); these associations were not observed among men. Findings related to sunburn and sun protection were similar to those of previous studies. The association between ambient UVR and women's precautionary measures suggests that information about UVR may influence their decision to protect their skin.

  18. Managing and Preventing Acute Urinary Retention

    PubMed Central

    Lepor, Herbert

    2005-01-01

    Acute urinary retention (AUR), an uncomfortable and potentially dangerous condition, often occurs in men who have benign prostatic hyperplasia. Although the reported incidence of AUR varies in the literature, there are a number of events that are known to precipitate episodes of AUR, including ingestion of certain agents, infection, general anesthesia, and performance of various diagnostic genitourinary procedures. Because it is preferable to avoid the need for catheterization (and the associated risks) in men at high risk for AUR, certain measures have been studied as means to prevent AUR episodes. Specifically, α-blockers and 5-α-reductase inhibitors have been shown to reduce the incidence of initial and subsequent AUR episodes in certain at-risk men. PMID:16985887

  19. Do statins prevent acute kidney injury?

    PubMed

    Philips, Barbara; MacPhee, Iain

    2015-10-01

    Statins were introduced as lipid-lowering agents with a specific action to decrease plasma cholesterol concentrations and they have led to significant reductions in cardiovascular morbidity and mortality. Since their introduction, they have been found to have highly pleiotropic effects and potential use in many medical conditions well beyond cardiovascular disease alone. With their widespread and increasing use, adverse effects have also become apparent and it is suggested from the interrogation of observational data from large datasets that an early complication of statin use may be acute kidney injury (AKI). This review explores the evidence relating to statins and the risks of AKI. The pathophysiology of AKI is considered and the statins are compared and contrasted. Statins have also been attributed with reno-protective effects and the literature relating to these circumstances are reviewed. The question of whether statins cause AKI remains unresolved. Evidence suggests that statins may both protect or harm kidneys acutely and that risk varies with the condition and the dose and type of statin used. However, any current adverse data should not deter prescription of statins in patients where there is clear evidence for either primary or secondary prevention of cardiovascular events.

  20. Can You Get a Sunburn Through Glass? Theory and an Experiment.

    ERIC Educational Resources Information Center

    Bartels, Richard; Loxsom, Fred

    1995-01-01

    Discusses factors that determine whether or not a sunburn is possible under glass, including the spectral dependence of the skin's sensitivity to sunburn, the ground-level spectrum of solar radiation, and the wavelength dependence of the transmission for the particular piece of glass. Concludes that it is possible to get sunburned through glass.…

  1. Can You Get a Sunburn Through Glass? Theory and an Experiment.

    ERIC Educational Resources Information Center

    Bartels, Richard; Loxsom, Fred

    1995-01-01

    Discusses factors that determine whether or not a sunburn is possible under glass, including the spectral dependence of the skin's sensitivity to sunburn, the ground-level spectrum of solar radiation, and the wavelength dependence of the transmission for the particular piece of glass. Concludes that it is possible to get sunburned through glass.…

  2. Parent and Child Characteristics Associated with Child Sunburn and Sun Protection Among U.S. Hispanics.

    PubMed

    Day, Ashley K; Stapleton, Jerod L; Natale-Pereira, Ana M; Goydos, James S; Coups, Elliot J

    2017-05-01

    Skin cancer incidence has been increasing in U.S. Hispanics over several decades and the postdiagnosis outcomes are worse for Hispanics than for non-Hispanic whites. Parents are influential in children's health preventive behaviors, but little is known about parental factors associated with children's skin cancer-related behaviors in the U.S. Hispanic population. The present study examined parental and child correlates of skin cancer-related behaviors (sunburns, sunbathing, sun-protective clothing use, and sunscreen use) of children of Hispanic parents. This survey study included a population-based sample of 360 U.S. Hispanic parents (44.8% male) who had a child 14 years of age or younger. Measures included parental reports of parent and child demographic characteristics, parent skin cancer knowledge and linguistic acculturation, and parent and child skin cancer-related behaviors. Approximately 28% of children and 31.9% of parents experienced at least one sunburn in the past year and approximately 29% of children and 36.7% of parents were reported to sunbathe. Moderate use of sun-protective clothing and sunscreen was reported for parents and their children. Child sun-protective clothing use and sunscreen use, sunburns, and sunbathing were associated with the corresponding behaviors of their parents. Future research should consider the role of acculturation and perceived risk in the sun protection behaviors of U.S. Hispanic children, particularly in those who report a fair skin type. Hispanic parents should be included in interventions targeting their children's skin cancer-related behaviors, and it is suggested that such interventions could also encourage parents to improve their own behaviors. © 2017 Wiley Periodicals, Inc.

  3. [On prevention of post-surgery acute urinary retention].

    PubMed

    Spivak, L G; Mel'nikov, A V

    2015-12-01

    The article highlights the issues of prevention of acute urinary retention after surgery. The authors present results of a study on the efficacy and safety of 1-blockers for the prevention of acute urinary retention after surgery. The results imply that the use of 1-blockers in pre- and postoperative period can significantly reduce the risk of postoperative ischuria, contribute to independent urination after a single urinary catheterization in patients who experience urinary retention, improve the postoperative period and promote recovery of patients.

  4. Getting a Base Tan: Does it Prevent Sunburn?

    MedlinePlus

    ... broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15. The American Academy of ... a broad-spectrum, water-resistant sunscreen with an SPF of at least 30. Apply sunscreen 15 to ...

  5. Acute hepatitis C: prevention and treatment.

    PubMed

    Ozaras, Resat; Tahan, Veysel

    2009-04-01

    HCV can cause acute or chronic hepatitis and is a health problem all over the world. It is one of the leading causes of cirrhosis and hepatocellular carcinoma, and is a common indication for liver transplantation. Unrecognized patients with HCV infection may transmit the virus to uninfected people. The acute form of the disease leads to chronic hepatitis in the majority of cases. Since the success rate of treatment given in the chronic phase is much lower than that given in the acute phase, recognizing acute hepatitis is critical. Although HCV is less prevalent since 1990s in the Western world after improved blood-donor screening programs, needle-exchange facilities and education among intravenous drug users, it is still endemic in some regions, including African countries, Egypt, Taiwan, China and Japan. Acute HCV infection may be a challenge for the clinician; since it is often asymptomatic, detection and diagnosis are usually difficult. After an incubation period of 7 weeks (2-12 weeks), only a minority of patients (10-15%) report symptoms. The spontaneous clearance of the virus is more frequent primarily during the first 3 months of clinical onset of the disease, but may occur anytime during the 6 months of acute infection. This spontaneous resolution seems to be more frequent in symptomatic cases. Viremia persisting more than 6 months is accepted as chronic infection. The virus is transmitted more frequently through infected blood or body fluids. Detection of antibodies against HCV is not a reliable method of diagnosing acute HCV infection since the appearance of antibodies against HCV can be delayed in up to 30% of patients at the onset of symptoms. Thus, the diagnosis of acute hepatitis C relies on the qualitative detection of HCV RNA, which may appear as early as 1-2 weeks after exposure quickly followed by highly elevated alanine aminotransferase. After a follow-up period of 8-12 weeks for allowing spontaneous resolution, treatment should be initiated

  6. Managing acute upper GI bleeding, preventing recurrences.

    PubMed

    Albeldawi, Mazen; Qadeer, Mohammed A; Vargo, John J

    2010-02-01

    Acute upper gastrointestinal (GI) bleeding is common and potentially life-threatening and needs a prompt assessment and aggressive medical management. All patients need to undergo endoscopy to diagnose, assess, and possibly treat any underlying lesion. In addition, patients found to have bleeding ulcers should receive a proton pump inhibitor, the dosage and duration of treatment depending on the endoscopic findings and clinical factors.

  7. Objective Assessment of Sunburn and Minimal Erythema Doses: Comparison of Noninvasive In Vivo Measuring Techniques after UVB Irradiation

    NASA Astrophysics Data System (ADS)

    Huang, Min-Wei; Lo, Pei-Yu; Cheng, Kuo-Sheng

    2010-12-01

    Military personnel movement is exposed to solar radiation and sunburn is a major problem which can cause lost workdays and lead to disciplinary action. This study was designed to identify correlation parameters in evaluating in vivo doses and epidermis changes following sunburn inflammation. Several noninvasive bioengineering techniques have made objective evaluations possible. The volar forearms of healthy volunteers ([InlineEquation not available: see fulltext.]), 2 areas, 20 mm in diameter, were irradiated with UVB 100 mj/[InlineEquation not available: see fulltext.] and 200 mj/[InlineEquation not available: see fulltext.], respectively. The skin changes were recorded by several monitored techniques before and 24 hours after UV exposures. Our results showed that chromameter [InlineEquation not available: see fulltext.] value provides more reliable information and can be adopted with mathematical model in predicting the minimal erythema dose (MED) which showed lower than visual assessment by 10 mj/[InlineEquation not available: see fulltext.] (Pearson correlation coefficient [InlineEquation not available: see fulltext.]). A more objective measure for evaluation of MED was established for photosensitive subjects' prediction and sunburn risks prevention.

  8. Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness.

    PubMed

    Lipman, Grant S; Pomeranz, David; Burns, Patrick; Phillips, Caleb; Cheffers, Mary; Evans, Kristina; Jurkiewicz, Carrie; Juul, Nick; Hackett, Peter

    2017-06-28

    Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide. This double-blind, randomized, placebo-controlled trial compared inhaled budesonide versus oral acetazolamide versus placebo, starting the morning of ascent from 1240 m (4100 ft) to 3810 m (12,570 ft) over 4 hours. The primary outcome was acute mountain sickness incidence (headache and Lake Louise Questionnaire ≥3 and another symptom). A total of 103 participants were enrolled and completed the study; 33 (32%) received budesonide, 35 (34%) acetazolamide, and 35 (34%) placebo. Demographics were not different between the groups (P > .09). Acute mountain sickness prevalence was 73%, with severe acute mountain sickness of 47%. Fewer participants in the acetazolamide group (n = 15, 43%) developed acute mountain sickness compared with both budesonide (n = 24, 73%) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.3-10.1) and placebo (n = 22, 63%) (OR 0.5, 95% CI 0.2-1.2). Severe acute mountain sickness was reduced with acetazolamide (n = 11, 31%) compared with both budesonide (n = 18, 55%) (OR 2.6, 95% CI 1-7.2) and placebo (n = 19, 54%) (OR 0.4, 95% CI 0.1-1), with a number needed to treat of 4. Budesonide was ineffective for the prevention of acute mountain sickness, and acetazolamide was preventive of severe acute mountain sickness taken just before rapid ascent. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Determinants of Sunburn and Sun Protection of Agricultural Workers During Occupational and Recreational Activities.

    PubMed

    Backes, Claudine; Milon, Antoine; Koechlin, Alice; Vernez, David; Bulliard, Jean-Luc

    2017-08-30

    The aim of this study was to identify determinants of occupational sunburn in agricultural workers and assess their occupational and recreational sun protection habits. Specific surveys of agricultural workers in Switzerland and France were conducted (N = 1538). Multivariate logistic regressions identified occupational sunburn determinants. Occupational and recreational sun protection habits were estimated and correlated. One-year occupational and recreational sunburn prevalences were 19.8% and 11.5%, respectively. Occupational sunburn increased with having a recent recreational sunburn, highly sensitive skin, young age, high perceived skin cancer risk, using sunscreen, and not wearing a hat. Correlation between protection habits during work and leisure was substantial (rs 0.5 to 0.7). Skin health knowledge was high and pro-tanning attitude moderate. Potentially modifiable sunburn determinants and suboptimal recreational and occupational sun protection practices were identified in agricultural workers. Refining and tailoring sun protection messages targeting the agricultural sector are needed.

  10. Contrast-Induced Acute Kidney Injury: Comparison of Preventative Therapies.

    PubMed

    Honicker, Theresa; Holt, Karyn

    2016-01-01

    Contrast medium is used daily for diagnostic and interventional procdures as a means to visualize blood vessels. The administration of contrast dye, however, can lead to an acute reduction in kidney function. This complication can impact length of hospital stay, risk of dialysis, and increased hospital mortality. Common preventative measures include N-acetylcysteine and intravenous hydration. The evidence reviewed revealed hydration to be the more effective treatment to reduce the risk of acute kidney injury.

  11. Corticosteroids for renal scar prevention in children with acute pyelonephritis.

    PubMed

    Sakulchit, Teeranai; Goldman, Ran D

    2017-04-01

    Question Acute pyelonephritis in children is of great concern and I usually refer these patients to a pediatrician or send them to the emergency department owing to the risk of renal scarring. Are steroids an acceptable treatment to reduce risk of scarring? Answer Several agents have been studied in an effort to prevent renal scar formation following acute pyelonephritis in children. Use of corticosteroids, in conjunction with standard therapy for acute pyelonephritis, shows promising findings. However, evidence is very limited and steroids should not be offered on a regular basis as part of treatment. Copyright© the College of Family Physicians of Canada.

  12. Prevention of deterioration in acutely ill patients in hospital.

    PubMed

    Steen, Colin

    The shift towards providing critical care in general wards has changed the way acutely ill patients are identified, treated and managed in hospital. This requires the expertise of knowledgeable, informed and capable staff. Effective education and appropriate knowledge and skills are required to aid identification of the deteriorating patient and provide prompt, timely and appropriate intervention to prevent further deterioration and possibly death. This article provides information about a systematic approach that will enable healthcare professionals to intervene to prevent deterioration in acutely ill patients.

  13. Systematic Review of Preventive and Acute Treatment of Menstrual Migraine.

    PubMed

    Nierenburg, Hida Del C; Ailani, Jessica; Malloy, Michele; Siavoshi, Sara; Hu, Nancy N; Yusuf, Nadia

    2015-09-01

    The aim of this systematic review is to identify the efficacy of different categories of treatments for menstrual migraines as found in randomized controlled trials or open label studies with similar efficacy endpoints. Menstrual migraine is very common and approximately 50% of women have increased risk of developing migraines related to the menstrual cycle. Attacks of menstrual migraine are usually more debilitating, of longer duration, more prone to recurrence, and less responsive to acute treatment than nonmenstrual migraine attacks. Search for evidence was done in 4 databases that included PubMed, EMBASE, Science Direct, and Web of Science. Eighty-four articles were selected for full text review by 2 separate readers. Thirty-six of the 84 articles were selected for final inclusion. Articles included randomized controlled and open label trials that focused on efficacy of acute and preventative therapies for menstrual migraine. Secondary analyses where excluded because the initial study population was not women with menstrual migraine. After final screening, 11 articles were selected for acute and 25 for preventive treatment of menstrual migraine. These were further subdivided into treatment categories. For acute treatment: triptans, combination therapy, prostaglandin synthesis inhibitor, and ergot alkaloids. For preventive treatment: triptans, combined therapy, oral contraceptives, estrogen, nonsteroidal anti-inflammatory drug, phytoestrogen, gonadotropin-releasing hormone agonist, dopamine agonist, vitamin, mineral, and nonpharmacological therapy were selected. Overall, triptans had strong evidence for treatment in both acute and short term prevention of menstrual migraine. Based on this literature search, of all categories of treatment for menstrual migraine, triptans have the most extensive research with strong evidence for both acute and preventive treatment of menstrual migraine. Further randomized controlled trials should be performed for other therapies

  14. The human sunburn reaction: histologic and biochemical studies

    SciTech Connect

    Gilchrest, B.A.; Soter, N.A.; Stoff, J.S.; Mihm, M.C. Jr.

    1981-01-01

    The ultraviolet-induced erythema reaction was investigated histologically and biochemically in four subjects, utilizing suction blister aspirates, analyzed for histamine and prostaglandin E2 (PGE2), and Epon-embedded 1-mu skin biopsy sections from control skin and from irradiated skin at intervals for 72 hours after exposure to a Hanovia lamp. Major histologic alterations in the epidermis included dyskeratotic and vacuolated keratinocytes (sunburn cells), and disappearance of Langerhans cells. In the dermis the major changes were vascular, involving both the superficial and deep venular plexuses. Endothelial cell enlargement was first apparent within 30 minutes of irradiation, peaked at 24 hours, and persisted throughout the 72-hour study period. Mast cell degranulation and associated perivenular edema were first apparent at 1 hour and striking at the onset of erythema, 3 to 4 hours postirradiation; edema was absent and mast cells were again normal in number and granule content at 24 hours. Histamine levels rose approximately fourfold above control values immediately after the onset of erythema and returned to baseline within 24 hours. PGE2 levels were statistically elevated even before the onset of erythema and reached approximately 150% of the control value at 24 hours. These data provide the first evidence that histamine may mediate the early phase of the human sunburn reaction and increase our understanding of its complex histologic and biochemical sequelae.

  15. [Consensus conference on acute bronchiolitis (v): prevention of acute bronchiolitis. Review of scientific evidence].

    PubMed

    González de Dios, J; Ochoa Sangrador, C

    2010-05-01

    A review of the evidence on prevention of acute bronchiolitis is presented. Acute bronchiolitis prevention arises from three basic approaches: preventive treatment to reduce recurrent wheezing following an episode of acute bronchiolitis, preventive treatment to reduce the frequency and severity of RSV bronchiolitis in the population at risk (prematurity, bronchopulmonary dysplasia, congenital heart disease, etc.), and general preventive measures to reduce nosocomial infection with RSV. There is sufficient evidence on the lack of efficacy of inhaled corticosteroids, oral corticosteroids and montelukast. Intravenous RSV immunoglobulin has an unfavorable risk-benefit balance, particularly with the availability of monoclonal antibodies. Palivizumab is effective as preventive treatment of RSV infection in risk populations (high risk preterm infants and hemodynamically significant congenital heart disease), but not in the frequency and severity (ICU admission, need for mechanical ventilation and mortality) of the acute bronchiolitis. The benefits of palivizumab (less admissions) seem to be worth the adverse effects, but we do not know the cost-benefit ratio. The control and prevention measures of nosocomial transmission of RSV infection (isolation, hand washing, use of mask, gloves, cap and shoes) are based on indirect evidence.

  16. The acute and preventative treatment of episodic migraine

    PubMed Central

    Miller, Sarah

    2012-01-01

    Episodic migraine is a common debilitating condition with significant worldwide impact. An effective management plan must include acute treatment to relieve the pain and potential disability associated with the attacks and may also include preventative treatments with an aim of decreasing attack frequency and severity in the longer term. Acute treatments must be limited to a maximum of 2-3 days a week to prevent medication overuse headache and focus on simple analgesia, non-steroidal anti-inflammatory drugs and triptans. Preventative treatments are numerous and should be considered when migraine attacks are frequent and or disabling, acute medication is failing, in special circumstances such as hemiplegic migraines or if the patient requests them. All preventative medications must be given at therapeutic doses for at least 6-8 weeks before an adequate trial can be judged ineffective. The most important factor in choosing drugs is the patient and the clinical features of their attack and treatment should be tailored to these. Relative co-morbidities will influence drug choice, as will the side effect profile and the efficacy of the drug. First line preventative drugs include ß-blockers, amitriptyline and anti-epileptic drugs such as topiramate and valproate. Drugs with lower efficacy or poorer side effect profiles include selective serotonin reuptake inhibitors (SSRIs), calcium channel antagonists, gabapentin and herbal medicines. PMID:23024562

  17. The acute and preventative treatment of episodic migraine.

    PubMed

    Miller, Sarah

    2012-08-01

    Episodic migraine is a common debilitating condition with significant worldwide impact. An effective management plan must include acute treatment to relieve the pain and potential disability associated with the attacks and may also include preventative treatments with an aim of decreasing attack frequency and severity in the longer term. Acute treatments must be limited to a maximum of 2-3 days a week to prevent medication overuse headache and focus on simple analgesia, non-steroidal anti-inflammatory drugs and triptans. Preventative treatments are numerous and should be considered when migraine attacks are frequent and or disabling, acute medication is failing, in special circumstances such as hemiplegic migraines or if the patient requests them. All preventative medications must be given at therapeutic doses for at least 6-8 weeks before an adequate trial can be judged ineffective. The most important factor in choosing drugs is the patient and the clinical features of their attack and treatment should be tailored to these. Relative co-morbidities will influence drug choice, as will the side effect profile and the efficacy of the drug. First line preventative drugs include ß-blockers, amitriptyline and anti-epileptic drugs such as topiramate and valproate. Drugs with lower efficacy or poorer side effect profiles include selective serotonin reuptake inhibitors (SSRIs), calcium channel antagonists, gabapentin and herbal medicines.

  18. Acute Rheumatic Fever: Global Persistence of a Preventable Disease.

    PubMed

    Bono-Neri, Francine

    2016-10-21

    The persistence of acute rheumatic fever continues to be seen globally. Once thought to be eradicated in various parts of the world, the disease came back with a vengeance secondary to a lack of diligence on the part of providers. Today, the global burden of group A streptococcal infection, the culprit of the numerous sequelae manifested in acute rheumatic fever, is considerable. Although a completely preventable disease, rheumatic fever continues to exist. It is a devastating disease that involves long-term, multisystem treatment and monitoring for patients who were unsuccessful at eradicating the precipitating group A streptococcal infection. Prevention is the key to resolving the dilemma of the disease's global burden, yet the method to yield its prevention still remains unknown. Thus, meticulous attention to implementing proper treatment is the mainstay and remains a top priority.

  19. Acute respiratory distress syndrome: prevention and early recognition.

    PubMed

    de Haro, Candelaria; Martin-Loeches, Ignacio; Torrents, Eva; Artigas, Antonio

    2013-04-24

    Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.

  20. Acute heart failure: Epidemiology, risk factors, and prevention.

    PubMed

    Farmakis, Dimitrios; Parissis, John; Lekakis, John; Filippatos, Gerasimos

    2015-03-01

    Acute heart failure represents the first cause of hospitalization in elderly persons and is the main determinant of the huge healthcare expenditure related to heart failure. Despite therapeutic advances, the prognosis of acute heart failure is poor, with in-hospital mortality ranging from 4% to 7%, 60- to 90-day mortality ranging from 7% to 11%, and 60- to 90-day rehospitalization from 25% to 30%. Several factors including cardiovascular and noncardiovascular conditions as well as patient-related and iatrogenic factors may precipitate the rapid development or deterioration of signs and symptoms of heart failure, thus leading to an acute heart failure episode that usually requires patient hospitalization. The primary prevention of acute heart failure mainly concerns the prevention, early diagnosis, and treatment of cardiovascular risk factors and heart disease, including coronary artery disease, while the secondary prevention of a new episode of decompensation requires the optimization of heart failure therapy, patient education, and the development of an effective transition and follow-up plan. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Human thermoregulatory responses during heat exposure after artificially induced sunburn.

    PubMed

    Pandolf, K B; Gange, R W; Latzka, W A; Blank, I H; Kraning, K K; Gonzalez, R R

    1992-04-01

    Thermoregulatory responses in the heat (ambient temperature 49 degrees C, 20% relative humidity, 1 m/s wind) were investigated in 10 unacclimated men during 50 min of cycle ergometer exercise (approximately 53% of maximal aerobic power) after a 10-min rest before as well as 24 h and 1 wk after twice the minimal erythemal dose of UV-B radiation that covered approximately 85% of the body surface area. In 7 subjects esophageal temperature (Tes) was recorded while in all 10 subjects five-site skin and rectal temperatures, heart rate, and back, left forearm, and shielded (12 cm2 area) right forearm sweating rates (msw) were recorded at 15-s intervals. Venous blood was collected before and after exercise-heat stress. Mean skin temperature, Tes, rectal temperature, heart rate, and total body sweating rate were not significantly (P greater than 0.05) affected by sunburn. Pre- and postexercise values of hematocrit, hemoglobin, plasma protein, plasma volume, and plasma osmolality were also not affected (P greater than 0.05) by sunburn. Analysis of presunburn and post-sunburn data showed that the Tes intercept for sweating (degrees C) was unaffected (P greater than 0.05), but msw/Tes and final msw from the left forearm (msw/Tes 0.24 +/- 0.02 vs. 0.17 +/- 0.01 mg.cm-2.min-1. degrees C-1, P less than 0.05; msw 0.60 +/- 0.05 vs. 0.37 +/- 0.02, mg.cm-2.min-1, P less than 0.05) and back (msw/Tes 0.43 +/- 0.03 vs. 0.36 +/- 0.01 mg.cm-2.min-1. degrees C-1, P = 0.052; msw 1.08 +/- 0.09 vs. 0.74 +/- 0.05 mg.cm-2.min-1, P less than 0.05) were significantly reduced 24 h postsunburn.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy

    PubMed Central

    McGreevy, Kai; Bottros, Michael M.; Raja, Srinivasa N.

    2011-01-01

    Chronic pain is the leading cause of disability in the United States. The transition from acute to persistent pain is thought to arise from maladaptive neuroplastic mechanisms involving three intertwined processes, peripheral sensitization, central sensitization, and descending modulation. Strategies aimed at preventing persistent pain may target such processes. Models for studying preventive strategies include persistent post-surgical pain (PPP), persistent post-trauma pain (PTP) and post-herpetic neuralgia (PHN). Such entities allow a more defined acute onset of tissue injury after which study of the long-term effects is more easily examined. In this review, we examine the pathophysiology, epidemiology, risk factors, and treatment strategies for the prevention of chronic pain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon. PMID:22102847

  3. Danaparoid sodium prevents cerulein-induced acute pancreatitis in rats.

    PubMed

    Hagiwara, Satoshi; Iwasaka, Hideo; Uchida, Tomohisa; Hasegawa, Akira; Asai, Nobuhiko; Noguchi, Takayuki

    2009-07-01

    Systemic inflammatory mediators, including the protein high-mobility group box 1 (HMGB1), play an important role in the development of acute pancreatitis. Anticoagulants such as danaparoid sodium (DA) may be able to inhibit sepsis-induced inflammation, but the mechanism of action is not well understood. We hypothesized that DA would act as an inhibitor of inflammation and prevent cerulein-induced acute pancreatitis. Male Wistar rats were used as subjects in this study. Each received a bolus of 50 U/kg of DA or saline-injected into the tail vein, followed by 4 injections of 50 mg/kg cerulean (i.p.) at 1-h intervals. Cytokine (IL-6), NO, and HMGB1 levels in serum and pancreatic tissue were measured after the cerulein injection. Pancreas histopathology and wet-dry ratio significantly improved in the DA-injected (50 U/kg) animals compared with saline-injected rats. Serum and pancreatic HMGB1 levels decreased over time in DA-treated animals. Danaparoid sodium also decreased cytokine, NO, and HMGB1 levels during cerulein-induced inflammation. As a result, DA ameliorated pancreas pathology in the rat model of cerulein-induced acute pancreatitis. This study demonstrates that DA treatment prevents cerulein-induced acute pancreatitis in a rat model. This effect may be mediated through inhibition of cytokines, NO, and HMGB1.

  4. Sunburn, sun exposure, and sun sensitivity in the Study of Nevi in Children.

    PubMed

    Satagopan, Jaya M; Oliveria, Susan A; Arora, Arshi; Marchetti, Michael A; Orlow, Irene; Dusza, Stephen W; Weinstock, Martin A; Scope, Alon; Geller, Alan C; Marghoob, Ashfaq A; Halpern, Allan C

    2015-11-01

    To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity. We describe an analysis of cross-sectional data from 443 children enrolled in the prospective Study of Nevi in Children. To evaluate the joint effect, we partitioned the sum of squares because of interaction between sunburn and sun exposure into orthogonal components representing (1) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends on sunburn), and (2) nonmonotonic pattern. In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (P = .08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (P < .001), but not among those with sunburn (P = .14). Sunburn was independently associated with log nevi (P = .02), even though sun sensitivity explained 29% (95% confidence interval: 2%-56%, P = .04) of its effect. Children with high sun sensitivity and sunburn had more nevi, regardless of sun exposure. A program of increasing sun protection in early childhood as a strategy for reducing nevi, when applied to the general population, may not equally benefit everyone. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. SUNBURN, SUN EXPOSURE, AND SUN SENSITIVITY IN THE STUDY OF NEVI IN CHILDREN

    PubMed Central

    Satagopan, Jaya M; Oliveria, Susan A; Arora, Arshi; Marchetti, Michael A; Orlow, Irene; Dusza, Stephen W; Weinstock, Martin A; Scope, Alon; Geller, Alan C; Marghoob, Ashfaq A; Halpern, Allan C

    2015-01-01

    Purpose To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity. Methods We describe an analysis of cross-sectional data from 443 children enrolled in the prospective study of nevi in children. To evaluate the joint effect, we partitioned the sum of squares due to interaction between sunburn and sun exposure into orthogonal components representing: (i) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends upon sunburn), and (ii) non-monotonic pattern. Results In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (p-value = 0.08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (p < 0.001), but not among those with sunburn (p = 0.14). Sunburn was independently associated with log nevi (p = 0.02), even though sun sensitivity explained 29% (95% CI: 2%-56%, p = 0.04) of its effect. Children with high sun sensitivity and sunburn had more nevi, regardless of sun exposure. Conclusions A program of increasing sun protection in early childhood as a strategy for reducing nevi, when applied to the general population, may not equally benefit everyone. PMID:26096189

  6. Cochrane Commentary: Probiotics For Prevention of Acute Upper Respiratory Infection.

    PubMed

    Quick, Melissa

    2015-01-01

    Probiotics may improve a person's health by regulating their immune function. Some trials have shown that probiotic strains can prevent respiratory infections. Even though the previous version of our review showed benefits of probiotics for acute upper respiratory tract infections (URTIs), several new studies have been published. To assess the effectiveness and safety of probiotics (any specified strain or dose), compared with placebo, in the prevention of acute URTIs in people of all ages, who are at risk of acute URTIs. We searched CENTRAL (2014, Issue 6), MEDLINE (1950 to July week 3, 2014), EMBASE (1974 to July 2014), Web of Science (1900 to July 2014), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to July 2014), the Chinese Medicine Popular Science Literature Database (from 2000 to July 2014) and the Masters Degree Dissertation of Beijing Union Medical College Database (from 1981 to July 2014). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for completed and ongoing trials on 31 July 2014. Randomised controlled trials (RCTs) comparing probiotics with placebo to prevent acute URTIs. Two review authors independently assessed the eligibility and quality of trials, and extracted data using the standard methodological procedures expected by The Cochrane Collaboration. We included 13 RCTs, although we could only extract data to meta-analyze 12 trials, which involved 3720 participants including children, adults (aged around 40 years) and older people. We found that probiotics were better than placebo when measuring the number of participants experiencing episodes of acute URTI [at least one episode: odds ratio (OR): 0.53; 95% CI = 0.37-0.76, P < .001, low quality evidence; at least three episodes: OR: 0.53; 95% CI = 0.36-0.80, P = .002, low quality evidence]; the mean duration of an episode of acute URTI [mean difference

  7. Knowledge deficit, attitude and behavior scales association to objective measures of sun exposure and sunburn in a Danish population based sample.

    PubMed

    Køster, Brian; Søndergaard, Jens; Nielsen, Jesper Bo; Christensen, Karl Bang; Allen, Martin; Olsen, Anja; Bentzen, Joan

    2017-01-01

    The objective of this study was to develop new scales measuring knowledge and attitude about UVR and sun related behavior, and to examine their association to sun related behavior objectively measured by personal dosimetry. During May-August 2013, 664 Danes wore a personal electronic UV-dosimeter for one week that measured their UVR exposure. Afterwards, they answered a questionnaire on sun-related items. We applied descriptive analysis, linear and logistic regression analysis to evaluate the associations between the questionnaire scales and objective UVR measures. Perceiving protection as routine and important were positively correlated with protective behavior. Knowledge deficit of UV and risk of melanoma, perceived benefits and importance of protection behavior was also correlated with use of protection. 'Knowledge deficit of UV and risk of melanoma and Perceived barrier towards sun avoidance between 12 and 15' were both associated with increased risk of sunburn. Attitude towards tan was associated to both outdoor time and exposure as well as use of protection, but not to sunburn. The results regarding Knowledge deficit of UV and risk of melanoma associated to UVR exposure and Perceived barrier towards sun avoidance between 12 and 15 emphasize the importance of awareness of melanoma risk and the priority of the skin cancer prevention advice. Shifting activities to outside the suns peak-hours could be an approach for structural and campaign preventive measures. Knowledge of items predicting exposure to UVR, use of protection and sunburn are important for planning of preventive interventions and melanoma research.

  8. Knowledge deficit, attitude and behavior scales association to objective measures of sun exposure and sunburn in a Danish population based sample

    PubMed Central

    Søndergaard, Jens; Nielsen, Jesper Bo; Christensen, Karl Bang; Allen, Martin; Olsen, Anja; Bentzen, Joan

    2017-01-01

    The objective of this study was to develop new scales measuring knowledge and attitude about UVR and sun related behavior, and to examine their association to sun related behavior objectively measured by personal dosimetry. During May-August 2013, 664 Danes wore a personal electronic UV-dosimeter for one week that measured their UVR exposure. Afterwards, they answered a questionnaire on sun-related items. We applied descriptive analysis, linear and logistic regression analysis to evaluate the associations between the questionnaire scales and objective UVR measures. Perceiving protection as routine and important were positively correlated with protective behavior. Knowledge deficit of UV and risk of melanoma, perceived benefits and importance of protection behavior was also correlated with use of protection. ‘Knowledge deficit of UV and risk of melanoma and Perceived barrier towards sun avoidance between 12 and 15’ were both associated with increased risk of sunburn. Attitude towards tan was associated to both outdoor time and exposure as well as use of protection, but not to sunburn. The results regarding Knowledge deficit of UV and risk of melanoma associated to UVR exposure and Perceived barrier towards sun avoidance between 12 and 15 emphasize the importance of awareness of melanoma risk and the priority of the skin cancer prevention advice. Shifting activities to outside the suns peak-hours could be an approach for structural and campaign preventive measures. Knowledge of items predicting exposure to UVR, use of protection and sunburn are important for planning of preventive interventions and melanoma research. PMID:28542543

  9. Patients with xeroderma pigmentosum complementation groups C, E and V do not have abnormal sunburn reactions.

    PubMed

    Sethi, M; Lehmann, A R; Fawcett, H; Stefanini, M; Jaspers, N; Mullard, K; Turner, S; Robson, A; McGibbon, D; Sarkany, R; Fassihi, H

    2013-12-01

    Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder of DNA repair. It is divided into eight complementation groups: XP-A to XP-G (classical XP) and XP variant (XP-V). Severe and prolonged sunburn reactions on minimal sun exposure have been considered a cardinal feature of classical XP. However, it has recently become clear that not all patients have abnormal sunburn reactions. To examine sunburn reactions in a cohort of patients with XP and correlate this to the complementation group. Sixty patients with XP attending the U.K. National XP Service from 2010 to 2012 were studied. Their history of burning after minimal sun exposure was assessed using a newly developed sunburn severity score. The age at which the first skin cancer was histologically diagnosed in each patient, and the presence of any neurological abnormality, was also recorded. Sunburn severity scores were abnormally high in patients with XP-A, XP-D, XP-F and XP-G compared with non-XP controls. There was no significant difference in sunburn score of patients with XP-C, XP-E and XP-V compared with controls (P > 0·05). Patients with XP-C, XP-E and XP-V were more likely to have skin cancer diagnosed at an earlier age than those with severe sunburn on minimal sun exposure. In addition, patients with XP with severe sunburn had an increased frequency of neurological abnormalities. Not all patients with XP have a history of severe and prolonged sunburn on minimal sun exposure. The normal sunburn response of patients with XP-C, XP-E and XP-V may relate to the preservation of transcription-coupled DNA repair in these groups. Those with a history of severe sunburn on minimal sun exposure developed their first skin cancer at an older age compared with patients with XP-C, XP-E and XP-V, but they had an increased frequency of neurological abnormalities. Physicians need to be aware that about half of all patients with XP will present without a history of abnormal sunburn. © 2013 British Association of

  10. Update: Acute coronary syndromes (IX). Secondary prevention strategies for acute coronary syndrome.

    PubMed

    Quiles, Juan; Miralles-Vicedo, Beatriz

    2014-10-01

    Cardiovascular disease is the main health problem in Europe and the rest of the world and is the leading cause of death and health care expenditure. By reducing mortality and ischemic event recurrence, prevention strategies play a fundamental role in patients who have had an acute coronary syndrome. Although these prevention strategies have focused with great success on high-risk individuals, they should also be used in the general population, which is showing an increase in the prevalence of obesity, diabetes mellitus, and other comorbidities that may reverse this trend toward reduced mortality. The present article consists of an up-to-date review of the main cardiovascular prevention measures, particularly the new developments of the last year, as well as the particularities of these measures when they are targeted at patients with a prior acute coronary syndrome. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  11. Contemporary themes in acute coronary syndrome management: from acute illness to secondary prevention.

    PubMed

    Brieger, David B; Redfern, Julie

    2013-08-05

    Acute coronary syndrome (ACS; myocardial infarction and unstable angina) is the leading cause of mortality in Australia, and those who survive one ACS event are at significant risk of experiencing another. Access to evidence-based and optimal ACS management in both the acute and long-term periods is of great importance. Management of ACS should include appropriate timely revascularisation, medical therapy and ongoing secondary prevention. A key consideration in selecting acute antithrombotic therapies is a careful determination of the risk of bleeding versus risk of recurrent ischaemia. Although there is a strong evidence base for the urgency of delivery and the quality of acute care, knowledge translation is suboptimal. There remains a need for ongoing research and policy development aimed at improving ease and equity of access to evidence-based care. Despite universal guideline recommendations for ongoing secondary prevention strategies, research indicates suboptimal use of evidence-based medications, poor adherence to lifestyle recommendations, and low levels of participation in traditional cardiac rehabilitation. Contemporary secondary prevention programs are evolving into flexible, multifaceted interventions to provide maximal clinical benefits to a majority of patients.

  12. Gouty Arthritis: A Review of Acute Management and Prevention.

    PubMed

    Wilson, Liza; Saseen, Joseph J

    2016-08-01

    Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities, lifestyle factors, and increased use of causative medications. With the increasing prevalence, there have been several innovations and evidence-based updates related to the diagnosis and management of gout. Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout. Add-on therapies that reduce serum urate concentration include traditional uricosuric agents and a novel uric acid reabsorption inhibitor. Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months. In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval.

  13. Current prevention and management of acute mountain sickness.

    PubMed Central

    Bia, F. J.

    1992-01-01

    Acute mountain sickness was known to the Chinese in ancient times, as they traversed mountain passes between the Great Headache and Little Headache mountains into present-day Afghanistan. The Jesuit priest, Father Joseph Acosta, lived in Peru during the sixteenth century; he described both this syndrome and deaths which occurred in the high Andes. The incidence of high-altitude illness will rise as previously remote sites become more accessible to trekkers and skiers. Prevention and treatment are important concerns for those physicians who wish to advise their more adventuresome patients properly. This article incorporates a selected review of pertinent investigations, in the English-language literature over the past five years, into material previously presented at travel symposia for clinicians managing the prophylaxis and treatment of acute mountain sickness. PMID:1290275

  14. Prevention of acute gastric mucosal lesions by Solcoseryl.

    PubMed

    Brzozowski, T; Radecki, T; Sendur, R; Gustaw, P; Konturek, S J

    1987-04-01

    Solcoseryl, a deproteinized extract from calf blood containing various biologically active substances, has been reported to promote the healing of skin wounds and gastric ulceration In this study, the gastroprotective effects of Solcoseryl vis-a-vis acute gastric mucosal damage were examined in rats. Solcoseryl significantly reduced the formation of acute lesions induced by intragastric application of absolute ethanol or acidified taurocholate and by water immersion and restraint stress, but failed to affect those caused by acidified aspirin. Since Solcoseryl did not offer protection in the absence of mucosal prostaglandins (PG) e.g. in aspirin-induced gastric damage, it is likely that PG may be involved in the observed gastroprotective activity of the drug. Solcoseryl failed to affect gastric acid or pepsin secretion, but increased mucosal blood flow. Thus PG generated by Solcoseryl might contribute to the maintenance of the observed mucosal microcirculation and the prevention of lesion formation by corrosive substances and stress conditions.

  15. Pharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

    PubMed Central

    Tasanarong, Adis

    2014-01-01

    Contrast-induced acute kidney injury (CI-AKI) is the most common iatrogenic cause of acute kidney injury after intravenous contrast media administration. In general, the incidence of CI-AKI is low in patients with normal renal function. However, the rate is remarkably elevated in patients with preexisting chronic kidney disease, diabetes mellitus, old age, high volume of contrast agent, congestive heart failure, hypotension, anemia, use of nephrotoxic drug, and volume depletion. Consequently, CI-AKI particularly in high risk patients contributes to extended hospitalizations and increases long-term morbidity and mortality. The pathogenesis of CI-AKI involves at least three mechanisms; contrast agents induce renal vasoconstriction, increase of oxygen free radicals through oxidative stress, and direct tubular toxicity. Several strategies to prevent CI-AKI have been evaluated in experimental studies and clinical trials. At present, intravascular volume expansion with either isotonic saline or sodium bicarbonate solutions has provided more consistent positive results and was recommended in the prevention of CI-AKI. However, the proportion of patients with risk still develops CI-AKI. This review critically evaluated the current evidence for pharmacological strategies to prevent CI-AKI in patients with a risk of developing CI-AKI. PMID:24719848

  16. Inhaled budesonide and oral dexamethasone prevent acute mountain sickness.

    PubMed

    Zheng, Cheng-Rong; Chen, Guo-Zhu; Yu, Jie; Qin, Jun; Song, Pan; Bian, Shi-Zhu; Xu, Bai-Da; Tang, Xu-Gang; Huang, Yong-Tao; Liang, Xiao; Yang, Jie; Huang, Lan

    2014-10-01

    This double-blind, randomized controlled trial aimed to investigate inhaled budesonide and oral dexamethasone compared with placebo for their prophylactic efficacy against acute mountain sickness after acute high-altitude exposure. There were 138 healthy young male lowland residents recruited and randomly assigned to receive inhaled budesonide (200 μg, twice a day [bid]), oral dexamethasone (4 mg, bid), or placebo (46 in each group). They traveled to 3900 m altitude from 400 m by car. Medication started 1 day before high-altitude exposure and continued until the third day of exposure. Primary outcome measure was the incidence of acute mountain sickness after exposure. One hundred twenty-four subjects completed the study (42, 39, and 43 in the budesonide, dexamethasone, and placebo groups, respectively). Demographic characteristics were comparable among the 3 groups. After high-altitude exposure, significantly fewer participants in the budesonide (23.81%) and dexamethasone (30.77%) groups developed acute mountain sickness compared with participants receiving placebo (60.46%) (P = .0006 and P = .0071, respectively). Both the budesonide and dexamethasone groups had lower heart rate and higher pulse oxygen saturation (SpO2) than the placebo group at altitude. Only the budesonide group demonstrated less deterioration in forced vital capacity and sleep quality than the placebo group. Four subjects in the dexamethasone group reported adverse reactions. Both inhaled budesonide (200 μg, bid) and oral dexamethasone (4 mg, bid) were effective for the prevention of acute mountain sickness, especially its severe form, compared with placebo. Budesonide caused fewer adverse reactions than dexamethasone. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Treatment of Neuromyelitis Optica Spectrum Disorder: Acute, Preventive, and Symptomatic

    PubMed Central

    Kessler, Remi A.; Mealy, Maureen A.; Levy, Michael

    2016-01-01

    Opinion statement Neuromyelitis optica spectrum disorder (NMOSD) is a rare, autoimmune disease of the central nervous system that primarily attacks the optic nerves and spinal cord leading to blindness and paralysis. The spectrum of the disease has expanded based on the specificity of the autoimmune response to the aquaporin-4 water channel on astrocytes. With wider recognition of NMOSD, a standard of care for treatment of this condition has condition based on a growing series of retrospective and prospective studies. This review covers the present state of the field in the treatment of acute relapses, preventive approaches, and therapies for symptoms of NMOSD. PMID:26705758

  18. [Treatment guidelines for acute and preventive treatment of cluster headache].

    PubMed

    Chen, Ping-Kun; Chen, Hsi-Ming; Chen, Wei-Hung; Chen, Yeng-Yu; Fuh, Jong-Ling; Lee, Lian-Hui; Liao, Yi-Chu; Lin, Kao-Chang; Tseng, Hung-Ping; Tsai, Jing-Jane; Wang, Po-Jen; Wang, Shuu-Jiun; Yang, Chun-Pai; Yiu, Chun-Hing; Wu, Zin-An

    2011-09-01

    The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated both the acute and the preventive treatments for cluster headache now being used in Taiwan, based on the principles of evidence- based medicine. We assessed the quality of clinical trials and levels of evidence, and referred to other treatment guidelines proposed by other countries. Throughout several panel discussions, we merged opinions from the subcommittee members and proposed a consensus on the major roles, recommended levels, clinical efficacy, adverse events and cautions of clinical practice regarding acute and preventive treatments of cluster headache. The majority of Taiwanese patients have episodic cluster headaches, because chronic clusters are very rare. Cluster headache is characterized by severe and excruciating pain which develops within a short time and is associated with ipsilateral autonomic symptoms. Therefore, emergency treatment for a cluster headache attack is extremely important. Within the group of acute medications currently available in Taiwan, the subcommittee determined that high-flow oxygen inhalation has the best evidence of effectiveness, followed by intranasal triptans. Both are recommended as first-line medical treatments for acute attacks. Oral triptans were determined to be second-line medications. For transitional prophylaxis, oral corticosteroids are recommended as the first-line medication, and ergotamine as the second-line choice. As for maintenance prophylaxis, verapamil has the best evidence and is recommended as the first-line medication. Lithium, melatonin, valproic acid, topiramate and gabapentin are suggested as the second-line preventive medications. Surgical interventions, including occipital nerve stimulation, deep brain stimulation, radiofrequency block of the sphenopalatine ganglion, percutaneous radiofrequency rhizotomy and trigeminal nerve section, are invasive and their long-term efficacy and adverse events are still not clear in

  19. Acute kidney injury by radiographic contrast media: pathogenesis and prevention.

    PubMed

    Andreucci, Michele; Faga, Teresa; Pisani, Antonio; Sabbatini, Massimo; Michael, Ashour

    2014-01-01

    It is well known that iodinated radiographic contrast media may cause kidney dysfunction, particularly in patients with preexisting renal impairment associated with diabetes. This dysfunction, when severe, will cause acute renal failure (ARF). We may define contrast-induced Acute Kidney Injury (AKI) as ARF occurring within 24-72 hrs after the intravascular injection of iodinated radiographic contrast media that cannot be attributed to other causes. The mechanisms underlying contrast media nephrotoxicity have not been fully elucidated and may be due to several factors, including renal ischaemia, particularly in the renal medulla, the formation of reactive oxygen species (ROS), reduction of nitric oxide (NO) production, and tubular epithelial and vascular endothelial injury. However, contrast-induced AKI can be prevented, but in order to do so, we need to know the risk factors. We have reviewed the risk factors for contrast-induced AKI and measures for its prevention, providing a long list of references enabling readers to deeply evaluate them both.

  20. Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

    PubMed Central

    Faga, Teresa; Pisani, Antonio; Michael, Ashour

    2014-01-01

    It is well known that iodinated radiographic contrast media may cause kidney dysfunction, particularly in patients with preexisting renal impairment associated with diabetes. This dysfunction, when severe, will cause acute renal failure (ARF). We may define contrast-induced Acute Kidney Injury (AKI) as ARF occurring within 24–72 hrs after the intravascular injection of iodinated radiographic contrast media that cannot be attributed to other causes. The mechanisms underlying contrast media nephrotoxicity have not been fully elucidated and may be due to several factors, including renal ischaemia, particularly in the renal medulla, the formation of reactive oxygen species (ROS), reduction of nitric oxide (NO) production, and tubular epithelial and vascular endothelial injury. However, contrast-induced AKI can be prevented, but in order to do so, we need to know the risk factors. We have reviewed the risk factors for contrast-induced AKI and measures for its prevention, providing a long list of references enabling readers to deeply evaluate them both. PMID:25197639

  1. Emerging Therapies for the Prevention of Acute Respiratory Distress Syndrome

    PubMed Central

    Ruthman, Carl A.; Festic, Emir

    2015-01-01

    The development of the acute respiratory distress syndrome (ARDS) carries significant risk of morbidity and mortality. To date, pharmacologic therapy has been largely ineffective for patients with ARDS. We present our personal review aimed at outlining current and future directions for the pharmacologic prevention of ARDS. Several available risk-stratification or prediction scores strategies for identification of patients at risk of ARDS have been reported. Although not ready for the clinical everyday use, they are and will be instrumental in the ongoing and future trials of pharmacoprevention of ARDS. Several systemic medications established the potential role in ARDS prevention based on the preclinical studies and observational data. Due to potential for systemic adverse effects to neutralize any pharmacologic benefits of systemic therapy, inhaled medications appear particularly attractive candidates for ARDS prevention. This is because of their direct delivery to the site of the proposed action (lungs), while pulmonary epithelial surface is still functional. We postulate that overall morbidity and mortality rates from ARDS in the future will be contingent upon decreasing the overall incidence of ARDS through effective identification of those at risk and early application of proven supportive care and pharmacologic interventions. PMID:26002528

  2. Ambroxol for the prevention of acute upper respiratory disease.

    PubMed

    Nobata, K; Fujimura, M; Ishiura, Y; Myou, S; Nakao, S

    2006-06-01

    Although acute upper respiratory diseases (AURDs) such as common cold and influenza are common, few interventions have been proven to be effective in their prevention and treatment. The aim of this study was to assess the efficacy of ambroxol for preventing AURD. Fifty-four patients were randomly divided into 3 groups: a rebamipide (non-mucoactive drug) group (300 mg/day), carbocisteine group (1500 mg/day) and ambroxol group (45 mg/day). The study was divided into 2 terms, the first half-year (summer season) and the second half-year (winter season). In the preceding winter, only 19.5% of the patients had been vaccinated against influenza viruses (flu). The primary goal of this study was to evaluate the effectiveness of mucoactive drugs in decreasing the frequency of AURD. Treatment with ambroxol, but not carbocisteine, significantly reduced the median number of AURD episodes (P=0.0049 vs. rebamipide). Thirty-three patients without vaccination against flu were assessed especially during the second half-year. Treatment with ambroxol also significantly reduced the median number of AURD episodes in this assessment (P=0.0028 vs. rebamipide in the second half-year). In conclusion, ambroxol may be useful for preventing AURD.

  3. Dexamethasone for prevention and treatment of acute mountain sickness.

    PubMed

    Hackett, P H; Roach, R C; Wood, R A; Foutch, R G; Meehan, R T; Rennie, D; Mills, W J

    1988-10-01

    We wished to determine in a field study the effectiveness of dexamethasone for prevention and treatment of acute mountain sickness (AMS). Prevention Trial: We transported 15 subjects from sea level to 4,400 m (PB = 400 mm Hg) on Denali (Mt. McKinley) by means of a 1-h helicopter flight. In a randomized, double-blind fashion we gave eight subjects a placebo and seven subjects 2 mg dexamethasone orally every 6 h, starting 1 h before take-off. The entire placebo group and five of the dexamethasone group developed AMS within 5 h, and became progressively more ill until 12 h when the trial was terminated. We concluded that 2 mg of dexamethasone every 6 h did not prevent AMS in active soldiers rapidly transported to high altitude. Treatment Trial: We treated 11 of those with moderate to severe AMS (symptom score 4.5 +/- 0.7, range 3 to 11) with 4 mg of dexamethasone every 6 h orally or intramuscularly for 24 h. All were markedly improved at 12 h (symptom score 1.0 +/- 0.3, p less than 0.001, range 0 to 3), but symptoms increased after the drug was discontinued at 24 h (symptom score = 2.4 +/- 0.5). We conclude that dexamethasone in a dosage of 4 mg PO or IM every 6 h is an effective treatment for AMS, but that illness may recur with abrupt discontinuation of the drug.

  4. Red Wine Prevents the Acute Negative Vascular Effects of Smoking.

    PubMed

    Schwarz, Viktoria; Bachelier, Katrin; Schirmer, Stephan H; Werner, Christian; Laufs, Ulrich; Böhm, Michael

    2017-01-01

    Moderate consumption of red wine is associated with fewer cardiovascular events. We investigated whether red wine consumption counteracts the adverse vascular effects of cigarette smoking. Participants smoked 3 cigarettes alone or after drinking a titrated volume of red wine. Clinical chemistry, blood counts, plasma cytokine enzyme-linked immunosorbent assays, immunomagnetic separation of CD14(+) monocytes for gene expression analysis, fluorescence-activated cell sorting for microparticles, and isolation of circulating mononuclear cells to measure telomerase activity were performed, and urine cotinine levels were quantified. Compared with baseline, leukocytosis (P = .019), neutrophilia (P <.001), lymphopenia (P <.001), and eosinopenia (P = .008) were observed after only smoking. Endothelial and platelet-, monocyte-, and leukocyte-derived microparticles (P <.001 each) were elevated. In monocytes, messenger RNA expression of interleukin (IL)-6 (2.6- ± 0.57-fold), tumor necrosis factor alpha (2.2- ± 0.62-fold), and IL-1b (2.3- ± 0.44-fold) were upregulated, as was IL-6 (1.2 ± 0.12-fold) protein concentration in plasma. Smoking acutely inhibited mononuclear cell telomerase activity. Markers of endothelial damage, inflammation, and cellular aging were completely attenuated by red wine consumption. Cigarette smoke results in acute endothelial damage, vascular and systemic inflammation, and indicators of the cellular aging processes in otherwise healthy nonsmokers. Pretreatment with red wine was preventive. The findings underscore the magnitude of acute damage exerted by cigarette smoking in "occasional lifestyle smokers" and demonstrate the potential of red wine as a protective strategy to avert markers of vascular injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. A robust impact assessment that informs actionable climate change adaptation: future sunburn browning risk in apple

    NASA Astrophysics Data System (ADS)

    Webb, Leanne; Darbyshire, Rebecca; Erwin, Tim; Goodwin, Ian

    2016-11-01

    Climate change impact assessments are predominantly undertaken for the purpose of informing future adaptation decisions. Often, the complexity of the methodology hinders the actionable outcomes. The approach used here illustrates the importance of considering uncertainty in future climate projections, at the same time providing robust and simple to interpret information for decision-makers. By quantifying current and future exposure of Royal Gala apple to damaging temperature extremes across ten important pome fruit-growing locations in Australia, differences in impact to ripening fruit are highlighted, with, by the end of the twenty-first century, some locations maintaining no sunburn browning risk, while others potentially experiencing the risk for the majority of the January ripening period. Installation of over-tree netting can reduce the impact of sunburn browning. The benefits from employing this management option varied across the ten study locations. The two approaches explored to assist decision-makers assess this information (a) using sunburn browning risk analogues and (b) through identifying hypothetical sunburn browning risk thresholds, resulted in varying recommendations for introducing over-tree netting. These recommendations were location and future time period dependent with some sites showing no benefit for sunburn protection from nets even by the end of the twenty-first century and others already deriving benefits from employing this adaptation option. Potential best and worst cases of sunburn browning risk and its potential reduction through introduction of over-tree nets were explored. The range of results presented highlights the importance of addressing uncertainty in climate projections that result from different global climate models and possible future emission pathways.

  6. A robust impact assessment that informs actionable climate change adaptation: future sunburn browning risk in apple

    NASA Astrophysics Data System (ADS)

    Webb, Leanne; Darbyshire, Rebecca; Erwin, Tim; Goodwin, Ian

    2017-05-01

    Climate change impact assessments are predominantly undertaken for the purpose of informing future adaptation decisions. Often, the complexity of the methodology hinders the actionable outcomes. The approach used here illustrates the importance of considering uncertainty in future climate projections, at the same time providing robust and simple to interpret information for decision-makers. By quantifying current and future exposure of Royal Gala apple to damaging temperature extremes across ten important pome fruit-growing locations in Australia, differences in impact to ripening fruit are highlighted, with, by the end of the twenty-first century, some locations maintaining no sunburn browning risk, while others potentially experiencing the risk for the majority of the January ripening period. Installation of over-tree netting can reduce the impact of sunburn browning. The benefits from employing this management option varied across the ten study locations. The two approaches explored to assist decision-makers assess this information (a) using sunburn browning risk analogues and (b) through identifying hypothetical sunburn browning risk thresholds, resulted in varying recommendations for introducing over-tree netting. These recommendations were location and future time period dependent with some sites showing no benefit for sunburn protection from nets even by the end of the twenty-first century and others already deriving benefits from employing this adaptation option. Potential best and worst cases of sunburn browning risk and its potential reduction through introduction of over-tree nets were explored. The range of results presented highlights the importance of addressing uncertainty in climate projections that result from different global climate models and possible future emission pathways.

  7. A robust impact assessment that informs actionable climate change adaptation: future sunburn browning risk in apple.

    PubMed

    Webb, Leanne; Darbyshire, Rebecca; Erwin, Tim; Goodwin, Ian

    2017-05-01

    Climate change impact assessments are predominantly undertaken for the purpose of informing future adaptation decisions. Often, the complexity of the methodology hinders the actionable outcomes. The approach used here illustrates the importance of considering uncertainty in future climate projections, at the same time providing robust and simple to interpret information for decision-makers. By quantifying current and future exposure of Royal Gala apple to damaging temperature extremes across ten important pome fruit-growing locations in Australia, differences in impact to ripening fruit are highlighted, with, by the end of the twenty-first century, some locations maintaining no sunburn browning risk, while others potentially experiencing the risk for the majority of the January ripening period. Installation of over-tree netting can reduce the impact of sunburn browning. The benefits from employing this management option varied across the ten study locations. The two approaches explored to assist decision-makers assess this information (a) using sunburn browning risk analogues and (b) through identifying hypothetical sunburn browning risk thresholds, resulted in varying recommendations for introducing over-tree netting. These recommendations were location and future time period dependent with some sites showing no benefit for sunburn protection from nets even by the end of the twenty-first century and others already deriving benefits from employing this adaptation option. Potential best and worst cases of sunburn browning risk and its potential reduction through introduction of over-tree nets were explored. The range of results presented highlights the importance of addressing uncertainty in climate projections that result from different global climate models and possible future emission pathways.

  8. Polymyxin B hemoperfusion prevents acute kidney injury in sepsis model.

    PubMed

    Mitaka, Chieko; Masuda, Takahiro; Kido, Koji; Uchida, Tokujiro; Abe, Shinya; Miyasho, Taku; Tomita, Makoto; Inada, Eiichi

    2016-03-01

    Direct hemoperfusion with a polymyxin B-immobilized column (PMX-DHP) adsorbs endotoxin and has been used for the treatment of septic shock. Yet, the mechanisms by which PMX-DHP acts on acute kidney injury are only partially understood. Rats were anesthetized, tracheostomized, and placed on mechanical ventilation. The animals were randomized to three groups: a cecal ligation and puncture (CLP) + dummy-DHP group (n = 10), a CLP + PMX-DHP group (n = 10), and a sham group (n = 4). Four hours after CLP, a dummy-DHP or PMX-DHP was performed for 1 h. The heart rate, mean arterial pressure, arterial blood gases, and plasma concentrations of creatinine, lactate, potassium, interleukin (IL)-6, and IL-10 were measured at 0 h and 8 h. Eight hours after CLP, the kidney was harvested, and histopathologic examination was performed. The expressions of cleaved poly (ADP-ribose) polymerase (PARP) and nuclear factor (NF)-κB p65 were examined by immunohistochemistry. A terminal deoxynucleotide transferase dUTP nick-end labeling assay was performed to detect apoptotic nuclei in kidney sections. PMX-DHP maintained hemodynamics and the acid-base balance and significantly (P < 0.05) decreased the plasma concentrations of lactate, creatinine, potassium, IL-6, and IL-10 compared with dummy-DHP. PMX-DHP significantly (P < 0.001) attenuated the expressions of cleaved PARP and NF-κB p65 in renal tubular cells and renal tubular cell apoptosis compared with dummy-DHP. These findings suggest that PMX-DHP may protect against acute kidney injury not only by inhibiting the NF-κB signaling pathway but also by preventing renal tubular cell apoptosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Sunburn related to UV radiation exposure, age, sex, occupation, and sun bed use based on time-stamped personal dosimetry and sun behavior diaries.

    PubMed

    Thieden, Elisabeth; Philipsen, Peter A; Sandby-Møller, Jane; Wulf, Hans Christian

    2005-04-01

    To assess when sunburn occurs and who experiences sunburn by personal UV dosimetry and diaries. Open prospective observational study. University hospital. A convenience sample of 340 Danish volunteers: children, adolescents, indoor workers, sun worshippers, golfers, and gardeners (age range, 4-68 years). Subjects recorded sunburn and sun-exposure behavior in diaries and carried personal, electronic, wristwatch UV radiation (UVR) dosimeters that measured time-stamped UVR doses continuously for a median of 119 days covering 346 sun-years (1 sun-year equals 1 subject participating during 1 summer half-year). A typical sunburn day was a day off work (91%; odds ratio, 4.1) with risk behavior (sunbathing/exposing shoulders) (79%; odds ratio, 15.9) in May, June, or July (90%) for 6.4 exposure hours (interquartile range, 5-7.7 hours), of which 2.8 hours fell between noon and 3 pm. Subjects had a median of 1 sunburn per sun-year; adolescents, sun worshippers, and indoor workers had more than children, golfers, and gardeners (P<.05). Sunburn peaked at age 20 years, and female subjects had more sunburns than male subjects (P<.01). Skin type IV had fewer sunburns than types I through III (P<.01). Sunburned persons had more risk-behavior days and lower skin type (P<.01) than nonsunburned persons. The median UVR doses received were significantly higher on sunburn days than on nonsunburn days with risk behavior (P<.01). There was a significant correlation between sunburn size and severity; sunburn and sunscreen use; and sunburn and sun-bed use (P<.01 for all 3 comparisons). Sunburn was highly correlated with risk behavior. Reduction of risk-behavior days and/or exposure hours around noon can reduce sunburn. Sunburn was not found during breaks on normal full-time indoor work or school days.

  10. The sunburn cell in hairless mouse epidermis: quantitative studies with UV-A radiation and mono- and bifunctional psoralens

    SciTech Connect

    Young, A.R.; Magnus, I.A.

    1982-10-01

    The production of the sunburn cell by UV-A radiation and topical psoralens in hairless mouse epidermis has been studied. It has been shown that the appearance of this cell is dependent on the dose of both UV-A radiation and of the psoralen. The time-course with 8-methoxypsoralen has peak sunburn cell numbers at 28 hr postirradiation. A comparison of 2 bifunctional (8-methoxypsoralen and 5-methoxypsoralen) and 2 monofunctional (angelicin and 3-carbethoxypsoralen) psoralens showed the former are more potent. This suggests that DNA crosslink lesions may play a rle in sunburn cell production.

  11. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

    PubMed Central

    Gower, Emily W; Lindsley, Kristina; Nanji, Afshan A; Leyngold, Ilya; McDonnell, Peter J

    2014-01-01

    Background Endophthalmitis is a severe inflammation of the anterior and/or posterior chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. Objectives The objective of this review was to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 October 2012. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. Trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic) or postoperative antibiotic prophylaxis for acute endophthalmitis were included. We did not include studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine, nor did we include studies that evaluated antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two

  12. The measurement of ultraviolet radiation and sunburn time over southern Ontario

    NASA Technical Reports Server (NTRS)

    Evans, W. F. J.

    1994-01-01

    Studies of the depletion of ozone which have been conducted from the TOMS instrument on the NIMBUS 7 satellite indicate that total ozone has declined by 5 percent over the last 12 years at most mid-latitudes in the Northern Hemisphere typical of southern Ontario. The measurement of the actual resultant increases in UVB is now important. A monitoring program of UVB (biologically active solar ultraviolet radiation) has been conducted for the last 24 months at a site near Bolton, Ontario. The sunburn time varies from less than 17 minutes in late July, to over 4 hours in December on clear days. The levels depend on solar insolation and total ozone column. The ultraviolet levels are strongly affected by cloud and sky conditions. The implications of present and future depletion on the sunburn time are discussed.

  13. Proteomics approach reveals mechanism underlying susceptibility of loquat fruit to sunburn during color changing period.

    PubMed

    Jiang, Ji-Mou; Lin, Yong-Xiang; Chen, Yi-Yong; Deng, Chao-Jun; Gong, Hui-Wen; Xu, Qi-Zhi; Zheng, Shao-Quan; Chen, Wei

    2015-06-01

    The objective of this work was to investigate why loquat fruit peels are more sensitive to high temperature and strong sunlight, making them highly susceptible to sunburn, during the color changing period (CCP). Two dimensional gel electrophoresis (2-DE) of the fruit peel proteins was performed over three developmental periods, namely green fruit period (GFP), color changing period and yellow ripening period (YRP). Fifty-five protein spots with at least 2-fold differences in abundance were successfully identified by MALDI-TOF-TOF/MS. The identified proteins were divided into categories related to heat-shock response, stress response and defense, energy metabolism, photosynthesis and protein biosynthesis. The results showed that expression of proteins related to anaerobic respiration and photorespiration were increased while the proteins related to ROS scavenging, polyamine biosynthesis, defense pathogens and photosynthesis were decreased during CCP under heat stress. Our findings provide new insights into the molecular mechanism of loquat fruit susceptible to sunburn during CCP.

  14. The sunburn cell: regulation of death and survival of the keratinocyte.

    PubMed

    Van Laethem, An; Claerhout, Sofie; Garmyn, Maria; Agostinis, Patrizia

    2005-08-01

    Sunburn cells are keratinocytes undergoing apoptosis after they have received a physiological UVB dose that irreversibly and severely damaged their DNA or other chromophores. If these cells would escape programmed cell death, a cancer prone phenotype could arise. On the other hand, if the decision to die is made too prematurely, the proliferative compartment of basal keratinocytes would be inevitably lost, thereby hampering normal skin homeostasis. Pro- and anti-apoptotic mediators carefully control crucial points of the cell death program by regulating complex signalling cascades originating at the cell membrane, the nucleus and the cytoplasm. The balance between survival and apoptogenic factors determines the final cell fate, and growing evidence suggests that the deregulation of this balance by chronic UVB stress, results in the development of skin malignancy. The present paper reviews recent data on the major pathways regulating UVB-induced sunburn cell formation and implicates the deregulation of these pathways in the development of skin cancer.

  15. A randomized study of the prevention of acute graft-versus-host disease

    SciTech Connect

    Ramsay, N.K.C.; Kersey, J.H.; Robison, L.L.; McGlave, P.B.; Woods, W.G.; Krivit, W.; Kim, T.H.; Goldman, A.I.; Nesbit, M.E., Jr.

    1982-02-01

    Acute graft-versus-host disease is a major problem in allogeneic bone-marrow transplantation. We performed a randomized study to compare the effectiveness of two regimens in the prevention of acute graft-versus-host disease. Thirty-five patients received methotrexate alone, and 32 received methotrexate, antithymocyte globulin, and prednisone. Of the patients who received methotrexate alone, 48 percent had acute graft-versus-host disease, as compared with 21 per cent of those who received methotrexate, antithymocyte globulin, and prednisone (P = 0.01). The age of the recipient was a significant factor in the development of acute graft-versus-host disease: Older patients had a higher incidence of the disease (P = 0.001). We conclude that the combination of methotrexate, antithymocyte globulin, and prednisone significantly decreased the incidence of acute graft-versus-host disease and should be used to prevent this disorder in patients receiving allogeneic marrow transplants.

  16. Double trouble from sunburn: UVB-induced erythema is associated with a transient decrease in skin pigmentation.

    PubMed

    Casetti, F; Miese, A; Mueller, M L; Simon, J C; Schempp, C M

    2011-01-01

    Ultraviolet B (UVB) radiation may cause an immediate inflammatory response followed by a delayed increase in skin pigmentation. The early time course of erythema and pigmentation has so far not been monitored simultaneously by photometric measurements. Test areas on the volar forearms of 15 volunteers were irradiated with 210 mJ/cm(2) UVB. Skin erythema and pigmentation were determined photometrically at time 0, after 6 h, and after 1, 2, 3 and 7 days. Punch biopsies were taken before irradiation, after 6 h and after 7 days. Melanocytes were stained using the DOPA method. UVB irradiation caused an increase in skin erythema at all time points, peaking at 24 h and slowly decreasing until day 7. Surprisingly, this was associated with a pronounced decrease in skin pigmentation at early readings. DOPA staining of melanocytes confirmed this observation. Only after 7 days was there an increase in skin pigmentation over the initial levels. Acute UVB-induced skin erythema seems to be associated with increased susceptibility to the deleterious effects of solar radiation due to a concomitant decrease in skin pigmentation. These findings underline the importance of avoiding even moderate sunburns and of slowly adapting the skin to solar radiation. Copyright © 2011 S. Karger AG, Basel.

  17. Melanocytic Nevi and Sun Exposure in a Cohort of Colorado Children: Anatomic Distribution and Site-Specific Sunburn

    PubMed Central

    Dodd, Athena T.; Morelli, Joseph; Mokrohisky, Stefan T.; Asdigian, Nancy; Byers, Tim E.; Crane, Lori A.

    2010-01-01

    Sun exposure and high prevalence of melanocytic nevi are major risk factors for melanoma, but the relationship between them is not well understood. This study examines the relationship between sun exposure (detailed by anatomic location and history of site-specific sunburns) and the presence of melanocytic nevi on 743 White children in Denver, Colorado. Parental reports of site-specific sunburns were collected annually for 2 years starting at ages 5 to 6 years. In the third year, nevi were counted and mapped by anatomic location. Nevus density was higher for boys (36.0 nevi/m2) than for girls (31.0 nevi/m2; P = 0.04). Nevus density was highest on the face, neck, and lateral forearms and was significantly higher in chronically versus intermittently sun-exposed areas (P < 0.0001). Compared with girls, boys had higher nevus density on the face, neck, and trunk, and lower nevus density on the upper arms and thighs (P < 0.01). In 2 years of reports, most subjects (69%) received at least one sunburn. The face, shoulders, and back were the most frequently sunburned areas of the body. When adjusted for host factors, total number of sunburns was significantly associated with higher total nevus prevalence (P = 0.01 for one burn). Site-specific sunburns were significantly associated with nevus prevalence on the back (P = 0.03 for three or more sunburns), but not on the face, arms, or legs. In this high-risk population, there is evidence for two pathways to nevus accumulation: by chronic sun exposure and by intermittent exposure related to sunburns. PMID:17932362

  18. Melanocytic nevi and sun exposure in a cohort of colorado children: anatomic distribution and site-specific sunburn.

    PubMed

    Dodd, Athena T; Morelli, Joseph; Mokrohisky, Stefan T; Asdigian, Nancy; Byers, Tim E; Crane, Lori A

    2007-10-01

    Sun exposure and high prevalence of melanocytic nevi are major risk factors for melanoma, but the relationship between them is not well understood. This study examines the relationship between sun exposure (detailed by anatomic location and history of site-specific sunburns) and the presence of melanocytic nevi on 743 White children in Denver, Colorado. Parental reports of site-specific sunburns were collected annually for 2 years starting at ages 5 to 6 years. In the third year, nevi were counted and mapped by anatomic location. Nevus density was higher for boys (36.0 nevi/m2) than for girls (31.0 nevi/m2; P = 0.04). Nevus density was highest on the face, neck, and lateral forearms and was significantly higher in chronically versus intermittently sun-exposed areas (P < 0.0001). Compared with girls, boys had higher nevus density on the face, neck, and trunk, and lower nevus density on the upper arms and thighs (P < 0.01). In 2 years of reports, most subjects (69%) received at least one sunburn. The face, shoulders, and back were the most frequently sunburned areas of the body. When adjusted for host factors, total number of sunburns was significantly associated with higher total nevus prevalence (P = 0.01 for one burn). Site-specific sunburns were significantly associated with nevus prevalence on the back (P = 0.03 for three or more sunburns), but not on the face, arms, or legs. In this high-risk population, there is evidence for two pathways to nevus accumulation: by chronic sun exposure and by intermittent exposure related to sunburns.

  19. [Prevention and treatment of acute diarrhea in infants].

    PubMed

    Turck, D

    2007-11-01

    The prognosis of acute diarrhoea in infants is most often satisfactory in industrialized countries. However, it has been estimated that 10 to 15 children die every year in France from acute dehydration due to acute diarrhoea. In spite of an increasing use over the least few years, oral rehydration solutions (ORS) are used in only 70% of infants presenting with acute diarrhoea. The use of homemade ORS, plain water or fizzy drink should be strictly avoided. In case of acute diarrhoea there is no indication to stop breastfeeding or the use of infant formula for more than 4 hours. Lactose intolerance is observed in only 5-10% of infants. Lactose free formulae should only be used in infants with severe, persistent or recurrent diarrhoea. Under 3-4 months of age, infants with severe diarrhoea should receive for a period of 2-4 weeks lactose free protein hydrolysate formulae. Racecadotril is the only drug with anti-diarrheal properties, with a reduction of the stool output of 50%. Oral antibiotics should only be used in case of Shigella infection or in case of bacterial infection with severe sepsis or underlying debilitating disease. Oral Rotavirus vaccine, that is not reimbursed yet in France, has been shown to dramatically reduce the number of severe cases of diarrhoea with dehydration, and has been associated with a striking reduction of both morbidity and mortality, as well as of the number of hospitalisations during periods of epidemics.

  20. Severe Acute Respiratory Syndrome (SARS) Prevention in Taiwan

    ERIC Educational Resources Information Center

    Liu, Hsueh-Erh

    2004-01-01

    Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B…

  1. Fasting prevents acute pancreatitis induced by cerulein in rats.

    PubMed

    Otsuki, M; Tani, S; Okabayashi, Y; Fujii, M; Nakamura, T; Fujisawa, T; Koide, M; Itoh, H

    1990-07-01

    We examined the effect of fasting on the course of experimental acute pancreatitis induced in rats by four subcutaneous injections of 20 micrograms/kg body weight of cerulein at hourly intervals. Rats were either fasted from 24 hr before to 9 hr after the first cerulein injection or fed ad libitum throughout the experiment. Twenty-four hours of fasting reduced cerulein-induced increases in serum levels of amylase and anionic trypsin(ogen) to 50 and 70% of those in fed rats, respectively. Increases in pancreatic wet weight after cerulein injections were also less in fasted rats than in fed rats. Pancreatic content of trypsin was significantly decreased after a 24-hr fast, and no further changes were induced by cerulein injections. The histological signs of acute pancreatitis were greatly alleviated by fasting. However, 24 hr of fasting did not alter the sensitivity and responsiveness of the exocrine pancreas to cerulein in both in vivo and in vitro. Plasma CCK bioactivity and immunoreactive secretin concentration in 24-hr-fasted rats were significantly lower than those in fed rats. Administration of CCK receptor antagonist, loxiglumide, 12 hr prior to the induction of acute pancreatitis reduced the increase in serum amylase activity in fed rats to nearly the same levels as that in fasted rats and alleviated histological signs of pancreatitis to some extent. These present observations suggest that fasting lessens the severity of cerulein-induced acute pancreatitis by reducing endogenous CCK release.

  2. Severe Acute Respiratory Syndrome (SARS) Prevention in Taiwan

    ERIC Educational Resources Information Center

    Liu, Hsueh-Erh

    2004-01-01

    Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B…

  3. Preventing and Treating Acute Kidney Injury Among Hospitalized Patients with Cirrhosis and Ascites: A Narrative Review.

    PubMed

    Tapper, Elliot B; Bonder, Alan; Cardenas, Andres

    2016-05-01

    Acute kidney injury in the setting of ascites and cirrhosis is a medical emergency characterized by significant morbidity and mortality. Clinicians other than gastroenterologists are often the front line against acute kidney injury for patients with ascites. Owing to the specifics of cirrhotic physiology, the treatment and prevention of acute kidney injury in the setting of ascites has unique features, widespread knowledge of which will benefit our patients with cirrhosis. Early detection and treatment of infection, maximization of cardiac output, and avoidance of medications that limit cardiorenal adaptations to arterial underfilling are part of a multipronged strategy to protect the renal function of our patients with cirrhosis and ascites.

  4. Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis.

    PubMed

    Packer, Mark; Chang, David F; Dewey, Steven H; Little, Brian C; Mamalis, Nick; Oetting, Thomas A; Talley-Rostov, Audrey; Yoo, Sonia H

    2011-09-01

    This distillation of the peer-reviewed scientific literature on infection after cataract surgery summarizes background material on epidemiology, etiology, and pathogenesis, describes the roles of surgical technique and antibiotic prophylaxis in prevention, and discusses diagnostic and therapeutic interventions in cases of suspected endophthalmitis.

  5. [Prevention of peritoneal desiccation in acute adhesive intestinal obstruction].

    PubMed

    2014-01-01

    The research study was carried out on 30 white Wistar rats, which were divided into three groups. In the first group the effect of carboxyperitoneum on visceral peritoneum during a two hour period at a pressure of 9-10 mm Hg and after 20 minutes its further fractional replacement during 10 seconds was examined. In the second group, the study was carried out after modeling 12-hours acute adhesive intestinal obstruction. To the third group at the beginning was given a single injection of four component mixture (carboxyperitoneum gel carboxymetiltcellulose novocaine and antibiotic) into the abdominal cavity. In the first group under the condition of tension carboxyperitoneum after a day of use there were signs of desiccations of visceral peritoneum. The increase of lipid peroxidation products and decrease of antioxidant enzymes were also observed. In the second group of animals these processes were exacerbated by acute adhesive intestinal obstruction. In the third group intraabdominal use of four component disperse mixture reduced the negative organic and functional changes in visceral peritoneum and improved its protective properties.

  6. Preventive mechanisms of agmatine against ischemic acute kidney injury in rats.

    PubMed

    Sugiura, Takahiro; Kobuchi, Shuhei; Tsutsui, Hidenobu; Takaoka, Masanori; Fujii, Toshihide; Hayashi, Kentaro; Matsumura, Yasuo

    2009-01-28

    The excitation of renal sympathetic nervous system plays an important role in the development of ischemic acute kidney injury in rats. Recently, we found that agmatine, an adrenaline alpha(2)/imidazoline I(1)-receptor agonist, has preventive effects on ischemic acute kidney injury by suppressing the enhanced renal sympathetic nerve activity during renal ischemia and by decreasing the renal venous norepinephrine overflow after reperfusion. In the present study, we investigated preventive mechanisms of agmatine against ischemic acute kidney injury in rats. Ischemic acute kidney injury was induced by clamping the left renal artery and vein for 45 min followed by reperfusion, 2 weeks after the contralateral nephrectomy. Pretreatment with efaroxan (30 mumol/kg, i.v.), an alpha(2)/I(1)-receptor antagonist, abolished the suppressive effects of agmatine on the enhanced renal sympathetic nerve activity during renal ischemia and on the elevated norepinephrine overflow after reperfusion, and eliminated the preventing effects of agmatine on the ischemia/reperfusion-induced renal dysfunction and histological damage. On the other hand, pretreatment with yohimbine (6 mumol/kg, i.v.), an alpha(2)-receptor antagonist, eliminated the preventing effects of agmatine on the ischemia/reperfusion-induced renal injury and norepinephrine overflow, without affecting the lowering effect of agmatine on renal sympathetic nerve activity. These results indicate that agmatine prevents the ischemic renal injury by sympathoinhibitory effect probably via I(1) receptors in central nervous system and by suppressing the norepinephrine overflow through alpha(2) or I(1) receptors on sympathetic nerve endings.

  7. Human thermoregulatory responses during cold-water immersion after artificially-induced sunburn

    SciTech Connect

    Pandolf, K.B.; Gange, R.W.; Latzka, W.A.; Blank, I.H.; Young, A.J.; Sawka, M.N. Massachusetts General Hospital, Boston )

    1991-03-11

    Thermoregulatory responses during cold-water immersion (T{sub w} = 22C) were compared in 10 men prior to artificially-induced sunburn (CONB), as well as 24-h, and 1-wk after a 2 minimal erythemal dose of UV-B radiation (SUNB) which covered {approximately}85% of the body. After 10 min of rest in cold water, these men exercised for 50 min ({approximately}51% {dot V}O{sub 2}max). Esophageal (T{sub es}), rectal (T{sub re}), and mean skin ({bar T}{sub sk}) temperatures, mean heat flow ({bar h}{sub c}), and heart rate (HR) were measured. Venous blood samples were collected before and after immersion. The {bar T}{sub sk} was higher throughout the 60-min immersion both 24-h and 1-wk after SUNB compared to CONB. The {anti h}{sub c} was higher after 10 min resting immersion and during the first 10 min of exercise when 24-h SUNB waqs compared to CONB with the difference attributed to higher h{sub c} from the back and chest. While T{sub re} and HR did not differ between conditions, T{sub es} prior to and throughout the 60-min immersion was higher when 24-h SUNB was compared to CONB. Plasma volume increased after 1-wk SUNB compared to CONB while plasma protein was reduced. Post-exercise cortisol was greater 24-h SUNB compared to either CONB or 1-wk SUNB. In conclusion, sunburn impaired the ability of these men to vasoconstrict during cold-water immersion resulting in greater heat loss. These adverse effects were still present 1 wk after sunburn when the associated erythema had disappeared.

  8. Caffeine prevents acute mortality after TBI in rats without increased morbidity.

    PubMed

    Lusardi, Theresa A; Lytle, Nikki K; Szybala, Cory; Boison, Detlev

    2012-03-01

    Severe traumatic brain injury (TBI) is associated with a high incidence of acute mortality followed by chronic alteration of homeostatic network activity that includes the emergence of posttraumatic seizures. We hypothesized that acute and chronic outcome after severe TBI critically depends on disrupted bioenergetic network homeostasis, which is governed by the availability of the brain's endogenous neuroprotectant adenosine. We used a rat lateral fluid percussion injury (FPI) model of severe TBI with an acute mortality rate of 46.7%. A subset of rats was treated with 25mg/kg caffeine intraperitoneally within 1 min of the injury. We assessed neuromotor function at 24h and 4 weeks, and video-EEG activity and histology at 4 weeks following injury. We first demonstrate that acute mortality is related to prolonged apnea and that a single acute injection of the adenosine receptor antagonist caffeine can completely prevent TBI-induced mortality when given immediately following the TBI. Second, we demonstrate that neuromotor function is not affected by caffeine treatment at either 24h or 4 weeks following injury. Third, we demonstrate development of epileptiform EEG bursts as early as 4 weeks post-injury that are significantly reduced in duration in the rats that received caffeine. Our data demonstrate that acute treatment with caffeine can prevent lethal apnea following fluid percussion injury, with no negative influence on motor function or histological outcome. Further, we show epileptiform bursting is reduced after caffeine treatment, suggesting a potential role in the modulation of epilepsy development after severe injury.

  9. Post-acute crisis text messaging outreach for suicide prevention: a pilot study.

    PubMed

    Berrouiguet, Sofian; Gravey, Michel; Le Galudec, Mickaël; Alavi, Zarrin; Walter, Michel

    2014-07-30

    Several post-suicide prevention strategies such as sending postcards or making phone calls have been used to keep in contact with suicide attempters. The continuity of care has been beneficial to the prevention of post-acute suicidal behaviors. The aim of the study was to evaluate the technical feasibility and acceptability of text messaging outreach in post-acute suicide attempters. Eighteen post-suicidal patients were included in a prospective, monocentric, open-label, 2 months pilot study. The text messages were sent from the intranet program that we specially developed for the study. Technical feasibility of this text message intervention was evaluated by the analysis of text message reports. Acceptability of such intervention was evaluated by a standardized phone interview. Our study showed that receiving text messages sent from an intranet program after a suicide attempt is technically possible. This post-crisis outreach program was accepted by the patients who found it to have a positive preventive impact. Text messaging outreach offers several advantages such as lower cost, and easier utilization compared to current post-acute care strategies. We suggest further randomized controlled trials in a large sample of suicidal patients to assess the efficacy of this novel outreach tool for prevention of post-acute suicide.

  10. Approaches to prevent acute bacterial meningitis in developing countries.

    PubMed Central

    Wright, P. F.

    1989-01-01

    Endemic acute bacterial meningitis of childhood appears to be neglected as a cause of morbidity and mortality in developing countries, probably because it has been overshadowed by the dramatic epidemics of meningococcal disease in sub-Saharan Africa. The available data based on reviews of hospitalized patients suggest that endemic meningitis is mostly a disease of young infants, Streptococcus pneumoniae and Haemophilus influenzae type b being the most important etiologic agents. The epidemiological pattern appears to be different in developing countries, compared with northern Europe or the USA, and closely resembles the early age of onset and high incidence of meningitis observed among the native American populations in Alaska. The mortality from meningitis appears to be much higher in developing countries than in industrialized countries. The availability of vaccines against the pneumococcus and haemophilus, particularly those in which the bacterial polysaccharide is conjugated to a protein, promises protection against systemic bacterial infection from these organisms. The assessment of the efficacy of such vaccines will have to include a close examination of meningitis as an outcome. It is suggested that before such vaccines become available careful clinical and epidemiological studies of meningitis will help both to define the impact of this disease and how to design an intervention strategy. PMID:2611973

  11. The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn.

    PubMed

    Magnette, John; Kienzler, Jean-Luc; Alekxandrova, Ioulia; Savaluny, Elly; Khemis, Abdallah; Amal, Saïd; Trabelsi, Mohamed; Césarini, Jean-Pierre

    2004-01-01

    A randomised, double-blind, single-centre, vehicle-controlled clinical trial was conducted to assess the efficacy and tolerability of diclofenac-Na 0.1% gel in 172 subjects suffering from acute first-degree natural sunburn. Overall 172 subjects with skin phototypes II-IV were randomised in a ratio of 2:1 to receive two applications of either diclofenac-Na 0.1% Emulgel gel or its vehicle Emulgel gel, 6 and 10 hours after the end of sun exposure. Subjects were drawn from a target population of healthy volunteers and well outdoor sunbathers with normal tolerance to ultraviolet light and the sun. Previously untanned areas were exposed to carefully determined standardised doses of sun (2.8 individual minimal erythema doses) on 15% body surface area to induce first-degree sunburn. After administration of diclofenac-Na 0.1% gel, subjects reported a significant reduction in spontaneous pain intensity compared with those on vehicle. Pain relief was rapid with a reduction in erythema, which was apparent within the first few hours after the first application of the trial medication with a maximum effect observed up to 30 hours after sun exposure. A good', very good', or excellent' cooling effect was recorded by 85% of subjects after treatment. Reported treatment-emergent adverse effects were infrequent, generally mild and none were considered to be related to the trial medication. Only one severe treatment emergent adverse event (abdominal pain) was recorded in the active group, and another (burning sensation) with vehicle.

  12. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience

    DTIC Science & Technology

    2015-10-01

    AWARD NUMBER: W81XWH-14-1-0618 TITLE: Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury...Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience 5a. CONTRACT NUMBER...DISTRIBUTION / AVAILABILITY STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Development of a pressure

  13. Sunburn (image)

    MedlinePlus

    ... the sun's rays and apply sunscreen with a sun protection factor (SPF) of at least 15. Protect the eyes with sunglasses that have UV protection and use a lip balm with sunscreen. Years of unprotected sun exposure can cause premature aging and cancer of ...

  14. Nonpharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

    PubMed Central

    Eiam-Ong, Somchai

    2014-01-01

    Contrast-induced AKI (CI-AKI) has been one of the leading causes for hospital-acquired AKI and is associated with independent risk for adverse clinical outcomes including morbidity and mortality. The aim of this review is to provide a brief summary of the studies that focus on nonpharmacological strategies to prevent CI-AKI, including routine identification of at-risk patients, use of appropriate hydration regimens, withdrawal of nephrotoxic drugs, selection of low-osmolar contrast media or isoosmolar contrast media, and using the minimum volume of contrast media as possible. There is no need to schedule dialysis in relation to injection of contrast media or injection of contrast agent in relation to dialysis program. Hemodialysis cannot protect the poorly functioning kidney against CI-AKI. PMID:24795882

  15. Characterization of Grape (Vitis vinifera L.) Berry Sunburn Symptoms by Reflectance.

    PubMed

    Rustioni, Laura; Rocchi, Letizia; Guffanti, Eugenio; Cola, Gabriele; Failla, Osvaldo

    2014-03-27

    Sunburn can affect grape quality both for chemical modifications and by visual impact of the browning. Optical properties of 17 white grape accessions were investigated in the visible region using a noninvasive instrument. Reflectance spectra were obtained using a Jaz System spectrometer. Browning was induced by exposing grape bunches to direct sunlight at 12:30 p.m. for 5 h. During the experiment, the global solar radiation ranged from 2.6 to 2.7 MJ m(-2) h(-1) and the air temperature from 24.3 to 29.2 °C; the exposed berries reached a temperature of 34.2 °C in comparison to the 30.4 °C of the shaded ones. Differences between the spectra of controlled and exposed berries mainly emphasized the loss in chlorophyll and the formation of brown compounds. A positive correlation between the chlorophyll concentration and berry browning was proposed. Developing rapid, noninvasive, and low-cost methods based on reflectance spectroscopy could support grapevine variety characterization with respect to sunburn susceptibility as well as study of the physiological processes involved in the symptoms' appearance.

  16. Action spectrum for bergamot-oil phototoxicity measured by sunburn cell counting.

    PubMed

    Yasui, Y; Hirone, T

    1994-05-01

    The present study investigated the phototoxic effect of bergamot oil and its photosensitive component, bergapten, on sunburn cell (SBC) production in guinea pig skin. The back skin was pretreated with bergamot oil or bergapten and exposed to monochromatic light under various conditions. After irradiation, skin specimens were excised, and histological sections were prepared. The number of sunburn cells in the interfollicular epidermis was counted. The SBC formation by bergamot oil or bergapten plus UVB radiation was the same as that without pretreatment with any photosensitizer. In contrast, a significant number of SBCs were induced by bergamot oil or bergapten plus UVA radiation, but no SBCs were found after the treatment with UVA alone. The result indicates that bergamot oil or bergapten was photosensitized by UVA irradiation. The SBCs were linearly increased in a UV-dose dependent manner. On the basis of the regression lines, an action spectrum and spectral peak for the photosensitizers plus UVA were obtained. The action spectrum for bergamot oil- and bergapten-induced SBC formation was in the ranges of 325-365 nm and 325-350 nm, and their spectral peaks were at 335-345 nm and 335-350 nm, respectively. The data are in good accordance with those estimated from skin erythema reactions. Therefore, counting SBCs is a very useful parameter for quantitative evaluation of phototoxicity.

  17. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

    PubMed Central

    Anderson, Deverick J.; Podgorny, Kelly; Berríos-Torres, Sandra I.; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Nyquist, Ann-Christine; Saiman, Lisa; Yokoe, Deborah S.; Maragakis, Lisa L.; Kaye, Keith S.

    2014-01-01

    PURPOSE Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2 PMID:24799638

  18. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update.

    PubMed

    Luks, Andrew M; McIntosh, Scott E; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Schoene, Robert B; Zafren, Ken; Hackett, Peter H

    2014-12-01

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155. Copyright © 2014 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  19. Graduated compression stockings to prevent venous thromboembolism in hospital: evidence from patients with acute stroke.

    PubMed

    Kearon, Clive; O'Donnell, Martin

    2011-01-01

    Pulmonary embolism is the most common preventable cause of death in hospital patients and prevention of venous thromboembolism (VTE) is cost-saving in high-risk patients. Low-dose anticoagulation is very effective at preventing VTE but increases bleeding. Graduated compression stockings and intermittent pneumatic compression devices are also used to prevent VTE and do not increase bleeding, which makes their use appealing in patients who cannot tolerate bleeding, such as patients with acute stroke. Studies that evaluated mechanical methods of preventing VTE were small and mainly used asymptomatic deep vein thrombosis (DVT), detected using screening tests, as the study outcome. The recently published CLOTS Trial 1 (Clots in Legs Or sTockings after Stroke) compared thigh-level compression stockings with no stockings in about 2500 patients with stroke and immobility, and found that thigh-level stockings were not effective. Indirectly, the findings of this study question the ability of stockings to prevent VTE in other patient groups, including those after surgery. CLOTS 1 compared thigh-level and below-knee stockings in about 3000 patients with acute stroke. Given that thigh-level stockings were ineffective in CLOTS 1, it is surprising that they were more effective than below-knee stockings in CLOTS Trial 2. A possible explanation is that below-knee stockings increase DVT, although this seems unlikely. CLOTS 1 and CLOTS 2 question whether graduated compression stockings prevent VTE and suggest the need for further trials evaluating their efficacy in medical and surgical patients.

  20. Strategies for prevention of acute kidney injury in cardiac surgery: an integrative review

    PubMed Central

    Santana-Santos, Eduesley; Marcusso, Marila Eduara Fátima; Rodrigues, Amanda Oliveira; de Queiroz, Fernanda Gomes; de Oliveira, Larissa Bertacchini; Rodrigues, Adriano Rogério Baldacin; Palomo, Jurema da Silva Herbas

    2014-01-01

    Acute kidney injury is a common complication after cardiac surgery and is associated with increased morbidity and mortality and increased length of stay in the intensive care unit. Considering the high prevalence of acute kidney injury and its association with worsened prognosis, the development of strategies for renal protection in hospitals is essential to reduce the associated high morbidity and mortality, especially for patients at high risk of developing acute kidney injury, such as patients who undergo cardiac surgery. This integrative review sought to assess the evidence available in the literature regarding the most effective interventions for the prevention of acute kidney injury in patients undergoing cardiac surgery. To select the articles, we used the CINAHL and MedLine databases. The sample of this review consisted of 16 articles. After analyzing the articles included in the review, the results of the studies showed that only hydration with saline has noteworthy results in the prevention of acute kidney injury. The other strategies are controversial and require further research to prove their effectiveness. PMID:25028954

  1. Nrf2 activation prevents cadmium-induced acute liver injury

    SciTech Connect

    Wu, Kai C.; Liu, Jie J.; Klaassen, Curtis D.

    2012-08-15

    Oxidative stress plays an important role in cadmium-induced liver injury. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor that up-regulates cytoprotective genes in response to oxidative stress. To investigate the role of Nrf2 in cadmium-induced hepatotoxicity, Nrf2-null mice, wild-type mice, kelch-like ECH-associated protein 1-knockdown (Keap1-KD) mice with enhanced Nrf2, and Keap1-hepatocyte knockout (Keap1-HKO) mice with maximum Nrf2 activation were treated with cadmium chloride (3.5 mg Cd/kg, i.p.). Blood and liver samples were collected 8 h thereafter. Cadmium increased serum alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) activities, and caused extensive hepatic hemorrhage and necrosis in the Nrf2-null mice. In contrast, Nrf2-enhanced mice had lower serum ALT and LDH activities and less morphological alternations in the livers than wild-type mice. H{sub 2}DCFDA (2′,7′-dichlorodihydrofluoresein diacetate) staining of primary hepatocytes isolated from the four genotypes of mice indicated that oxidative stress was higher in Nrf2-null cells, and lower in Nrf2-enhanced cells than in wild-type cells. To further investigate the mechanism of the protective effect of Nrf2, mRNA of metallothionein (MT) and other cytoprotective genes were determined. Cadmium markedly induced MT-1 and MT-2 in livers of all four genotypes of mice. In contrast, genes involved in glutathione synthesis and reducing reactive oxygen species, including glutamate-cysteine ligase (Gclc), glutathione peroxidase-2 (Gpx2), and sulfiredoxin-1 (Srxn-1) were only induced in Nrf2-enhanced mice, but not in Nrf2-null mice. In conclusion, the present study shows that Nrf2 activation prevents cadmium-induced oxidative stress and liver injury through induction of genes involved in antioxidant defense rather than genes that scavenge Cd. -- Highlights: ► Cadmium caused extensive hepatic hemorrhage and necrosis in Nrf2-null mice. ► Keap1-KD and Keap1-HKO mice

  2. Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study.

    PubMed

    Resnick, H; Acierno, R; Holmes, M; Kilpatrick, D G; Jager, N

    1999-01-01

    Violent sexual assault such as rape typically results in extremely high levels of acute distress. The intensity of these acute psychological reactions may play a role in later recovery, with higher levels of immediate distress associated with poorer outcome. Unfortunately, post-rape forensic evidence collection procedures may serve to increase, rather than reduce initial distress, potentially exacerbating future psychopathology. To address these concerns, an acute time-frame hospital-based video intervention was developed to: (a) minimize anxiety during forensic rape exams, and (b) prevent post-rape posttraumatic stress disorder (PTSD), panic, and anxiety. Preliminary data indicated that (1) psychological distress at the time of the exam was strongly related to PTSD symptomatology 6 weeks post-rape, and (2) the video intervention successfully reduced distress during forensic exams.

  3. "Sunburn" freckles, café-au-lait macules, and other pigmented lesions of schoolchildren: the Vancouver Mole Study.

    PubMed

    McLean, D I; Gallagher, R P

    1995-04-01

    Relatively few studies have evaluated the prevalence of pigmented lesions in children. We assessed the prevalence and constitutional correlates of "sunburn" freckles, café-au-lait macules, congenital nevi, and several other pigmented lesions. Six specially trained nurses examined 1592 Vancouver schoolchildren, 6 to 18 years old, under uniform lighting conditions and counted all pigmented lesions except those on the genitals, buttocks, and breasts in girls. In the 1146 white children of European origin, 378 Asian children, and 68 Indo-Pakistani children, the prevalence of one or more café-au-lait macules was essentially equivalent (28%). The prevalence of Becker's nevus, nevus spilus, and congenital nevi were also similar among white and Asian children. White children of European origin had a higher prevalence of sunburn freckles than the other ethnic groups. The prevalence among children of European descent was higher in subjects with light skin color, a propensity to burn rather than tan in the sun, a history of severe or frequent sunburn, freckling, and a high count of acquired melanocytic nevi. For most pigmented lesions prevalence rates were similar in the three ethnic groups examined. The results also suggest that the presence of large sunburn freckles in children of European descent correlates strongly with phenotypic risk factors that have been shown to be predictive of increased melanoma risk in adulthood. Parents should be counseled to take precautions with these children early in life in regard to overexposure to sunlight.

  4. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.

    PubMed

    Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

    2013-06-01

    Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  5. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates

    PubMed Central

    Yokoe, Deborah S.; Anderson, Deverick J.; Berenholtz, Sean M.; Calfee, David P.; Dubberke, Erik R.; Ellingson, Katherine D.; Gerding, Dale N.; Haas, Janet P.; Kaye, Keith S.; Klompas, Michael; Lo, Evelyn; Marschall, Jonas; Mermel, Leonard A.; Nicolle, Lindsay E.; Salgado, Cassandra D.; Bryant, Kristina; Classen, David; Crist, Katrina; Deloney, Valerie M.; Fishman, Neil O.; Foster, Nancy; Goldmann, Donald A.; Humphreys, Eve; Jernigan, John A.; Padberg, Jennifer; Perl, Trish M.; Podgorny, Kelly; Septimus, Edward J.; VanAmringe, Margaret; Weaver, Tom; Weinstein, Robert A.; Wise, Robert; Maragakis, Lisa L.

    2014-01-01

    Since the publication of “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS). PMID:25026611

  6. Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

    PubMed

    Bowers, Len; Nijman, Henk; Allan, Teresa; Simpson, Alan; Warren, Jonathan; Turner, Lynny

    2006-07-01

    Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

  7. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline.

    PubMed

    Criner, Gerard J; Bourbeau, Jean; Diekemper, Rebecca L; Ouellette, Daniel R; Goodridge, Donna; Hernandez, Paul; Curren, Kristen; Balter, Meyer S; Bhutani, Mohit; Camp, Pat G; Celli, Bartolome R; Dechman, Gail; Dransfield, Mark T; Fiel, Stanley B; Foreman, Marilyn G; Hanania, Nicola A; Ireland, Belinda K; Marchetti, Nathaniel; Marciniuk, Darcy D; Mularski, Richard A; Ornelas, Joseph; Road, Jeremy D; Stickland, Michael K

    2015-04-01

    COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to

  8. μ‐Opioid receptor activation prevents acute hepatic inflammation and cell death

    PubMed Central

    Chakass, Dania; Philippe, David; Erdual, Edmone; Dharancy, Sébastien; Malapel, Mathilde; Dubuquoy, Caroline; Thuru, Xavier; Gay, Jerome; Gaveriaux‐Ruff, Claire; Dubus, Pierre; Mathurin, Philippe; Kieffer, Brigitte L; Desreumaux, Pierre; Chamaillard, Mathias

    2007-01-01

    Background and aims The detrimental impact of opioid agonist on the clinical management of inflammatory diseases remains elusive. Given the anti‐inflammatory properties of the μ‐opioid receptor (MOR) agonists at the intestinal barrier, we hypothesised that MOR activation might also dampen acute hepatic inflammation and cell death—major determinants in the pathogenesis of liver diseases. Patients and methods The expression of MOR in liver biopsy specimens and peripheral blood mononuclear cells of untreated patients with chronic hepatitis C virus infection and controls, primary hepatocytes and cell lines was determined by quantitative PCR, immunoblotting and/or immunohistochemistry. The effects of peripheral MOR agonist (D‐Ala2,NMe‐Phe4,Gly5‐ol (DAMGO)) and/or antagonist (naloxone methiodide) were explored in two models of acute hepatitis in mice. MOR‐deficient mice were used to evaluate the essential regulatory role of MOR during carbon tetrachloride (CCl4)‐induced hepatitis. The role of DAMGO in cell death was investigated using terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labelling (TUNEL) analysis and quantification of lactate dehydrogenase release. Results The key role of MOR in the prevention of acute hepatic inflammation and cell death in vivo and in vitro is reported. Whereas MOR gene expression increased transiently in the model of acute liver injury and TNFα‐treated HepG2 cells, an impaired expression of MOR mRNA in human chronic hepatitis C samples was found. Furthermore, preventive administration of the selective MOR agonist DAMGO enhanced hepatoprotective‐signalling pathways in vivo that were blocked by using naloxone methiodide. Consistently, genetic and pharmacological inhibition of MOR enhanced the severity associated with experimental hepatotoxin‐induced hepatitis. Finally, treatment with DAMGO was shown to prevent cell death in vitro in HepG2 cells in a MOR‐dependent manner and to prevent concanavalin A

  9. Liver targeting of catalase by cationization for prevention of acute liver failure in mice.

    PubMed

    Ma, Shen-Feng; Nishikawa, Makiya; Katsumi, Hidemasa; Yamashita, Fumiyoshi; Hashida, Mitsuru

    2006-01-10

    To achieve hepatic delivery of CAT for the prevention of CCl4-induced acute liver failure in mice, two types of cationized CAT derivatives, HMD- and ED-conjugated CAT, were developed. Slight structural changes occurred during cationization and the number of increased free amino groups was 3.1 in HMD-CAT and 13.6 in ED-CAT. 111In-cationized CAT derivatives showed an increased binding to HepG2 cells, and were rapidly taken up by the liver. H2O2-induced cytotoxicity in HepG2 cells was significantly prevented by preincubation of the cells with cationized CAT derivatives. A bolus intravenous injection of the cationized CAT derivatives reduced the hepatotoxicity induced by CCl4 in mice. The ED-CAT, which showed more rapid and greater binding to the liver than the HMD-CAT, exhibited more beneficial effects as far as all the parameters examined (serum GOT, GPT, LDH and hepatic GSH) were concerned, suggesting that a high degree of cationization is effective in delivering CAT to the liver to prevent CCl4-induced hepatotoxicity. These results suggest that cationized CAT derivatives are effective in preventing acute liver failure, and ED-based cationization is a suitable method for developing liver-targetable cationized CAT derivatives, because it provides CAT with a high degree of cationization and a high remaining enzymatic activity.

  10. Corticosteroids prevent acute lung dysfunction caused by thoracic irradiation in unanesthetized sheep

    SciTech Connect

    Loyd, J.E.; Bolds, J.M.; Wickersham, N.; Malcolm, A.W.; Brigham, K.L.

    1988-11-01

    We sought to determine the effect of corticosteroid therapy in a new acute model of oxidant lung injury, thoracic irradiation in awake sheep. Sheep were irradiated with 1,500 rads to the whole chest except for blocking the heart and adjacent ventral lung. Seven experimental sheep were given methylprednisolone (1 g intravenously every 6 h for four doses) and thoracic irradiation; control sheep received only irradiation. In irradiated control sheep, lung lymph flow increased from baseline (7.6 ml/h) to peak at 3 h (13.2), and lung lymph protein clearance increased from 5.1 to 9.7 ml/h. Mean pulmonary artery pressure increased in the irradiated control sheep from 19 to 32.4 cm H/sub 2/O, whereas the lung lymph thromboxane concentration increased from 0.09 to 6.51 ng/ml at 3 h. Arterial oxygen tension in irradiated control sheep fell gradually from 86 mm Hg at baseline to 65 mm Hg at 8 h. Methylprednisolone administration significantly prevented the increase in lung lymph protein clearance, mean pulmonary artery pressure, and lung lymph thromboxane concentration. Methylprednisolone also prevented the fall in arterial oxygen tension after thoracic irradiation, but did not prevent a further decrease in lymphocytes in blood or lung lymph after radiation. We conclude that corticosteroid therapy prevents most of the acute physiologic changes caused by thoracic irradiation in awake sheep.

  11. The effectiveness of rotavirus vaccine in preventing acute gastroenteritis during rotavirus seasons among Polish children

    PubMed Central

    Kieltyka, Agnieszka; Majewska, Renata; Augustyniak, Malgorzata

    2016-01-01

    Introduction Rotavirus is the main etiological cause of intestinal infections in children. Voluntary rotavirus vaccines were included in the Polish vaccination schedule in 2007. The aim of this study was to assess the effectiveness of a completed rotavirus vaccination course in preventing acute gastroenteritis in Polish infants during their first five years of life. Material and methods This was a retrospective cohort study conducted in Lesser Poland (Malopolska Province). The sample population included a group of 303 children who received the completed rotavirus vaccination course and 303 children not vaccinated against rotavirus. The date of the child's acute gastroenteritis diagnosis and his or her vaccination history were extracted from the physicians’ records. Each kind of diagnosed acute gastroenteritis during winter-spring rotavirus seasons was treated as the endpoint. The relative risk of having gastrointestinal infection was assessed using the hazard ratio from the Cox proportional hazards regression model. Results In the examined group, 96 (15.8%) children had winter-spring gastrointestinal infections. In the non-vaccinated children, the cumulative incidence of these infections in the first 5 years of life was 20.8%, whereas in the children vaccinated with Rotarix it was only 10.9%. Those who were vaccinated with Rotarix had a 44% reduction in the risk of a winter-spring acute gastroenteritis infection compared to those not vaccinated with Rotarix (p = 0.005). Birth weight less than 2500 g increased the risk of the infection twofold and also reached statistical significance (p = 0.044). Conclusions The results showed that Rotarix is effective in preventing acute gastroenteritis in Polish children during rotavirus seasons. PMID:27279856

  12. Strategies for the prevention of acute mountain sickness and treatment for large groups making a rapid ascent in China.

    PubMed

    Luo, Yongjun; Yang, Xiaohong; Gao, Yuqi

    2013-10-30

    Approximately 26.8% of China's land area has an elevation of 3000 m above sea level or higher. Because of recent demands for economic development and new construction in highland areas, many people have relocated from the plains to high plateau regions and have to face the possibility of contracting acute mountain sickness. Therefore, prevention and treatment strategies are necessary to reduce the incidence of acute mountain sickness in people who rapidly ascend to plateau areas. This paper describes the Chinese experience when large numbers of people moved to the plateau and the steps that were taken to deal with this illness. These steps included implementing basic prevention measures, increasing medical awareness among populations ascending to high altitudes, and installing standardized medical management systems to prevent and treat acute mountain sickness before, during, and after ascent. The incidence of acute mountain sickness can be reduced by improving prevention and treatment and by implementing the recommendations described in this manuscript.

  13. A Polyamine-Deficient Diet Prevents Oxaliplatin-Induced Acute Cold and Mechanical Hypersensitivity in Rats

    PubMed Central

    Ferrier, Jérémy; Bayet-Robert, Mathilde; Pereira, Bruno; Daulhac, Laurence; Eschalier, Alain; Pezet, Denis; Moulinoux, Jacques-Philippe; Balayssac, David

    2013-01-01

    Background Oxaliplatin is an anticancer drug used for the treatment of advanced colorectal cancer, but it can also cause painful peripheral neuropathies. The pathophysiology of these neuropathies has not been yet fully elucidated, but may involve spinal N-methyl-D-aspartate (NMDA) receptors, particularly the NR2B subunit. As polyamines are positive modulators of NMDA-NR2B receptors and mainly originate from dietary intake, the modulation of polyamines intake could represent an interesting way to prevent/modulate neuropathic pain symptoms by opposing glutamate neurotransmission. Methods The effect of a polyamine deficient diet was investigated in an animal model of oxaliplatin-induced acute pain hypersensitivity using behavioral tests (mechanical and cold hypersensitivity). The involvement of spinal glutamate neurotransmission was monitored by using a proton nuclear magnetic resonance spectroscopy based metabolomic approach and by assessing the expression and phosphorylation of the NR2B subunit of the NMDA receptor. Results A 7-day polyamine deficient diet totally prevented oxaliplatin-induced acute cold hypersensitivity and mechanical allodynia. Oxaliplatin-induced pain hypersensitivity was not associated with an increase in NR2B subunit expression or phosphorylation, but with an increase of glutamate level in the spinal dorsal horn which was completely prevented by a polyamine deficient diet. As a validation that the oxaliplatin-induced hypersensitivity could be due to an increased activity of the spinal glutamate system, an intrathecal administration of the specific NR2B antagonist, ifenprodil, totally reversed oxaliplatin-induced mechanical and cold hypersensitivity. Conclusion A polyamine deficient diet could represent a promising and valuable nutritional therapy to prevent oxaliplatin-induced acute pain hypersensitivity. PMID:24204988

  14. Preventing cerebral oedema in acute liver failure: the case for quadruple-H therapy.

    PubMed

    Warrillow, S J; Bellomo, R

    2014-01-01

    Severe cerebral oedema is a life-threatening complication of acute liver failure. Hyperammonaemia and cerebral hyperaemia are major contributing factors. A multimodal approach, which incorporates hyperventilation, haemodiafiltration, hypernatraemia and hypothermia (quadruple-H therapy), may prevent or attenuate severe cerebral oedema. This approach is readily administered by critical care clinicians and is likely to be more effective than the use of single therapies. Targeting of PaCO2 in the mild hyperventilation range, as seen in acute liver failure patients before intubation, aims to minimise hyperaemic cerebral oedema. Haemodiafiltration aims to achieve the rapid control of elevated blood ammonia concentrations by its removal and to reduce production via the lowering of core temperature. The administration of concentrated saline increases serum tonicity and further reduces cerebral swelling. In addition, the pathologically increased cerebral blood-flow is further attenuated by therapeutic hypothermia. The combination of all four treatments in a multimodal approach may be a safe and effective means of attenuating or treating the cerebral oedema of acute liver failure and preventing death from neurological complications.

  15. Preventing attacks of acute gout when introducing urate-lowering therapy: a systematic literature review.

    PubMed

    Seth, Rakhi; Kydd, Alison S R; Falzon, Louise; Bombardier, Claire; van der Heijde, Désirée M; Edwards, Christopher J

    2014-09-01

    To systematically review the evidence on treatment available to prevent an acute attack of gout when initiating a urate-lowering therapy (ULT) and for how long this treatment should be continued. To also evaluate the evidence on the optimal time to start a ULT after an acute attack of gout. A systematic review as part of the 3e (Evidence, Expertise, Exchange) Initiative on Diagnosis and Management of Gout was performed using Medline, Embase, Cochrane Central Register of Controlled Trials (from 1950 to October 2011), and the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) 2010/2011 meeting abstracts. Two reviewers independently screened titles and abstracts for selection criteria. Included articles were reviewed in detail, and a risk of bias assessment (using the Cochrane tool) was performed. The search identified 8168 articles and 197 abstracts, from which 4 randomized controlled trials were included in the review. Two of these studies compared placebo with colchicine, 1 compared differing durations of colchicine, and 1 compared colchicine with canakinumab. Two randomized controlled trials have shown that colchicine prophylaxis for at least 6 months, when starting a ULT, reduces the risk of acute attacks. Canakinumab, although not currently licensed for gout, has been shown to provide prophylaxis superior to colchicine, when starting a ULT. There is no evidence on the optimum time to start a ULT after an acute gout attack.

  16. Carfilzomib-related acute kidney injury may be prevented by N-acetyl-L-cysteine.

    PubMed

    Wanchoo, Rimda; Khan, Seyyar; Kolitz, Jonathan E; Jhaveri, Kenar D

    2015-08-01

    Carfilzomib is a second-generation epoxyketone proteasome inhibitor that is approved for treatment of relapsed and refractory multiple myeloma. Phase 2 trials have reported that 25% of treated patients have renal adverse effects. Pre-renal/vasoconstriction-related insult from this chemotherapy agent has been documented. We describe a case of a 78-year-old man with refractory multiple myeloma with acute kidney injury associated with carfilzomib treatment. We show that use of N-acetyl-l-cysteine in our patient partially mitigated the renal injury upon re-challenge. This case report hypothesizes that acute renal injury from carfilzomib is caused by vasoconstriction of the renal vessels, which may be prevented by N-acetyl-l-cysteine.

  17. Humanized monoclonal antibody against the chemokine CXCL-8 (IL-8) effectively prevents acute lung injury.

    PubMed

    Bao, ZhiYao; Ye, QingWei; Gong, WangHua; Xiang, Yi; Wan, HuanYing

    2010-02-01

    As one of the most important endogenous chemotactic factors for neutrophils, the chemokine CXCL8 (IL-8) is involved in the pathogenesis of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), characterized by massive neutrophil infiltration in the lung. Since neutralization of CXCL8 with polyclonal antibody has been shown to reduce the severity of ALI/ARDS in animal models, we explored the potential of humanized anti-CXCL8 antibody as a preventive or therapeutic agent for ALI. We used a 'two-hit' protocol to induce ALI in rabbits that showed extensive edema in the alveolar lumina, marked infiltration of neutrophils in the lung tissue, fibrin deposition in alveolar space, and destruction of pulmonary architecture, culminating in severe hypoxemia. Concomitant challenge with endotoxin after priming with oleic acid (OA) induced a marked elevation of CXCL8 level in bronchoalveolar lavage fluid. Treatment of the rabbits with a humanized anti-CXCL8 antibody prevented neutrophil infiltration in the lung in association with alleviated ALI syndrome. Our results indicate a promising future for utilization of humanized anti-CXCL8 antibody in the prevention and treatment of ALI and ARDS in human. Copyright 2009. Published by Elsevier B.V.

  18. Metabolic causes and prevention of ventricular fibrillation during acute coronary syndromes.

    PubMed

    Oliver, Michael F

    2002-03-01

    The mechanisms leading to ventricular fibrillation that occur during acute myocardial ischemia are ill understood. Whether primary ventricular fibrillation is due to a transient imbalance of electrolytes, an alteration of membrane permeability, electrical re-entry phenomena, or other factors, one overriding influence is the development of regional myocardial energy crises. Acute alteration in the balance of substrate supply may lead, during greatly reduced blood flow, to instability of myocardial electrical conduction with the development of re-entry circuits. An immediate response to the angor animi and initial symptoms of an acute coronary syndrome is a rapid and marked increase in catecholamine release, which leads to adipose tissue lipolysis with an acute increase in plasma free fatty acid concentrations, suppression of insulin activity, and a reduction in glucose uptake by the myocardium. The utilization of free fatty acids instead of glucose by the ischemic myocardium could precipitate regional oxygen or energy crises. Prevention therefore should focus on minimizing the catecholamine response and providing the myocardium with an optimum supply of energy substrates. Since catecholamines are inotropic, the aim should be to redress the imbalance of substrate availability by controlling adipose lipolysis with reduction of plasma free fatty acid concentrations, increasing the availability of glucose, or both. Other approaches include inhibition of acylcarnitine transport and manipulation of fatty acid intermediaries. To combat primary ventricular fibrillation, preventive treatment must be established within 6 to 10 hours of the onset of ischemia. There is already experimental and clinical evidence that antilipolytic drugs decrease the incidence of ventricular fibrillation, but their potential has not been explored extensively.

  19. Efficacy and harm of pharmacological prevention of acute mountain sickness: quantitative systematic review

    PubMed Central

    Dumont, Lionel; Mardirosoff, Chahé; Tramèr, Martin R

    2000-01-01

    Objective To quantify efficacy and harm of pharmacological prevention of acute mountain sickness. Data sources Systematic search (Medline, Embase, Cochrane Library, internet, bibliographies, authors) in any language, up to October 1999. Study selection Randomised placebo controlled trials. Data extraction Dichotomous data on efficacy and harm from 33 trials (523 subjects received 13 different interventions, 519 a placebo). Data synthesis At above 4000 m the mean incidence of acute mountain sickness with placebo was 67% (range 25% to 100%); incidence depended on the rate of ascent, but not on the altitude or the mode of ascent. Across all ascent rates, dexamethasone 8-16 mg prevented acute mountain sickness (relative risk 2.50 (95% confidence interval 1.71 to 3.66); number needed to treat (NNT) 2.8 (2.0 to 4.6)), without evidence of dose responsiveness. Acetazolamide 750 mg was also efficacious (2.18 (1.52 to 3.15); NNT 2.9 (2.0 to 5.2)), but 500 mg was not. In two trials, adverse reaction (including depression) occurred after dexamethasone was stopped abruptly (4.45 (1.08 to 18); NNT 3.7 (2.5 to 6.9)). With acetazolamide, paraesthesia (4.02 (1.71 to 9.43); NNT 3.0 (2.0 to 6.0)) and polyuria (4.24 (1.92 to 9.37); NNT 3.6 (2.5 to 6.2)) were reported. Data were sparse on nifedipine, frusemide (furosemide), dihydroxyaluminium-sodium, spironolactone, phenytoin, codeine, phenformin, antidiuretic hormone, and ginkgo biloba. Conclusions At above 4000 m, with a high ascent rate, fewer than three subjects need to be treated with prophylactic dexamethasone 8-16 mg or acetazolamide 750 mg for one subject not to experience acute mountain sickness who would have done so had they all received a placebo. Acetazolamide 500 mg does not work. PMID:10915127

  20. The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented?

    PubMed

    Pozek, John-Paul J; Beausang, David; Baratta, Jaime L; Viscusi, Eugene R

    2016-01-01

    Chronic postsurgical pain (CPSP) is a distressing disease process that can lead to long-term disability, reduced quality of life, and increased health care spending. Although the exact mechanism of development of CPSP is unknown, nerve injury and inflammation may lead to peripheral and central sensitization. Given the complexity of the disease process, no novel treatment has been identified. The preoperative use of multimodal analgesia has been shown to decrease acute postoperative pain, but it has no proven efficacy in preventing development of CPSP.

  1. [Preventive and cessation therapy of mental disorders in patients with the acute coronary syndrome].

    PubMed

    Medvedev, V E; Epifanov, A V; Zverev, K V

    2012-01-01

    An open prospective trial of 93 inpatients divided into two main groups (61 patients) - with mental disorders (31) and without mental disorders (30) and a comparison group (32 patients) was carried out. All patients survived the acute coronary syndrome (myocardial infarction, unstable angina). The efficacy and safety of both preventive and cessation therapy with pantogam active in mean doses 1.8 and 1.2 g /daily, respectively, was demonstrated in respect of heterogeneous depressive, anxiety and somatoform disorders of the neurotic level.

  2. The Five Ps of Acute Ischemic Stroke Treatment: Parenchyma, Pipes, Perfusion, Penumbra, and Prevention of Complications

    PubMed Central

    Felberg, Robert A.; Naidech, Andrew

    2003-01-01

    Stroke is a treatable disease. Despite the therapeutic nihilism of the past, the advent of thrombolysis has changed the way stroke treatment is approached. Acute ischemic stroke is a challenging and heterogeneous disease, and treatment must be based on an understanding of the underlying pathophysiology of ischemia. Interventions are designed to improve neuronal salvage and outcome. The underlying tenets of stroke therapy focus on the brain parenchyma, arterial flow (pipes), perfusion, the ischemic milieu or penumbra, and prevention of complications. This article focuses on the practical issues of ischemic stroke care with a brief review of supporting literature. PMID:22470250

  3. Effects of UVB irradiation on epidermal adenylate cyclase responses in vitro: its relation to sunburn cell formation.

    PubMed

    Iizuka, H; Ishida-Yamamoto, A; Kajita, S; Tsutsui, M; Ohkuma, N

    1988-01-01

    UVB irradiation augmented the beta-adrenergic adenylate cyclase response of pig skin epidermis in vitro. The effect was observed 2-4 h following the irradiation and lasted at least for 48 h. There was no significant difference in cyclic AMP phosphodiesterase activity between control and UVB-irradiated epidermis at lower irradiation dose (150 mJ/cm2), which is the dose of the most marked beta-adrenergic augmentation effect. The augmentation effect was specific to the beta-adrenergic system; adenosine and histamine adenylate cyclase responses were unchanged or decreased depending on the irradiation dose. Histologically, marked sunburn-cell formation was observed following the UVB irradiation. It has been suggested that oxygen intermediates generated by ultraviolet radiation participate in sunburn-cell formation. The addition of superoxide dismutase (SOD) in the incubation medium significantly inhibited sunburn-cell formation. On the other hand, the beta-adrenergic augmentation effect was not affected by the addition of SOD. Other scavengers of oxygen intermediates (catalase, catalase + SOD, xanthine, or mannitol) did not inhibit the UVB-induced beta-adrenergic augmentation effect. Further, superoxide-anion generating systems (hypoxanthine-xanthine oxidase system and acetaldehyde-xanthine oxidase system) revealed no stimulatory effect on the beta-adrenergic response of epidermis. These results indicate that (a) the UVB-induced beta-adrenergic augmentation effect is inherent to skin and does not depend on systemic factors such as inflammatory infiltrates following UVB irradiation; (b) in contrast to sunburn-cell formation, induction of the beta-adrenergic adenylate cyclase response is not directly associated with oxygen intermediates generated by UVB irradiation.

  4. Vaccines to prevent severe acute respiratory syndrome coronavirus-induced disease

    PubMed Central

    Enjuanes, Luis; DeDiego, Marta L.; Álvarez, Enrique; Deming, Damon; Sheahan, Tim; Baric, Ralph

    2009-01-01

    An important effort has been performed after the emergence of severe acute respiratory syndrome (SARS) epidemic in 2003 to diagnose and prevent virus spreading. Several types of vaccines have been developed including inactivated viruses, subunit vaccines, virus-like particles (VLPs), DNA vaccines, heterologous expression systems, and vaccines derived from SARS-CoV genome by reverse genetics. This review describes several aspects essential to develop SARS-CoV vaccines, such as the correlates of protection, virus serotypes, vaccination side effects, and bio-safeguards that can be engineered into recombinant vaccine approaches based on the SARS-CoV genome. The production of effective and safe vaccines to prevent SARS has led to the development of promising vaccine candidates, in contrast to the design of vaccines for other coronaviruses, that in general has been less successful. After preclinical trials in animal models, efficacy and safety evaluation of the most promising vaccine candidates described has to be performed in humans. PMID:17416434

  5. Wilderness Medical Society consensus guidelines for the prevention and treatment of acute altitude illness.

    PubMed

    Luks, Andrew M; McIntosh, Scott E; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Schoene, Robert B; Zafren, Ken; Hackett, Peter H

    2010-06-01

    To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the prevention and treatment of acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations for their roles in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to the prevention and management of each disorder that incorporate these recommendations. Copyright (c) 2010. Published by Elsevier Inc.

  6. UVB radiation generates sunburn pain and affects skin by activating epidermal TRPV4 ion channels and triggering endothelin-1 signaling.

    PubMed

    Moore, Carlene; Cevikbas, Ferda; Pasolli, H Amalia; Chen, Yong; Kong, Wei; Kempkes, Cordula; Parekh, Puja; Lee, Suk Hee; Kontchou, Nelly-Ange; Yeh, Iwei; Ye, Iwei; Jokerst, Nan Marie; Fuchs, Elaine; Steinhoff, Martin; Liedtke, Wolfgang B

    2013-08-20

    At our body surface, the epidermis absorbs UV radiation. UV overexposure leads to sunburn with tissue injury and pain. To understand how, we focus on TRPV4, a nonselective cation channel highly expressed in epithelial skin cells and known to function in sensory transduction, a property shared with other transient receptor potential channels. We show that following UVB exposure mice with induced Trpv4 deletions, specifically in keratinocytes, are less sensitive to noxious thermal and mechanical stimuli than control animals. Exploring the mechanism, we find that epidermal TRPV4 orchestrates UVB-evoked skin tissue damage and increased expression of the proalgesic/algogenic mediator endothelin-1. In culture, UVB causes a direct, TRPV4-dependent Ca(2+) response in keratinocytes. In mice, topical treatment with a TRPV4-selective inhibitor decreases UVB-evoked pain behavior, epidermal tissue damage, and endothelin-1 expression. In humans, sunburn enhances epidermal expression of TRPV4 and endothelin-1, underscoring the potential of keratinocyte-derived TRPV4 as a therapeutic target for UVB-induced sunburn, in particular pain.

  7. UVB radiation generates sunburn pain and affects skin by activating epidermal TRPV4 ion channels and triggering endothelin-1 signaling

    PubMed Central

    Moore, Carlene; Cevikbas, Ferda; Pasolli, H. Amalia; Chen, Yong; Kong, Wei; Kempkes, Cordula; Parekh, Puja; Lee, Suk Hee; Kontchou, Nelly-Ange; Yeh, Iwei; Jokerst, Nan Marie; Fuchs, Elaine; Steinhoff, Martin; Liedtke, Wolfgang B.

    2013-01-01

    At our body surface, the epidermis absorbs UV radiation. UV overexposure leads to sunburn with tissue injury and pain. To understand how, we focus on TRPV4, a nonselective cation channel highly expressed in epithelial skin cells and known to function in sensory transduction, a property shared with other transient receptor potential channels. We show that following UVB exposure mice with induced Trpv4 deletions, specifically in keratinocytes, are less sensitive to noxious thermal and mechanical stimuli than control animals. Exploring the mechanism, we find that epidermal TRPV4 orchestrates UVB-evoked skin tissue damage and increased expression of the proalgesic/algogenic mediator endothelin-1. In culture, UVB causes a direct, TRPV4-dependent Ca2+ response in keratinocytes. In mice, topical treatment with a TRPV4-selective inhibitor decreases UVB-evoked pain behavior, epidermal tissue damage, and endothelin-1 expression. In humans, sunburn enhances epidermal expression of TRPV4 and endothelin-1, underscoring the potential of keratinocyte-derived TRPV4 as a therapeutic target for UVB-induced sunburn, in particular pain. PMID:23929777

  8. Individual phenolic response and peroxidase activity in peel of differently sun-exposed apples in the period favorable for sunburn occurrence.

    PubMed

    Zupan, Anka; Mikulic-Petkovsek, Maja; Slatnar, Ana; Stampar, Franci; Veberic, Robert

    2014-11-15

    Extreme weather events like high solar radiation can cause stress in apple fruits (Malus domestica Borkh.). The aim of the study was to make a screening of individual phenols and peroxidase activity in apple peel as a response to sunburn and different sun-exposures in the period when weather conditions are suitable for sunburn occurrence. Apple fruits of 'Golden Delicious' and 'Braeburn' were sampled. Fruit temperature and color were measured prior HPLC-MS(2) and peroxidase activity analyses. Sunburned peel was darker and more yellow-red in comparison to healthy peel, which appeared yellow-green. Fruit temperature, total as well as individual flavonols and dihydrochalcones, total hydroxycinnamics and perixodase activity were highest in sunburned peel in comparison with healthy sun-exposed peel, furthermore both were different than shaded sides of both fruits and peel of apples inside the tree crown; moreover in sunburned peel dihydrochalcones were determined for the first time. Chlorogenic acid was up to 2.5 times higher, 3-hydroxy-phloretin-2'-O-xyloglucoside was up to 10 times higher and quercetin-3-galactoside was up to 33 times higher in sunburned peel, comparing to shaded sided peels. Flavanols did not show a distinct pattern. A deeper insight in phenolic response against environmental stress caused by high solar radiation and high air temperatures has been made. Copyright © 2014 Elsevier GmbH. All rights reserved.

  9. Preventive Antibacterial Therapy in Acute Ischemic Stroke: A Randomized Controlled Trial

    PubMed Central

    Klehmet, Juliane; Rogge, Witold; Drenckhahn, Christoph; Göhler, Jos; Bereswill, Stefan; Göbel, Ulf; Wernecke, Klaus Dieter; Wolf, Tilo; Arnold, Guy; Halle, Elke; Volk, Hans-Dieter; Dirnagl, Ulrich; Meisel, Andreas

    2008-01-01

    Background Pneumonia is a major risk factor of death after acute stroke. In a mouse model, preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections, it also reduces mortality, and improves neurological outcome significantly. In this study we investigate whether this approach is effective in stroke patients. Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) is a randomized, double-blind, placebo-controlled trial in 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the middle cerebral artery (MCA) territory. Patients received either intravenous moxifloxacin (400 mg daily) or placebo for 5 days starting within 36 hours after stroke onset. Primary endpoint was infection within 11 days. Secondary endpoints included neurological outcome, survival, development of stroke-induced immunodepression, and induction of bacterial resistance. Findings On intention-to treat analysis (79 patients), the infection rate at day 11 in the moxifloxacin treated group was 15.4% compared to 32.5% in the placebo treated group (p = 0.114). On per protocol analysis (n = 66), moxifloxacin significantly reduced infection rate from 41.9% to 17.1% (p = 0.032). Stroke associated infections were associated with a lower survival rate. In this study, neurological outcome and survival were not significantly influenced by treatment with moxifloxacin. Frequency of fluoroquinolone resistance in both treatment groups did not differ. On logistic regression analysis, treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression (a marker for immunodepression) at day 1 after stroke onset was independently and highly predictive for post-stroke infections. Interpretation PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo. In addition, the results emphasize the

  10. Vitamin D Beliefs and Associations with Sunburns, Sun Exposure, and Sun Protection

    PubMed Central

    Kim, Bang Hyun; Glanz, Karen; Nehl, Eric J.

    2012-01-01

    The main objective of this study was to examine certain beliefs about vitamin D and associations with sun exposure, sun protection behaviors, and sunburns. A total of 3,922 lifeguards, pool managers, and parents completed a survey in 2006 about beliefs regarding vitamin D and sun-related behaviors. Multivariate ordinal regression analyses and linear regression analysis were used to examine associations of beliefs and other variables. Results revealed that Non-Caucasian lifeguards and pool managers were less likely to agree that they needed to go out in the sun to get enough vitamin D. Lifeguards and parents who were non-Caucasian were less likely to report that sunlight helped the body to produce vitamin D. A stronger belief about the need to go out in the sun to get enough vitamin D predicted more sun exposure for lifeguards. For parents, a stronger belief that they can get enough vitamin D from foods predicted greater sun protection and a stronger belief that sunlight helps the body produce vitamin D predicted lower sun exposure. This study provides information regarding vitamin D beliefs and their association with certain sun related behaviors across different demographic groups that can inform education efforts about vitamin D and sun protection. PMID:22851950

  11. Galectin-7 overexpression is associated with the apoptotic process in UVB-induced sunburn keratinocytes

    PubMed Central

    Bernerd, Francoise; Sarasin, Alain; Magnaldo, Thierry

    1999-01-01

    Galectin-7 is a β-galactoside binding protein specifically expressed in stratified epithelia and notably in epidermis, but barely detectable in epidermal tumors and absent from squamous carcinoma cell lines. Galectin-7 gene is an early transcriptional target of the tumor suppressor protein P53 [Polyak, K., Xia, Y., Zweier, J., Kinzler, K. & Vogelstein, B. (1997) Nature (London) 389, 300–305]. Because p53 transcriptional activity is increased by genotoxic stresses we have examined the possible effects of ultraviolet radiations (UVB) on galectin-7 expression in epidermal keratinocytes. The amounts of galectin-7 mRNA and protein are increased rapidly after UVB irradiation of epidermal keratinocytes. The increase of galectin-7 is parallel to P53 stabilization. UVB irradiation of skin reconstructed in vitro and of human skin ex vivo demonstrates that galectin-7 overexpression is associated with sunburn/apoptotic keratinocytes. Transfection of a galectin-7 expression vector results in a significant increase in terminal deoxynucleotidyltransferase-mediated UTP end labeling-positive keratinocytes. The present findings demonstrate a keratinocyte-specific protein involved in the UV-induced apoptosis, an essential process in the maintenance of epidermal homeostasis. PMID:10500176

  12. Clinicians' perceptions and recognition of practice improvement strategies to prevent harms to older people in acute care hospitals.

    PubMed

    McGrath, Michele; Botti, Mari; Redley, Bernice

    2017-08-03

    Explore clinicians' perceptions of practice improvement strategies used to prevent harms to older people during acute hospitalisation. Older people are vulnerable to many interrelated preventable harms during acute care hospitalisation. Improvement strategies recommend standardisation of practices to assist healthcare staff mitigate risk, however, older people continue to suffer preventable harms in acute hospitals. A qualitative exploratory descriptive design was used to collect data using focus groups and individual interviews from a purposive sample of 33 participants. Participants represented a wide range of clinicians from four diverse healthcare organisations. Qualitative content analysis used a framework informed by common preventable harms derived from key literature and policy documents. Participants' perceptions of practice improvement strategies varied depending on their role within their organisational hierarchy. Recognition of preventable harms was guided by standard risk assessment and management tools used in their organisations. Preventable harms relating to skin integrity and falls were universally recognised across all sites and roles. Alternatively, there was variability in participant recognition of preventable harms related to nutrition, continence, medications and cognition; pain was consistently overlooked as a contributor to preventable harms. Hospital staff perceived standard clinical risk assessment and management tools as the main practice improvement strategy to prevent harms. These tools prompted staff recognition of preventable harms to older people during acute hospitalisation. Variability in the recognition of some preventable harms was attributed to variable use of standard assessment tools. Pain was unlikely to be recognised as contributing to preventable harms. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. ZFX controls propagation and prevents differentiation of acute T-lymphoblastic and myeloid leukemia.

    PubMed

    Weisberg, Stuart P; Smith-Raska, Matthew R; Esquilin, Jose M; Zhang, Ji; Arenzana, Teresita L; Lau, Colleen M; Churchill, Michael; Pan, Haiyan; Klinakis, Apostolos; Dixon, Jack E; Mirny, Leonid A; Mukherjee, Siddhartha; Reizis, Boris

    2014-02-13

    Tumor-propagating cells in acute leukemia maintain a stem/progenitor-like immature phenotype and proliferative capacity. Acute myeloid leukemia (AML) and acute T-lymphoblastic leukemia (T-ALL) originate from different lineages through distinct oncogenic events such as MLL fusions and Notch signaling, respectively. We found that Zfx, a transcription factor that controls hematopoietic stem cell self-renewal, controls the initiation and maintenance of AML caused by MLL-AF9 fusion and of T-ALL caused by Notch1 activation. In both leukemia types, Zfx prevents differentiation and activates gene sets characteristic of immature cells of the respective lineages. In addition, endogenous Zfx contributes to gene induction and transformation by Myc overexpression in myeloid progenitors. Key Zfx target genes include the mitochondrial enzymes Ptpmt1 and Idh2, whose overexpression partially rescues the propagation of Zfx-deficient AML. These results show that distinct leukemia types maintain their undifferentiated phenotype and self-renewal by exploiting a common stem-cell-related genetic regulator. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Hepatocyte Growth Factor Prevents Acute Renal Failure of Accelerates Renal Regeneration in mice

    NASA Astrophysics Data System (ADS)

    Kawaida, Kouichi; Matsumoto, Kunio; Shimazu, Hisaaki; Nakamura, Toshikazu

    1994-05-01

    Although acute renal failure is encountered with administration of nephrotoxic drugs, ischemia, or unilateral nephrectomy, there has been no effective drug which can be used in case of acute renal failure. Hepatocyte growth factor (HGF) is a potent hepatotropic factor for liver regeneration and is known to have mitogenic, motogenic, and morphogenic activities for various epithelial cells, including renal tubular cells. Intravenous injection of recombinant human HGF into mice remarkably suppressed increases in blood urea nitrogen and serum creatinine caused by administration of cisplatin, a widely used antitumor drug, or HgCl_2, thereby indicating that HGF strongly prevented the onset of acute renal dysfunction. Moreover, exogenous HGF stimulated DNA synthesis of renal tubular cells after renal injuries caused by HgCl_2 administration and unilateral nephrectomy and induced reconstruction of the normal renal tissue structure in vivo. Taken together with our previous finding that expression of HGF was rapidly induced after renal injuries, these results allow us to conclude that HGF may be the long-sought renotropic factor for renal regeneration and may prove to be effective treatment for patients with renal dysfunction, especially that caused by cisplatin.

  15. Acute nicotine treatment prevents REM sleep deprivation-induced learning and memory impairment in rat.

    PubMed

    Aleisa, A M; Helal, G; Alhaider, I A; Alzoubi, K H; Srivareerat, M; Tran, T T; Al-Rejaie, S S; Alkadhi, K A

    2011-08-01

    Rapid eye movement (REM) sleep deprivation (SD) is implicated in impairment of spatial learning and memory and hippocampal long-term potentiation (LTP). An increase in nicotine consumption among habitual smokers and initiation of tobacco use by nonsmokers was observed during SD. Although nicotine treatment was reported to attenuate the impairment of learning and memory and LTP associated with several mental disorders, the effect of nicotine on SD-induced learning and memory impairment has not been studied. Modified multiple platform paradigm was used to induce SD for 24 or 48 h during which rats were injected with saline or nicotine (1 mg kg(-1) s.c.) twice a day. In the radial arm water maze (RAWM) task, 24- or 48-h SD significantly impaired learning and short-term memory. In addition, extracellular recordings from CA1 and dentate gyrus (DG) regions of the hippocampus in urethane anesthetized rats showed a significant impairment of LTP after 24- and 48-h SD. Treatment of normal rats with nicotine for 24 or 48 h did not enhance spatial learning and memory or affect magnitude of LTP in the CA1 and DG regions. However, concurrent, acute treatment of rats with nicotine significantly attenuated SD-induced impairment of learning and STM and prevented SD-induced impairment of LTP in the CA1 and DG regions. These results show that acute nicotine treatment prevented the deleterious effect of sleep loss on cognitive abilities and synaptic plasticity.

  16. Efficacy of cilostazol in preventing aspiration pneumonia in acute cerebral infarction.

    PubMed

    Osawa, Aiko; Maeshima, Shinichiro; Tanahashi, Norio

    2013-08-01

    This retrospective study examined the effectiveness of cilostazol in preventing aspiration pneumonia in patients with acute cerebral infarction. The 189 subjects ranged in age from 31 to 95 years and included 57 with small-artery occlusion, 107 with large-artery atherothrombosis, and 25 with other disorders. Patients with cardiogenic cerebral embolism or preexisting pneumonia at the time of hospital admission were excluded from the analysis. Neurologic symptoms, cognitive function, and swallowing function were assessed at the first clinical examination, and the ability to perform activities of daily living was assessed at both hospital admission and discharge. Outcome and food intake status were also assessed at hospital discharge. Pneumonia was detected in 27 of 189 subjects (14.3%), in 20 subjects during nasogastric tube feeding implemented because of oral intake difficulties (fasting group) and in 7 subjects after initiation of oral feeding (oral intake group). Cilostazol was administered to 48 of the 189 subjects (25.4%). The incidence of pneumonia was 6.3% (3 of 48) in patients who received cilostazol, compared with 17% (24 of 141) in those who did not receive cilostazol. Our data suggest that cilostazol appears to prevent the occurrence of pneumonia in both the chronic and acute stages of cerebral infarction.

  17. Use of medicines recommended for secondary prevention of acute coronary syndrome

    PubMed Central

    Gaedke, Mari Ângela; da Costa, Juvenal Soares Dias; Manenti, Euler Roberto Fernandes; Henn, Ruth Liane; Paniz, Vera Maria Vieira; Nunes, Marcelo Felipe; da Motta, Monique Adriane; Olinto, Maria Teresa Anselmo

    2015-01-01

    ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition

  18. Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball.

    PubMed

    Seagrave, Richard A; Perez, Luis; McQueeney, Sean; Toby, E Bruce; Key, Vincent; Nelson, Joshua D

    2014-06-01

    Hamstring injuries are the second most common injury causing missed days in professional baseball field players. Recent studies have shown the preventive benefit of eccentric conditioning on the hamstring muscle group in injury prevention. Specifically, Nordic-type exercises have been shown to decrease the incidence of acute hamstring injuries in professional athletes. This was a prospective study performed in coordination with a single Major League Baseball (MLB) organization (major and minor league teams) that targeted the effects of Nordic exercises on the incidence of acute hamstring injuries in the professional-level baseball player. Prospective cohort study; Level of evidence, 2. The daily workouts of 283 professional baseball players throughout all levels of a single MLB organization were prospectively recorded. The intervention group participated in the Nordic exercise program and was compared with a randomly selected control group of professional athletes within the organization not participating in the exercise program. The incidence of hamstring injuries in both groups was compared, and the total number of days missed due to injury was compared with the 2 previous seasons. There were 10 hamstring injuries that occurred during the 2012 season among the 283 professional athletes that required removal from play. There were no injuries that occurred in the intervention group (n = 65, 0.00%; P = .0381). The number needed to treat (NNT) to prevent 1 hamstring injury was 11.3. The average repetitions per week of the injured group were assessed at multiple time points (2, 4, 6, and total weeks) prior to injury. There were significantly fewer repetitions per week performed in the injured group at all time points compared with overall average repetitions per week in the noninjured group (P = .0459, .0127, .0164, and .0299, respectively). After beginning the Nordic exercise program, there were 136 total days missed due to a hamstring injury during the 2012 season

  19. Preventive Effects of Eccentric Training on Acute Hamstring Muscle Injury in Professional Baseball

    PubMed Central

    Seagrave, Richard A.; Perez, Luis; McQueeney, Sean; Toby, E. Bruce; Key, Vincent; Nelson, Joshua D.

    2014-01-01

    Background: Hamstring injuries are the second most common injury causing missed days in professional baseball field players. Recent studies have shown the preventive benefit of eccentric conditioning on the hamstring muscle group in injury prevention. Specifically, Nordic-type exercises have been shown to decrease the incidence of acute hamstring injuries in professional athletes. Purpose: This was a prospective study performed in coordination with a single Major League Baseball (MLB) organization (major and minor league teams) that targeted the effects of Nordic exercises on the incidence of acute hamstring injuries in the professional-level baseball player. Study Design: Prospective cohort study; Level of evidence, 2. Methods: The daily workouts of 283 professional baseball players throughout all levels of a single MLB organization were prospectively recorded. The intervention group participated in the Nordic exercise program and was compared with a randomly selected control group of professional athletes within the organization not participating in the exercise program. The incidence of hamstring injuries in both groups was compared, and the total number of days missed due to injury was compared with the 2 previous seasons. Results: There were 10 hamstring injuries that occurred during the 2012 season among the 283 professional athletes that required removal from play. There were no injuries that occurred in the intervention group (n = 65, 0.00%; P = .0381). The number needed to treat (NNT) to prevent 1 hamstring injury was 11.3. The average repetitions per week of the injured group were assessed at multiple time points (2, 4, 6, and total weeks) prior to injury. There were significantly fewer repetitions per week performed in the injured group at all time points compared with overall average repetitions per week in the noninjured group (P = .0459, .0127, .0164, and .0299, respectively). After beginning the Nordic exercise program, there were 136 total days

  20. Cannabinoids in the treatment of chemotherapy-induced nausea and vomiting: beyond prevention of acute emesis.

    PubMed

    Slatkin, Neal E

    2007-05-01

    Chemotherapy-induced nausea and vomiting (CINV) remains a significant problem in the care of cancer patients. Although the use of serotonin (5-HT3) receptor antagonists, as well as neurokinin-1 inhibitors, has reduced rates of acute emesis, many patients still experience acute vomiting; moreover, these agents have reduced efficacy in preventing nausea, delayed CINV, and breakthrough CINV. Nausea, in particular, continues to have a major--and often overlooked--impact on patients' quality of life. Optimizing the treatment for CINV likely will involve combinations of agents that inhibit the numerous neurotransmitter systems involved in nausea and vomiting reflexes. Cannabinoids are active in many of these systems, and two oral formulations, dronabinol (Marinol) and nabilone (Cesamet), are approved by the US Food and Drug Administration for use in CINV refractory to conventional antiemetic therapy. Agents in this class have shown superiority to dopamine receptor antagonists in preventing CINV, and there is some evidence that the combination of a dopamine antagonist and cannabinoid is superior to either alone and is particularly effective in preventing nausea. The presence of side effects from the cannabinoids may have slowed their adoption into clinical practice, but in a number of comparative clinical trials, patients have expressed a clear preference for the cannabinoid, choosing its efficacy over any undesired effects. Improvement in antiemetic therapy across the entire spectrum of CINV will involve the use of agents with different mechanisms of action in concurrent or sequential combinations, and the best such combinations should be identified. In this effort, the utility of the cannabinoids should not be overlooked.

  1. Role of dexamethasone in the prevention of migraine recurrence in the acute care setting: a review.

    PubMed

    Giuliano, Christopher; Smalligan, Roger D; Mitchon, Greg; Chua, Matt

    2012-05-01

    Patients with migraine headaches are commonly encountered by clinicians both in the clinic and in the emergency department. Migraines impose a significant financial burden on patients, caregivers, and society. Up to 49% of patients treated acutely for migraine headache will have a recurrence within 72 hours. Recurrence of migraines is dependent on a number of factors, including the choice of abortive agent, age, sex, and initial severity of the migraine. Dexamethasone has been proposed and studied as a medication that may decrease the frequency of such recurrences of migraine headaches in affected patients. Dexamethasone is a corticosteroid that has been proposed to prevent recurrence of migraines through its prevention of neurogenic inflammation. Initial trials, with less-than-ideal methodology, showed large decreases in the number of patients experiencing recurrent migraines. Later randomized controlled trials revealed mixed results, with subsequent meta-analyses showing an overall benefit in the prevention of recurrence of migraines. These meta-analyses suggest that dexamethasone will prevent recurrence in about 10% of patients, although trials that used higher doses of dexamethasone and followed patients for ≥ 72 hours showed a larger benefit. Very few adverse events were reported in the randomized controlled trials following a single dose of dexamethasone. Given the benign side effect profile and wide tolerability to a single high dose of dexamethasone, it appears to be a safe and modestly effective addition to standard migraine abortive therapy for the prevention of migraine recurrence. Dexamethasone should not be used in patients with non-migraine headaches or contraindications to steroids. Further studies should help delineate if dexamethasone can be tailored to specific patient populations and hence enhance its therapeutic effectiveness.

  2. The clinical challenge of preventing sudden cardiac death immediately after acute ST-elevation myocardial infarction.

    PubMed

    Manolis, Antonis S

    2014-12-01

    Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI. In-hospital SCD due to ventricular tachyarrhythmias is manageable, with either preventive measures or drugs or electrical cardioversion. There is general agreement for secondary prevention of SCD post-MI with implantation of a cardioverter defibrillator (ICD) when malignant ventricular arrhythmias occur late (>48 h) after an MI, and are not due to reversible or correctable causes. The major challenge remains that of primary prevention, that is, how to prevent SCD during the first 1-3 months after ST-elevation MI for patients who have low left ventricular ejection fraction and are not candidates for an ICD according to current guidelines, due to the results of two studies, which did not show any benefits of early (<40 days after an MI) ICD implantation. Two recent documents may provide direction as to how to bridge the gap for this early post-MI period. Both recommend an electrophysiology study to guide implantation of an ICD, at least for those developing syncope or non-sustained ventricular tachycardia, who have an inducible sustained ventricular tachycardia at the electrophysiology study. An ICD is also recommended for patients with indication for a permanent pacemaker due to bradyarrhythmias, who also meet primary prevention criteria for SCD.

  3. Pressure ulcers and prevention among acute care hospitals in the United States.

    PubMed

    Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy

    2013-09-01

    Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.

  4. Acute and preventive treatment of cluster headache and other trigeminal autonomic cephalgias.

    PubMed

    Bussone, Gennaro; Rapoport, Alan

    2010-01-01

    Patients with cluster headache or any of the trigeminal autonomic cephalalgias (TACs) are often good candidates for preventive treatment as their headaches are frequent and severe. While acute and symptomatic therapies must be used often, they do not alter the course of the cluster period or the duration of the TACs, and they do not usually decrease the frequency of attacks. In this chapter we discuss the aim and the choice of prevention. Verapamil is considered the first choice for prevention of cluster headache, but as with all of the medications to be mentioned, it has various adverse effects to be aware of. Other frequently used preventives for cluster include lithium carbonate, methysergide where available, methylergonovine, clonidine, melatonin, valproate, gabapentin, topiramate, and others. Several other medications can be used as bridge therapy, to decrease the frequency of cluster temporarily, giving time for the preventives to begin to work. The most commonly used bridge therapies are 7-21 days of prednisone at high and then tapering doses and ergots such as ergotamine tartrate and dihydroergotamine. Patients with chronic cluster headache who are unresponsive to all medical therapies can be considered for occipital nerve stimulation and various surgical procedures such as ganglyogliolysis of all three branches of the ipsilateral trigeminal nerve at the root entry zone. A somewhat controversial but highly successful procedure, at least as done by the neurosurgeons in Professor Bussone's group at the Institute of Neurology in Milan, has been deep-brain stimulation of the posterior hypothalamus. Other TACs, such as short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), can be hard to treat effectively with medications, but the paroxysmal hemicranias and cluster tic respond somewhat better to traditional therapies.

  5. Prevention of Acute Kidney Injury by Tauroursodeoxycholic Acid in Rat and Cell Culture Models

    PubMed Central

    Li, Shunan; Abedin, Md. Joynal; Noppakun, Kajohnsak; Wang, Lawrence; Kaur, Tarundeep; Najafian, Behzad; Rodrigues, Cecília M. P.

    2012-01-01

    Background Acute kidney injury (AKI) has grave short- and long-term consequences. Often the onset of AKI is predictable, such as following surgery that compromises blood flow to the kidney. Even in such situations, present therapies cannot prevent AKI. As apoptosis is a major form of cell death following AKI, we determined the efficacy and mechanisms of action of tauroursodeoxycholic acid (TUDCA), a molecule with potent anti-apoptotic and pro-survival properties, in prevention of AKI in rat and cell culture models. TUDCA is particularly attractive from a translational standpoint, as it has a proven safety record in animals and humans. Methodology/Principal Findings We chose an ischemia-reperfusion model in rats to simulate AKI in native kidneys, and a human kidney cell culture model to simulate AKI associated with cryopreservation in transplanted kidneys. TUDCA significantly ameliorated AKI in the test models due to inhibition of the mitochondrial pathway of apoptosis and upregulation of survival pathways. Conclusions This study sets the stage for testing TUDCA in future clinical trials for prevention of AKI, an area that needs urgent attention due to lack of effective therapies. PMID:23152827

  6. Prevention and therapy of fungal infection in severe acute pancreatitis: A prospective clinical study

    PubMed Central

    He, Yue-Ming; Lv, Xin-Sheng; Ai, Zhong-Li; Liu, Zhi-Su; Qian, Qun; Sun, Quan; Chen, Ji-Wei; Lei, Dao-Xiong; Jiang, Cong-Qing; Yuan, Yu-Fong

    2003-01-01

    AIM: To investigate the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). METHODS: Seventy patients with SAP admitted from Jan. 1998 to Dec. 2002 were randomly divided into garlicin prevention group, fluconazole (low dosage) prevention group and control group. The incidence of fungal infection, the fungal clearance and mortality after treatment were compared. RESULTS: The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group (16% vs 30%, P < 0.05 and 9% vs 30%, P < 0.01, respectively). Amphotericin B or therapy-dose fluconazole had effects on patients with fungal infection in garlicin group and control group, but had no effects on patients with fungal infection in fluconzole group. CONCLUSION: Prophylactic dosage of antifungal agents (garlicin or low dosage fluconazole) can reduce the incidence of fungal infection in patients with SAP. But once fungal infection occurs, amphotericin B should be used as early as possible if fluconazole is not effective. PMID:14606111

  7. Antioxidants prevent depression of the acute hypoxic ventilatory response by subanaesthetic halothane in men

    PubMed Central

    Teppema, Luc J; Nieuwenhuijs, Diederik; Sarton, Elise; Romberg, Raymonda; Olievier, Cees N; Ward, Denham S; Dahan, Albert

    2002-01-01

    We studied the effect of the antioxidants (AOX) ascorbic acid (2 g, I.V.) and α-tocopherol (200 mg, P.O.) on the depressant effect of subanaesthetic doses of halothane (0.11 % end-tidal concentration) on the acute isocapnic hypoxic ventilatory response (AHR), i.e. the ventilatory response upon inhalation of a hypoxic gas mixture for 3 min (leading to a haemoglobin saturation of 82 ± 1.8 %) in healthy male volunteers. In the first set of protocols, two groups of eight subjects each underwent a control hypoxic study, a halothane hypoxic study and finally a halothane hypoxic study after pretreatment with AOX (study 1) or placebo (study 2). Halothane reduced the AHR by more than 50 %, from 0.79 ± 0.31 to 0.36 ± 0.14 l min−1 %−1 in study 1 and from 0.79 ± 0.40 to 0.36 ± 0.19 l min−1 %−1 in study 2, P < 0.01 for both. Pretreatment with AOX prevented this depressant effect of halothane in the subjects of study 1 (AHR returning to 0.77 ± 0.32 l min−1 %−1, n.s. from control), whereas placebo (study 2) had no effect (AHR remaining depressed at 0.36 ± 0.27 l min−1 %−1, P < 0.01 from control). In a second set of protocols, two separate groups of eight subjects each underwent a control hypoxic study, a sham halothane hypoxic study and finally a sham halothane hypoxic study after pretreatment with AOX (study 3) or placebo (study 4). In studies 3 and 4, sham halothane did not modify the control hypoxic response, nor did AOX (study 3) or placebo (study 4). The 95 % confidence intervals for the ratio of hypoxic sensitivities, (AOX + halothane):halothane in study 1 and (AOX - sham halothane):sham halothane in study 3, were [1.7, 2.6] and [1.0, 1.2], respectively. Because the antioxidants prevented the reduction of the acute hypoxic response by halothane, we suggest that this depressant effect may be caused by reactive species produced by a reductive metabolism of halothane during hypoxia or that a change in redox state of carotid body cells by the

  8. One-year outcomes and secondary prevention in patients after acute minor stroke: results from the China National Stroke Registry.

    PubMed

    Tan, Ying; Pan, Yuesong; Liu, Liping; Wang, Yilong; Zhao, Xingquan; Wang, Yongjun

    2017-06-01

    Limited data are available on secondary preventive therapy use and patient outcomes after acute minor ischemic stroke in China. This study investigated secondary prevention strategies and outcomes up to 1 year after minor ischemic stroke. Patients from the China National Stroke Registry experienced a minor ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score ≤5) and admitted to hospital within 24 hours of symptom onset were included. One-year rates of recurrent stroke, stroke-related disability, and all-cause death were evaluated. Risk factors associated with 1-year stroke recurrence were examined in a multivariate model. The secondary prevention strategies in the acute phase were evaluated as combination of secondary prevention medication classes and the medications used in 1 year follow-up were examined. The study included 1913 patients who had experienced acute minor ischemic stroke (mean age: 65.1 years; 67.3% men; mean NIHSS score: 2.5). Rates of recurrent stroke, disability, and death were 13.2, 17.0, and 6.3% at 1 year, respectively. History of hypertension, ischemic stroke, transient ischemic attack, and atrial fibrillation were independent predictors of one-year stroke recurrence. Rate of 1 year all-cause death in patients with triple combined therapy in acute phase was 4.1%, whereas in patients with none was 14.5%. At 1 year, only half patients continued the secondary prevention medications. Outcomes in individuals in China who had experienced acute minor stroke were unfavorable, underscoring the importance of early, sustained preventive therapy in this patient population. Combination of secondary prevention medication classes was associated with a lower risk of death.

  9. Frovatriptan for the acute treatment of migraine and prevention of predictable menstrual migraine.

    PubMed

    Elkind, Arthur H; MacGregor, E Anne

    2008-05-01

    Frovatriptan is a 5-HT(1B/1D) receptor agonist that belongs to the triptan therapeutic class. Relative to other triptans, frovatriptan has a long half-life (26 h) and a low incidence of migraine recurrence (17%). Frovatriptan is indicated for the acute treatment of migraine with or without aura, and has a relatively good safety and tolerability profile. Recent studies have also shown that a 6-day regimen of frovatriptan scheduled during the perimenstrual period significantly reduced the incidence and severity of menstrual migraine (MM; attacks that regularly start day -2 to +3 relative to menses). Prevention may be important because MM attacks have been characterized as being of longer duration, more severe and more refractory to treatment than non-MM attacks.

  10. Remote ischaemic pre-conditioning for the prevention of acute kidney injury.

    PubMed

    Ho, Phoebe Wing-Lam; Pang, Wing-Fai; Szeto, Cheuk-Chun

    2016-04-01

    Acute kidney injury (AKI) is a common complication associated with high morbidity and mortality in hospitalized patients. One potential mechanism underlying renal injury is ischaemia/reperfusion injury (IRI), which attributed the organ damage to the inflammatory and oxidative stress responses induced by a period of renal ischaemia and subsequent reperfusion. Therapeutic strategies that aim at minimizing the effect of IRI on the kidneys may prevent AKI and improve clinical outcomes significantly. In this review, we examine the technique of remote ischaemic preconditioning (rIPC), which has been shown by several trials to confer organ protection by applying transient, brief episodes of ischaemia at a distant site before a larger ischaemic insult. We provide an overview of the current clinical evidence regarding the renoprotective effect of rIPC in the key clinical settings of cardiac or vascular surgery, contrast-induced AKI, pre-existing chronic kidney disease (CKD) and renal transplantation, and discuss key areas for future research.

  11. Chronic mitochondrial uncoupling treatment prevents acute cold-induced oxidative stress in birds.

    PubMed

    Stier, Antoine; Massemin, Sylvie; Criscuolo, François

    2014-12-01

    Endotherms have evolved two major types of thermogenesis that allow them to actively produce heat in response to cold exposure, either through muscular activity (i.e. shivering thermogenesis) or through futile electro-chemical cycles (i.e. non-shivering thermogenesis). Amongst the latter, mitochondrial uncoupling is of key importance because it is suggested to drive heat production at a low cost in terms of oxidative stress. While this has been experimentally shown in mammals, the oxidative stress consequences of cold exposure and mitochondrial uncoupling are clearly less understood in the other class of endotherms, the birds. We compared metabolic and oxidative stress responses of zebra finches chronically treated with or without a chemical mitochondrial uncoupler (2,4-dinitrophenol: DNP), undergoing an acute (24 h) and a chronic (4 weeks) cold exposure (12 °C). We predicted that control birds should present at least a transient elevation of oxidative stress levels in response to cold exposure. This oxidative stress cost should be more pronounced in control birds than in DNP-treated birds, due to their lower basal uncoupling state. Despite similar increase in metabolism, control birds presented elevated levels of DNA oxidative damage in response to acute (but not chronic) cold exposure, while DNP-treated birds did not. Plasma antioxidant capacity decreased overall in response to chronic cold exposure. These results show that acute cold exposure increases oxidative stress in birds. However, uncoupling mitochondrial functioning appears as a putative compensatory mechanism preventing cold-induced oxidative stress. This result confirms previous observations in mice and underlines non-shivering thermogenesis as a putative key mechanism for endotherms in mounting a response to cold at a low oxidative cost.

  12. Acute and chronic cardiovascular effects of hyperkalemia: new insights into prevention and clinical management.

    PubMed

    McCullough, Peter A; Beaver, Thomas M; Bennett-Guerrero, Elliott; Emmett, Michael; Fonarow, Gregg C; Goyal, Abhinav; Herzog, Charles A; Kosiborod, Mikhail; Palmer, Biff F

    2014-01-01

    The plasma pool of potassium is a partial reflection of the overall body, transient cellular shifts, and potassium elimination regulated by the kidneys. Potassium concentrations elevating above the upper limit of normal (> 5.0 mEq/L) have become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad applications of drugs that modulate potassium excretion by either reducing production of angiotensin II (angiotensin-converting enzyme inhibitors, direct renin inhibitors, beta-adrenergic receptor antagonists), blocking angiotensin II receptors (angiotensin receptor blockers), or antagonizing the action of aldosterone on mineralocorticoid receptors (mineralocorticoid receptor antagonists). In addition, acute kidney injury, critical illness, crush injuries, and massive red blood cell transfusions can result in hyperkalemia. Progressively more severe elevations in potassium are responsible for abnormalities in cardiac depolarization and repolarization and contractility. Untreated severe hyperkalemia results in sudden cardiac death. Traditional management steps have included reducing dietary potassium and discontinuing potassium supplements; withdrawal of exacerbating drugs; acute treatment with intravenous calcium gluconate, insulin, and glucose; nebulized albuterol; correction of acidosis with sodium bicarbonate for short-term shifts out of the plasma pool; and, finally, gastrointestinal ion exchange with oral sodium polystyrene sulfonate in sorbitol, which is mainly used in the hospital and is poorly tolerated due to gastrointestinal adverse effects. This review explores hyperkalemia as a complication in cardiovascular patients and highlights new acute, chronic, and preventative oral therapies (patiromer calcium, cross-linked polyelectrolyte, ZS-9) that could potentially create a greater margin of safety for vulnerable patients with combined heart and kidney disease.

  13. Preventive use of Lactobacillus plantarum LS/07 and inulin to relieve symptoms of acute colitis.

    PubMed

    Hijová, Emília; Šoltésová, Alena; Salaj, Rastislav; Kuzma, Jozef; Strojný, Ladislav; Bomba, Alojz; Gregová, Kristína

    2015-01-01

    The aim of presented study was to investigate the influence of Lactobacillus plantarum LS/07 and inulin on the activity of β-glucuronidase enzyme, and counts of coliform and lactobacilli in fresh caecal digesta, cytokine levels (IL-6, IL-8), and trancription nuclear factor kappa beta (NFκB) activities in colon tissue and blood samples of rats with dextran sulphate sodium (DSS) induced acute colitis. The rats were randomly divided into four groups - CG, AC, AC+PRE and AC+PRO. Colitis was induced using of 5% DSS in drinking water for 7d. DSS application increased activity of β-glucuronidase (P < 0.001), increased counts of coliforms, and decreased lactobacilli counts (P < 0.05) in comparison to control group. Serum and tissue levels of IL-6 and IL-8 as well as tissue NFκB activities showed increased expression in acute colitis group. Inulin diet modified counts of microorganims and decreased β-glucuronidase activity, suppressed NFκB activities (P < 0.001) and down regulate synthesis of IL-6 (P < 0.01) in serum and colon tissue and tissue IL-8 (P < 0.05). Lactobacillus plantarum LS/07 decreased β-glucuronidase activity (P < 0.05), levels of IL-6 and IL-8 (P < 0.001). These results were consistent with the addition of histological findings. Our results indicate that dietary intake of Lactobacillus plantarum LS/07 and inulin suppressed expression observed markers, which play an important role in the inflammatory process, which predisposes their use in prevention or treatment of acute colitis.

  14. Blockade of the renin-angiotensin system prevents acute and immunologically relevant colitis in murine models.

    PubMed

    Okawada, Manabu; Wilson, Michael W; Larsen, Scott D; Lipka, Elke; Hillfinger, John; Teitelbaum, Daniel H

    2016-12-01

    Blockade of the renin-angiotensin system (RAS) has been shown to alleviate inflammatory processes in the gastrointestinal tract. The aim of this study was to determine if blockade of the RAS would be effective in an immunologically relevant colitis model, and to compare outcome with an acute colitis model. A losartan analog, CCG-203025 (C23H26ClN3O5S) containing a highly polar sulfonic acid moiety that we expected would allow localized mucosal antagonism with minimal systemic absorption was selected as an angiotensin II type 1a receptor antagonist (AT1aR-A). Two colitis models were studied: (1) Acute colitis was induced in 8- to 10-week-old C57BL/6J mice by 2.5 % dextran sodium sulfate (DSS, in drinking water) for 7 days. (2) IL10-/-colitis Piroxicam (200 ppm) was administered orally in feed to 5-week-old IL-10-/-mice (C57BL/6J background) for 14 days followed by enalaprilat (ACE-I), CCG-203025 or PBS administered transanally for 14 days. In the DSS model, weight loss and histologic score for CCG-203025 were better than with placebo. In the IL10-/-model, ACE-I suppressed histologic damage better than CCG-203025. Both ACE-I and CCG-203025 reduced pro-inflammatory cytokines and chemokines. This study demonstrated the therapeutic efficacy of both ACE-I and AT1aR-A for preventing the development of both acute and immunologically relevant colitis.

  15. Flaxseed lignans enriched in secoisolariciresinol diglucoside prevent acute asbestos-induced peritoneal inflammation in mice

    PubMed Central

    Pietrofesa, Ralph A.; Velalopoulou, Anastasia; Arguiri, Evguenia; Menges, Craig W.; Testa, Joseph R.; Hwang, Wei-Ting; Albelda, Steven M.

    2016-01-01

    Malignant mesothelioma (MM), linked to asbestos exposure, is a highly lethal form of thoracic cancer with a long latency period, high mortality and poor treatment options. Chronic inflammation and oxidative tissue damage caused by asbestos fibers are linked to MM development. Flaxseed lignans, enriched in secoisolariciresinol diglucoside (SDG), have antioxidant, anti-inflammatory and cancer chemopreventive properties. As a prelude to chronic chemoprevention studies for MM development, we tested the ability of flaxseed lignan component (FLC) to prevent acute asbestos-induced inflammation in MM-prone Nf2+/mu mice. Mice (n = 16–17 per group) were placed on control (CTL) or FLC-supplemented diets initiated 7 days prior to a single intraperitoneal bolus of 400 µg of crocidolite asbestos. Three days post asbestos exposure, mice were evaluated for abdominal inflammation, proinflammatory/profibrogenic cytokine release, WBC gene expression changes and oxidative and nitrosative stress in peritoneal lavage fluid (PLF). Asbestos-exposed mice fed CTL diet developed acute inflammation, with significant (P < 0.0001) elevations in WBCs and proinflammatory/profibrogenic cytokines (IL-1ß, IL-6, TNFα, HMGB1 and active TGFß1) relative to baseline (BL) levels. Alternatively, asbestos-exposed FLC-fed mice had a significant (P < 0.0001) decrease in PLF WBCs and proinflammatory/profibrogenic cytokine levels relative to CTL-fed mice. Importantly, PLF WBC gene expression of cytokines (IL-1ß, IL-6, TNFα, HMGB1 and TGFß1) and cytokine receptors (TNFαR1 and TGFßR1) were also downregulated by FLC. FLC also significantly (P < 0.0001) blunted asbestos-induced nitrosative and oxidative stress. FLC reduces acute asbestos-induced peritoneal inflammation, nitrosative and oxidative stress and may thus prove to be a promising agent in the chemoprevention of MM. PMID:26678224

  16. Flaxseed lignans enriched in secoisolariciresinol diglucoside prevent acute asbestos-induced peritoneal inflammation in mice.

    PubMed

    Pietrofesa, Ralph A; Velalopoulou, Anastasia; Arguiri, Evguenia; Menges, Craig W; Testa, Joseph R; Hwang, Wei-Ting; Albelda, Steven M; Christofidou-Solomidou, Melpo

    2016-02-01

    Malignant mesothelioma (MM), linked to asbestos exposure, is a highly lethal form of thoracic cancer with a long latency period, high mortality and poor treatment options. Chronic inflammation and oxidative tissue damage caused by asbestos fibers are linked to MM development. Flaxseed lignans, enriched in secoisolariciresinol diglucoside (SDG), have antioxidant, anti-inflammatory and cancer chemopreventive properties. As a prelude to chronic chemoprevention studies for MM development, we tested the ability of flaxseed lignan component (FLC) to prevent acute asbestos-induced inflammation in MM-prone Nf2(+/mu) mice. Mice (n = 16-17 per group) were placed on control (CTL) or FLC-supplemented diets initiated 7 days prior to a single intraperitoneal bolus of 400 µg of crocidolite asbestos. Three days post asbestos exposure, mice were evaluated for abdominal inflammation, proinflammatory/profibrogenic cytokine release, WBC gene expression changes and oxidative and nitrosative stress in peritoneal lavage fluid (PLF). Asbestos-exposed mice fed CTL diet developed acute inflammation, with significant (P < 0.0001) elevations in WBCs and proinflammatory/profibrogenic cytokines (IL-1ß, IL-6, TNFα, HMGB1 and active TGFß1) relative to baseline (BL) levels. Alternatively, asbestos-exposed FLC-fed mice had a significant (P < 0.0001) decrease in PLF WBCs and proinflammatory/profibrogenic cytokine levels relative to CTL-fed mice. Importantly, PLF WBC gene expression of cytokines (IL-1ß, IL-6, TNFα, HMGB1 and TGFß1) and cytokine receptors (TNFαR1 and TGFßR1) were also downregulated by FLC. FLC also significantly (P < 0.0001) blunted asbestos-induced nitrosative and oxidative stress. FLC reduces acute asbestos-induced peritoneal inflammation, nitrosative and oxidative stress and may thus prove to be a promising agent in the chemoprevention of MM.

  17. Alginate Oligosaccharide Prevents Acute Doxorubicin Cardiotoxicity by Suppressing Oxidative Stress and Endoplasmic Reticulum-Mediated Apoptosis.

    PubMed

    Guo, Jun-Jie; Ma, Lei-Lei; Shi, Hong-Tao; Zhu, Jian-Bing; Wu, Jian; Ding, Zhi-Wen; An, Yi; Zou, Yun-Zeng; Ge, Jun-Bo

    2016-12-20

    Doxorubicin (DOX) is a highly potent chemotherapeutic agent, but its usage is limited by dose-dependent cardiotoxicity. DOX-induced cardiotoxicity involves increased oxidative stress and activated endoplasmic reticulum-mediated apoptosis. Alginate oligosaccharide (AOS) is a non-immunogenic, non-toxic and biodegradable polymer, with anti-oxidative, anti-inflammatory and anti-endoplasmic reticulum stress properties. The present study examined whether AOS pretreatment could protect against acute DOX cardiotoxicity, and the underlying mechanisms focused on oxidative stress and endoplasmic reticulum-mediated apoptosis. We found that AOS pretreatment markedly increased the survival rate of mice insulted with DOX, improved DOX-induced cardiac dysfunction and attenuated DOX-induced myocardial apoptosis. AOS pretreatment mitigated DOX-induced cardiac oxidative stress, as shown by the decreased expressions of gp91 (phox) and 4-hydroxynonenal (4-HNE). Moreover, AOS pretreatment significantly decreased the expression of Caspase-12, C/EBP homologous protein (CHOP) (markers for endoplasmic reticulum-mediated apoptosis) and Bax (a downstream molecule of CHOP), while up-regulating the expression of anti-apoptotic protein Bcl-2. Taken together, these findings identify AOS as a potent compound that prevents acute DOX cardiotoxicity, at least in part, by suppression of oxidative stress and endoplasmic reticulum-mediated apoptosis.

  18. Propagation prevention: a complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome.

    PubMed

    Marini, John J; Gattinoni, Luciano

    2008-12-01

    To describe the clinical implications of an often neglected mechanism through which localized acute lung injury may be propagated and intensified. Experimental and clinical evidence from the medical literature relevant to the airway propagation hypothesis and its consequences. The diffuse injury that characterizes acute respiratory distress syndrome is often considered a process that begins synchronously throughout the lung, mediated by inhaled or blood-borne noxious agents. Relatively little attention has been paid to possibility that inflammatory lung injury may also begin focally and propagate sequentially via the airway network, proceeding mouth-ward from distal to proximal. Were this true, modifications of ventilatory pattern and position aimed at geographic containment of the injury process could help prevent its generalization and limit disease severity. The purposes of this communication are to call attention to this seldom considered mechanism for extending lung injury that might further justify implementation of low tidal volume/high positive end-expiratory pressure ventilatory strategies for lung protection and to suggest additional therapeutic measures implied by this broadened conceptual paradigm.

  19. Moderate acute malnutrition: uncovering the known and unknown for more effective prevention and treatment.

    PubMed

    Wegner, Christopher William; Loechl, Cornelia; Mokhtar, Najat

    2015-03-01

    With a fast-approaching post-Millennium Development Goal era, there is an urgent need to boost global investment in efforts to reduce child malnutrition. Critical to the management of moderate malnutrition, and therefore to the new Sustainable Development Goals, is addressing severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Despite the considerable difference in the approximate number of children affected by MAM (33 million) compared with SAM (19 million), there is currently no standardized approach to the management of MAM. In partnership with Valid International, the World Food Programme, and the Micronutrient Initiative, the International Atomic Energy Agency hosted the International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions in Vienna, Austria, 26-29 May 2014. This symposium focused on the management (prevention and treatment) of MAM in children. The symposium convened over 350 participants from 63 countries, the majority of whom represented governments responding to moderate malnutrition in their populations, nearly 70 national and international organizations from the United Nations and nongovernmental sectors, and universities from around the world, as well as donor governments and private-sector entities. The symposium was structured around nine sessions over a 3-day period, progressing from a global analysis of the scale of the problem to recent research findings relevant to designing effective interventions. This Supplement contains a series of papers that summarize the symposium sessions and other fundamental aspects important to improving the management of moderate malnutrition in children.

  20. An acute post-rape intervention to prevent substance use and abuse.

    PubMed

    Acierno, Ron; Resnick, Heidi S; Flood, Amanda; Holmes, Melisa

    2003-12-01

    The trauma of rape is routinely associated with extreme acute distress. Such peri-event anxiety increases risk of developing psychopathology and substance use or abuse post-rape, with the degree of initial distress positively predicting future problems. Unfortunately, the nature of post-rape forensic evidence collection procedures may exacerbate initial distress, thereby potentiating post-rape negative emotional sequelae. Consequently, substance use may increase in an effort to ameliorate this distress. To address this, a two-part video intervention was developed for use in acute post-rape time frames to (a) minimize anxiety during forensic rape examinations, thereby reducing risk of future emotional problems, and (b) prevent increased post-rape substance use and abuse. Pilot study data with 124 rape victims indicated that the low-cost, easily administered intervention was effective in reducing risk of marijuana abuse at 6 weeks. Nonstatistically significant trends also were evident for reduced marijuana use. Trends were also noted in favor of the intervention in the subgroup of women who were actively using substances pre-rape (among pre-rape alcohol users, 28% viewers vs. 43% nonviewers met criteria for post-rape alcohol abuse; among pre-rape marijuana users, the rates of post-marijuana use were 17% vs. 43%).

  1. [Effects of controlling specific dangerous pesticides on prevention of acute pesticide poisoning in rural area].

    PubMed

    Zhang, Ping; Zhao, Jiang-xia; Chang, Xiu-li; Zhou, Zhi-jun

    2010-09-01

    To investigate the effects of controlling the specific dangerous pesticides on prevention of acute pesticide poisoning in rural area. The data of reported cases of pesticide poisoning were analyzed to find out the specific dangerous pesticide in acute pesticide poisoning. Then the occurrence of occupational pesticide poisoning and fatality of non-occupational pesticide poisoning were estimated under the hypothesis of removing the specific dangerous pesticides. The data indicated that parathion (including methyl parathion) was the specific dangerous pesticide inducing occupational pesticide poisoning. After removing the use of parathion, the hazard of pesticides which caused occupational pesticide poisoning would be significantly decreased (P < 0.01). Parathion was also the most dangerous pesticide which caused non-occupational pesticide poisoning, with its fatality up to 15.8%. If parathion was well controlled, the fatality of non-occupational pesticide poisoning would be declined from 9.4% to 7.4%. The analyses of related literatures also revealed the similar results. The occurrence of occupational pesticide poisoning and fatality of non-occupational pesticide poisoning may decrease if the most dangerous pesticides are well supervised.

  2. Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review.

    PubMed

    Yilmaz, T; Cordero-Coma, M; Gallagher, M J

    2012-02-01

    To assess the effectiveness of ketorolac vs control for prevention of acute pseudophakic cystoid macular edema (CME). The following databases were searched: Medline (1950-June 11, 2011), The Cochrane Library (Issue 2, 2011), and the TRIP Database (up to 11 June 2011), using no language or other limits. Randomized controlled clinical trials (RCTs) were included that consisted of patients with acute pseudophakic cystoid macular edema, those comparing ketorolac with control, and those having at least a minimum follow-up of 28 days. In the four RCTs evaluating ketorolac vs control, treatment with ketorolac significantly reduced the risk of CME development at the end of treatment (≈ 4 weeks) compared to control (P=0.008; 95% confidence interval (0.03-0.58)). When analyzed individually, each individual study was statistically nonsignificant in its findings with the exception of one study. When the pooled relative risk was calculated, the large sample size of this systematic review led to overall statistical significance, which is attributable to the review's large sample size and not to the individual studies themselves. In this systematic review of four RCTs, two of which compared ketorolac with no treatment and two of which evaluated ketorolac vs placebo drops, treatment with ketorolac significantly reduced the risk of developing CME at the end of ≈ 4 weeks of treatment compared with controls. These results, however, should be interpreted with caution considering the paucity of large randomized clinical trials in the literature.

  3. Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review

    PubMed Central

    Yilmaz, T; Cordero-Coma, M; Gallagher, M J

    2012-01-01

    To assess the effectiveness of ketorolac vs control for prevention of acute pseudophakic cystoid macular edema (CME). The following databases were searched: Medline (1950–June 11, 2011), The Cochrane Library (Issue 2, 2011), and the TRIP Database (up to 11 June 2011), using no language or other limits. Randomized controlled clinical trials (RCTs) were included that consisted of patients with acute pseudophakic cystoid macular edema, those comparing ketorolac with control, and those having at least a minimum follow-up of 28 days. In the four RCTs evaluating ketorolac vs control, treatment with ketorolac significantly reduced the risk of CME development at the end of treatment (∼4 weeks) compared to control (P=0.008; 95% confidence interval (0.03–0.58)). When analyzed individually, each individual study was statistically nonsignificant in its findings with the exception of one study. When the pooled relative risk was calculated, the large sample size of this systematic review led to overall statistical significance, which is attributable to the review's large sample size and not to the individual studies themselves. In this systematic review of four RCTs, two of which compared ketorolac with no treatment and two of which evaluated ketorolac vs placebo drops, treatment with ketorolac significantly reduced the risk of developing CME at the end of ∼4 weeks of treatment compared with controls. These results, however, should be interpreted with caution considering the paucity of large randomized clinical trials in the literature. PMID:22094296

  4. Alginate Oligosaccharide Prevents Acute Doxorubicin Cardiotoxicity by Suppressing Oxidative Stress and Endoplasmic Reticulum-Mediated Apoptosis

    PubMed Central

    Guo, Jun-Jie; Ma, Lei-Lei; Shi, Hong-Tao; Zhu, Jian-Bing; Wu, Jian; Ding, Zhi-Wen; An, Yi; Zou, Yun-Zeng; Ge, Jun-Bo

    2016-01-01

    Doxorubicin (DOX) is a highly potent chemotherapeutic agent, but its usage is limited by dose-dependent cardiotoxicity. DOX-induced cardiotoxicity involves increased oxidative stress and activated endoplasmic reticulum-mediated apoptosis. Alginate oligosaccharide (AOS) is a non-immunogenic, non-toxic and biodegradable polymer, with anti-oxidative, anti-inflammatory and anti-endoplasmic reticulum stress properties. The present study examined whether AOS pretreatment could protect against acute DOX cardiotoxicity, and the underlying mechanisms focused on oxidative stress and endoplasmic reticulum-mediated apoptosis. We found that AOS pretreatment markedly increased the survival rate of mice insulted with DOX, improved DOX-induced cardiac dysfunction and attenuated DOX-induced myocardial apoptosis. AOS pretreatment mitigated DOX-induced cardiac oxidative stress, as shown by the decreased expressions of gp91 (phox) and 4-hydroxynonenal (4-HNE). Moreover, AOS pretreatment significantly decreased the expression of Caspase-12, C/EBP homologous protein (CHOP) (markers for endoplasmic reticulum-mediated apoptosis) and Bax (a downstream molecule of CHOP), while up-regulating the expression of anti-apoptotic protein Bcl-2. Taken together, these findings identify AOS as a potent compound that prevents acute DOX cardiotoxicity, at least in part, by suppression of oxidative stress and endoplasmic reticulum-mediated apoptosis. PMID:27999379

  5. Acute care surgery: trauma, critical care, emergency general surgery … and preventative health?

    PubMed

    Hambright, Greg; Agrawal, Vaidehi; Sladek, Phillip L; Slonim, Suzanne M; Truitt, Michael S

    2016-11-01

    Acute care surgeons (ACS) often care for patients with limited access to health care. They may not participate in preventative screenings and interventions (PSIs) such as mammography, colonoscopy, or pneumococcal vaccinations (VAs). We sought to identify barriers to compliance and determine if ACS have an opportunity to facilitate PSI participation. All patients evaluated by an ACS were considered for inclusion in the study. Patients meeting national PSI inclusion criteria were enrolled. Surveys were administered to assess compliance and identify barriers to participation. The overall compliance rate with PSIs was 57%. Patients without a primary care physician had a compliance rate of 23%. The most common barrier to participation was lack of knowledge of PSI recommendations (42%). Males were less compliant than females (47% vs 62%). ACS evaluate a large number of general surgery and trauma patients. The acute care surgeon-patient encounter represents a valuable opportunity for education and improved PSI compliance. Additional research should focus on developing interventional strategies and evaluating their impact on patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. How to compare the efficacy of conjugate vaccines to prevent acute otitis media?

    PubMed

    De Wals, Philippe; Erickson, Lonny; Poirier, Béatrice; Pépin, Jacques; Pichichero, Michael E

    2009-05-11

    Although the currently available 7-valent pneumococcal conjugate vaccine (PCV7-CRM(197)) has been primarily designed for the prevention of invasive pneumococcal disease, it has also demonstrated the potential to prevent acute otitis media (AOM) and its associated complications. A candidate 11-valent pneumococcal conjugate vaccine (PCV11-HiD), which utilizes Haemophilus influenzae (Hi)-derived protein D as a carrier has demonstrated the ability to prevent AOM caused by not only vaccine serotypes of Streptococcus pneumoniae (Sp), but also those caused by Hi. The methodological, clinical, and epidemiological factors influencing results of vaccine trials for AOM prevention were reviewed and a model-based approach was developed, in order to assess the relative efficacy of different vaccine formulations. Six randomized trials having AOM as a measured outcome were identified. Vaccine efficacy (VE) ranged from -1% to 34% for all-cause AOM and between 56% and 64% for AOM caused by vaccine-type Sp. Using otopathogen-specific VE rates from the FinOM and POET trials and otopathogen distributions observed in three relatively unbiased studies, VE against all-cause AOM episodes under different scenarios was modeled. The most important factor explaining variation in VE estimates was bacterial replacement, which was present in the PCV7-CRM(197) FinOM study but not in the PCV11-HiD POET study. Another contributing factor was increased protection conferred against Hi AOM by protein D. Geographical variation in the distribution of otopathogens was a third factor explaining differences between trials. More studies on the current aetiology of AOM need to be performed to accurately predict the marginal benefit of a switch from PCV7-CRM(197) to the newly licensed PCV10-HiD-DiT or to the future PCV13-CRM(197).

  7. Long-term outcomes and secondary prevention after acute coronary events in patients with rheumatoid arthritis.

    PubMed

    Mantel, Ängla; Holmqvist, Marie; Jernberg, Tomas; Wållberg-Jonsson, Solveig; Askling, Johan

    2017-08-20

    Patients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS) and suffer from poorer short-term outcomes after ACS. The aims of this study were to assess long-term outcomes in patients with RA with ACS compared with non-RA patients with ACS, and to investigate whether the use of secondary preventive drugs could explain any differences in ACS outcome. We performed a cohort study based on 1135 patients with RA and 3184 non-RA patients who all developed an incident ACS between 2007 and 2010. We assessed 1-year and overall relative risks for ACS recurrence and mortality, as well as prescriptions of standard of care secondary preventive drugs. The risk of ACS recurrence, and of mortality, was increased in RA, both at 1 year after adjusting for baseline comorbidities (HR=1.30(95% CI 1.04 to 1.62) and 1.38(95% CI 1.20 to 1.59), respectively) and throughout the complete (mean 2 years) follow-up (HR=1.27(95% CI 1.06 to 1.52) and 1.50(95% CI 1.34 to 1.68), respectively). Among certain subgroups of ACS, there was a tendency of lower usage of statins, whereas there were no apparent differences in others. The increased rates of ACS recurrence and mortality remained in subgroup analyses of individuals whose prescription pattern indicated both adequate initiation and persistence to secondary preventive treatments. Patients with RA suffer from an increased risk of ACS recurrence and of death following ACS compared with general population, which in the present study could not readily be explained by differences in usage of secondary preventive drugs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. [Prevention and Treatment of Common Acute Adverse Effects With Antipsychotic Use in Adults With Schizophrenia Diagnosis].

    PubMed

    Arenas Borrero, Álvaro Enrique; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Vélez Traslaviña, Ángela; Castro Díaz, Sergio Mario; Jaramillo González, Luis Eduardo; García Valencia, Jenny

    2014-01-01

    To determine the most adequate strategies for the prevention and treatment of the acute adverse effects of the use of antipsychotics. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. A systematic literature search was carried out. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The non-pharmacological interventions such as nutritional counseling by a nutritionist, exercise and psychotherapy are effective in preventing weight gain with the use of antipsychotics. (Kg Weight reduction in DM of -3.05 (-4.16, -1.94)). The antipsychotic change from olanzapine to aripiprazole showed weight loss and decreased BMI (decreased weight in KG DM -3.21 (-9.03, -2.61). The use of beta blockers was ineffective in reducing akathisia induced by antipsychotic; using as outcome the 50% reduction of symptoms of akathisia comparing beta-blockers with placebo RR was 1.4 (0.59, 1.83). It is recommended to make psychotherapeutic accompaniment and nutrition management of overweight for patients with weight gain. If these alternatives are ineffective is suggested to change the antipsychotic or consider starting metformin. For the management of drug-induced akathisia it is recommended to decrease the dose of the drug and the addition of lorazepam. It is recommended using 5mg biperiden IM or trihexyphenidyl 5mg orally in case of secondary acute dystonia and for the treatment of antipsychotic-induced parkinsonism to decrease the dose of antipsychotic or consider using 2 - 4mg/day of biperiden or diphenhydramine 50mg once daily. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  9. Supplemental vitamin A prevents the acute radiation-induced defect in wound healing

    SciTech Connect

    Levenson, S.M.; Gruber, C.A.; Rettura, G.; Gruber, D.K.; Demetriou, A.A.; Seifter, E.

    1984-10-01

    Acute radiation injury leads to thymic involution, adrenal enlargement, leukopenia, thrombocytopenia, gastrointestinal ulceration, and impaired wound healing. The authors hypothesized that supplemental vitamin A would mitigate these adverse effects in rats exposed to acute whole-body radiation. To test their hypothesis, dorsal skin incisions and subcutaneous implantation of polyvinyl alcohol sponges were performed in anesthetized Sprague-Dawley rats at varying times following sham radiation or varying doses of whole-body radiation (175-850 rad). In each experiment, the control diet (which contains about 18,000 IU vit. A/kg chow (3 X the NRC RDA for normal rats)) was supplemented with 150,000 IU vit. A/kg diet beginning at, before, or after sham radiation and wounding or radiation and wounding. The supplemental vitamin A prevented the impaired wound healing and lessened the weight loss, leukopenia, thrombocytopenia, thymic involution, adrenal enlargement, decrease in splenic weight, and gastric ulceration of the radiated (750-850 rad) wounded rats. This was true whether the supplemental vitamin A was begun before (2 or 4 days) or after (1-2 hours to 4 days) radiation and wounding; the supplemental vitamin A was more effective when started before or up to 2 days after radiation and wounding. The authors believe that prevention of the impaired wound healing following radiation by supplemental vitamin A is due to its enhancing the early inflammatory reaction to wounding, including increasing the number of monocytes and macrophages at the wound site; possible effect on modulating collagenase activity; effect on epithelial cell (and possible mesenchymal cell) differentiation; stimulation of immune responsiveness; and lessening of the adverse effects of radiation.

  10. Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention.

    PubMed

    Louh, Irene K; Greendyke, William G; Hermann, Emilia A; Davidson, Karina W; Falzon, Louise; Vawdrey, David K; Shaffer, Jonathan A; Calfee, David P; Furuya, E Yoko; Ting, Henry H

    2017-04-01

    OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. INTERVENTIONS We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. RESULTS Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates. CONCLUSIONS Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates. Infect Control Hosp Epidemiol 2017;38:476-482.

  11. Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study.

    PubMed

    Mathews, Robin; Wang, Tracy Y; Honeycutt, Emily; Henry, Timothy D; Zettler, Marjorie; Chang, Michael; Fonarow, Gregg C; Peterson, Eric D

    2015-07-01

    Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes. Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence. Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial.

    PubMed

    Petersen, Jesper; Thorborg, Kristian; Nielsen, Michael Bachmann; Budtz-Jørgensen, Esben; Hölmich, Per

    2011-11-01

    The incidence of acute hamstring injuries is high in several sports, including the different forms of football. The authors investigated the preventive effect of eccentric strengthening of the hamstring muscles using the Nordic hamstring exercise compared with no additional hamstring exercise on the rate of acute hamstring injuries in male soccer players. Randomized controlled trial; Level of evidence, 1. Fifty Danish male professional and amateur soccer teams (942 players) were allocated to an intervention group (461 players) or a control group (481 players). Players in the intervention group conducted a 10-week progressive eccentric training program followed by a weekly seasonal program, whereas players in the control group followed their usual training program. The main outcome measures were numbers of overall, new, and recurrent acute hamstring injuries during 1 full soccer season. Fifty-two acute hamstring injuries in the control group compared with 15 injuries in the intervention group were registered. Comparing intervention versus the control group, overall acute hamstring injury rates per 100 player seasons were 3.8 versus 13.1 (adjusted rate ratio [RR], 0.293; 95% confidence interval [CI], 0.150-0.572; P < .001). New injury rates per 100 player seasons were 3.1 versus 8.1 (RR, 0.410; 95% CI, 0.180-0.933; P = .034), whereas recurrent injury rates per 100 player seasons were 7.1 versus 45.8 (RR, 0.137; 95% CI, 0.037-0.509; P = .003). Number needed to treat [NNT] to prevent 1 acute hamstring injury (new or recurrent) is 13 (95% CI, 9-23) players. The NNT to prevent 1 new injury is 25 (95% CI, 15-72) players, and NNT to prevent 1 recurrent injury is 3 (95% CI, 2-6) players. IN male professional and amateur soccer players, additional eccentric hamstring exercise decreased the rate of overall, new, and recurrent acute hamstring injuries.

  13. Rheumatoid arthritis patients receive less frequent acute reperfusion and secondary prevention therapy after myocardial infarction compared with the general population

    PubMed Central

    2010-01-01

    Introduction The 30-day case-fatality rate after acute myocardial infarction (MI) for rheumatoid arthritis (RA) patients is twice that of the general population. This study compared the frequency and timeliness of early reperfusion therapy and treatment with secondary prevention medications after acute MI in RA patients and controls. Methods We performed a structured medical chart review of RA patients and matched controls who had been admitted with acute MI to one of three hospitals in Victoria, Australia, between 1995 and 2005. The administration and timing of acute reperfusion therapy and in-hospital treatment with secondary prevention medications were compared between the two groups. Acute reperfusion was defined as thrombolysis or percutaneous coronary intervention (PCI) within 12 hours of the first symptom of MI. Results The medical charts of 90 RA patients and 90 matched controls were reviewed. The RA patients were significantly less likely to receive acute reperfusion compared with the controls (16% versus 37%: odds ratio (OR), 0.27; 95% confidence interval (CI), 0.10 to 0.64)), and this difference persisted after adjusting for type of MI, clinical setting of MI, and prior MI (OR, 0.2; 95% CI, 0.05 to 0.6). The RA patients also received less-frequent in-hospital treatment with beta blockers (71% versus 83%; OR, 0.42; 95% CI, 0.18 to 0.96) and lipid-lowering agents (40% versus 70%; OR, 0.21; 95% CI, 0.09 to 0.46). Conclusions RA patients who experience acute MI receive acute reperfusion and secondary prevention medications less frequently than do controls. This may contribute to higher case-fatality rates after MI in RA patients. PMID:20929534

  14. Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery

    PubMed Central

    Na, Hyo-Seok; Oh, Ah-Young; Koo, Bon-Wook; Lim, Dae-Jin; Ryu, Jung-Hee; Han, Ji-Won

    2016-01-01

    Abstract Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain. Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated. The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04). Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery. PMID:27196485

  15. Acute ethanol treatment prevents endocannabinoid-mediated long-lasting disinhibition of striatal output.

    PubMed

    Clarke, Rhona B C; Adermark, Louise

    2010-01-01

    Recent research has suggested that the neuronal circuit adaptations elicited by drugs of abuse share common features with traditional learning models, and that drugs of abuse cause long-term changes in behavior by altering synaptic function and plasticity. Especially, the endocannabinoid (eCB) system appears to be involved in the neuronal circuitry regulating ethanol (EtOH) preference in rodent. The aim of this study was to evaluate if acute EtOH exposure could modulate eCB-mediated plasticity in the dorsolateral striatum. Our data show that EtOH (20-50 mM) prevents eCB-mediated long-lasting disinhibition (DLL) of striatal output induced by a single stimulation train delivered at 5 Hz for 60 s, and reduces long-term depression (LTD) induced by low-frequency stimulation at inhibitory synapses. Acute EtOH-treatment also prevents DLL induced by the L-type calcium channel activator 2,5-dimethyl-4-[2-(phenylmethyl)benzoyl]-1H-pyrrole-3-carboxylic acid methylester (FPL64176; 500 nM), or by the cannabinoid 1 receptor (CB(1)R) agonist WIN55,212-2 (300 nM), indicating that EtOH affects eCB-signaling at a stage that is downstream from eCB production and release. Importantly, high-frequency stimulation, or a higher concentration of WIN55,212-2 (1 muM), induces EtOH-insensitive depression of striatal output, suggesting that EtOH affects CB(1)R-mediated signaling in a synapse-specific manner. Maintaining the balance between excitation and inhibition is vital for neuronal networks, and EtOH-mediated modulation of eCB-signaling might thus affect the stability and the fine-tuning of neuronal circuits in the striatum. Our data suggest that changes in eCB-signaling could be involved in the physiological response to acute alcohol intoxication. Copyright 2009 Elsevier Ltd. All rights reserved.

  16. Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases.

    PubMed

    Bellet, P S; Kalinyak, K A; Shukla, R; Gelfand, M J; Rucknagel, D L

    1995-09-14

    prevent the pulmonary complications (atelectasis and infiltrates) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm.

  17. Pharmacological Modulation of Acute Trauma Memories to Prevent PTSD: Considerations from a Developmental Perspective

    PubMed Central

    Hruska, Bryce; Cullen, Patrick K.; Delahanty, Douglas L.

    2014-01-01

    Estimates of the lifetime prevalence of posttraumatic stress disorder (PTSD) in American adults range from 6.4–6.8%. PTSD is associated with increased risk for comorbid major depression, substance use disorder, suicide, and a variety of other mental and physical health conditions. Given the negative sequelae of trauma/PTSD, research has focused on identifying efficacious interventions that could be administered soon after a traumatic event to prevent or reduce the subsequent incidence of PTSD. While early psychosocial interventions have been shown to be relatively ineffective, early (secondary) pharmacological interventions have shown promise. These pharmacological approaches are largely based on the hypothesis that disruption of altered stress hormone levels and the consequent formation of trauma memories could protect against the development of PTSD. The present manuscript reviews the literature regarding the role of peri-traumatic stress hormones as risk factors for the development of PTSD and reviews evidence for the efficacy of exogenously modulating stress hormone levels to prevent/buffer the development of PTSD symptoms. Whereas prior literature has focused primarily on either child or adult studies, the present review incorporates both child and adult studies in a developmental approach to understanding risk for PTSD and how pharmacological modulation of acute memories may buffer the development of PTSD symptoms. PMID:24513176

  18. Acute Administration of Diazepam Provokes Redox Homeostasis Imbalance in the Rat Brain: Prevention by Simvastatin.

    PubMed

    Eger, Guilherme André; Ferreira, Vinícius Vialle; Batista, Camila Ribeiro; Bonde, Henrique LuisPetrek; de Lima, Daniela Delwing; Rodrigues, André Felipe; da Cruz, José Geraldo Pereira; Magro, Débora Delwing Dal

    2016-10-01

    We investigated the effects of acute diazepam (DZP) administration on thiobarbituric acid-reactive substance (TBARS) levels, protein carbonyl content, and on the activities of the antioxidant enzymes catalase, glutathione peroxidase, and superoxide dismutase in the brain of rats. Additionally, we investigated the antioxidant role of chronic pretreatment with simvastatin on the effects provoked by DZP. Simvastatin was administered (1 or 10 mg/kg by oral gavage) for 30 days. On the 30th day of treatment, groups were randomized and DZP was administered (0.5 or 1.0 mg/kg by intraperitoneal injection). Control groups received saline. Results showed that DZP enhanced TBARS levels and protein carbonyl content and altered enzymatic activity in the brain of rats. Simvastatin prevented most of the alterations caused by DZP on the oxidative stress parameters. Data indicate that DZP administration causes an oxidative imbalance in the brain areas studied; however, in the presence of simvastatin, some of these alterations in oxidative stress were prevented. © 2016 Wiley Periodicals, Inc.

  19. Xanthohumol prevents carbon tetrachloride-induced acute liver injury in rats.

    PubMed

    Pinto, Carmen; Duque, Antonio L; Rodríguez-Galdón, Beatriz; Cestero, Juan J; Macías, Pedro

    2012-10-01

    Xanthohumol (XN), a prenyl flavonoid present in beer, prevents the acute hepatic injury induced by carbon tetrachloride (CCl4) in rats. Pre-treatment of rats with XN significantly reduced the increased liver weight observed in CCl4-intoxicated rats, normalised the increased values of plasma lactate dehydrogenase, glutamate oxaloacetate transaminase and glutamate pyruvate transaminase activities and reduced the incidence of histopathological alterations produced by CCl4. The oxidative stress induced by CCl4 administration elicited a significant decrease in the levels of reduced glutathione as well as an increase in thiobarbituric acid reactive substances (TBARS) and H2O2 concentrations. Pre-treatment of rats with XN resulted in a significant (p<0.05) increase in reduced glutathione (GSH) content and a reduction in TBARS and H2O2 concentrations to their normal values. XN pre-treatment also prevented the significant reductions of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glutathione S-transferase activities observed in CCl4-treated rats compared to control animals. Our results suggest that the hepatoprotective effect of XN is based on its antioxidant properties as well as it being an efficient inhibitor of lipid peroxidation and a protector against the degradation of antioxidant enzymes induced by CCl4 intoxication.

  20. Prevention of the collapse of pial collaterals by remote ischemic perconditioning during acute ischemic stroke.

    PubMed

    Ma, Junqiang; Ma, Yonglie; Dong, Bin; Bandet, Mischa V; Shuaib, Ashfaq; Winship, Ian R

    2017-08-01

    Collateral circulation is a key variable determining prognosis and response to recanalization therapy during acute ischemic stroke. Remote ischemic perconditioning (RIPerC) involves inducing peripheral ischemia (typically in the limbs) during stroke and may reduce perfusion deficits and brain damage due to cerebral ischemia. In this study, we directly investigated pial collateral flow augmentation due to RIPerC during distal middle cerebral artery occlusion (MCAo) in rats. Blood flow through pial collaterals between the anterior cerebral artery (ACA) and the MCA was assessed in male Sprague Dawley rats using in vivo laser speckle contrast imaging (LSCI) and two photon laser scanning microscopy (TPLSM) during distal MCAo. LSCI and TPLSM revealed that RIPerC augmented collateral flow into distal MCA segments. Notably, while control rats exhibited an initial dilation followed by a progressive narrowing of pial arterioles 60 to 150-min post-MCAo (constricting to 80-90% of post-MCAo peak diameter), this constriction was prevented or reversed by RIPerC (such that vessel diameters increased to 105-110% of post-MCAo, pre-RIPerC diameter). RIPerC significantly reduced early ischemic damage measured 6 h after stroke onset. Thus, prevention of collateral collapse via RIPerC is neuroprotective and may facilitate other protective or recanalization therapies by improving blood flow in penumbral tissue.

  1. Shockwaves prevent from heart failure after acute myocardial ischaemia via RNA/protein complexes.

    PubMed

    Tepeköylü, Can; Primessnig, Uwe; Pölzl, Leo; Graber, Michael; Lobenwein, Daniela; Nägele, Felix; Kirchmair, Elke; Pechriggl, Elisabeth; Grimm, Michael; Holfeld, Johannes

    2017-04-01

    Shock wave treatment (SWT) was shown to induce regeneration of ischaemic myocardium via Toll-like receptor 3 (TLR3). The antimicrobial peptide LL37 gets released by mechanical stress and is known to form complexes with nucleic acids thus activating Toll-like receptors. We suggested that SWT in the acute setting prevents from the development of heart failure via RNA/protein release. Myocardial infarction in mice was induced followed by subsequent SWT. Heart function was assessed 4 weeks later via transthoracic echocardiography and pressure-volume measurements. Human umbilical vein endothelial cells (HUVECs) were treated with SWT in the presence of RNase and proteinase and analysed for proliferation, tube formation and LL37 expression. RNA release and uptake after SWT was evaluated. We found significantly improved cardiac function after SWT. SWT resulted in significantly higher numbers of capillaries and arterioles and less left ventricular fibrosis. Supernatants of treated cells activated TLR3 reporter cells. Analysis of the supernatant revealed increased RNA levels. The effect could not be abolished by pre-treatment of the supernatant with RNase, but only by a sequential digestion with proteinase and RNase hinting strongly towards the involvement of RNA/protein complexes. Indeed, LL37 expression as well as cellular RNA uptake were significantly increased after SWT. We show for the first time that SWT prevents from left ventricular remodelling and cardiac dysfunction via RNA/protein complex release and subsequent induction of angiogenesis. It might therefore develop a potent regenerative treatment alternative for ischaemic heart disease.

  2. Framework for preventing falls in acute hospitals using passive sensor enabled radio frequency identification technology.

    PubMed

    Visvanathan, Renuka; Ranasinghe, Damith C; Shinmoto Torres, Roberto L; Hill, Keith

    2012-01-01

    We describe a distributed architecture for a real-time falls prevention framework capable of providing a technological intervention to mitigate the risk of falls in acute hospitals through the development of an AmbIGeM (Ambient Intelligence Geritatric Management system). Our approach is based on using a battery free, wearable sensor enabled Radio Frequency Identification device. Unsupervised classification of high risk falls activities are used to facilitate an immediate response from caregivers by alerting them of the high risk activity, the particular patient, and their location. Early identification of high risk falls activities through a longitudinal and unsupervised setting in real-time allows the preventative intervention to be administered in a timely manner. Furthermore, real-time detection allows emergency protocols to be deployed immediately in the event of a fall. Finally, incidents of high risk activities are automatically documented to allow clinicians to customize and optimize the delivery of care to suit the needs of patients identified as being at most risk.

  3. Will Parents Participate in and Comply with Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?

    ERIC Educational Resources Information Center

    Danhauer, Jeffrey L.; Johnson, Carole E.; Baker, Jason A.; Ryu, Jung A.; Smith, Rachel A.; Umeda, Claire J.

    2015-01-01

    Purpose: Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen…

  4. Will Parents Participate in and Comply with Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?

    ERIC Educational Resources Information Center

    Danhauer, Jeffrey L.; Johnson, Carole E.; Baker, Jason A.; Ryu, Jung A.; Smith, Rachel A.; Umeda, Claire J.

    2015-01-01

    Purpose: Antiadhesive properties in xylitol, a natural sugar alcohol, can help prevent acute otitis media (AOM) in children by inhibiting harmful bacteria from colonizing and adhering to oral and nasopharyngeal areas and traveling to the Eustachian tube and middle ear. This study investigated parents' willingness to use and comply with a regimen…

  5. Dietary β-conglycinin prevents acute ethanol-induced fatty liver in mice.

    PubMed

    Ikaga, Reina; Li, Dongyang; Yamazaki, Tomomi

    2017-09-01

    Alcoholic fatty liver is the earliest stage of alcohol-induced liver disease leading to liver cirrhosis. β-Conglycinin, one of the soy proteins, is known to prevent non-alcoholic fatty liver, hyperlipidemia and obesity. Therefore, we examined whether β-conglycinin feeding has an effect on the prevention of acute ethanol-induced fatty liver in mice. Male C57BL/6J mice were fed with 20 energy% β-conglycinin or casein for 4 weeks prior to ethanol administration and were then given ethanol or glucose, as a control, by gavage. Ethanol significantly increased liver triglyceride (TG) in mice fed casein due to the activation of peroxisome proliferator-activated receptor (PPAR) γ2, a nuclear transcription factor known for regulating lipid metabolism and de novo lipogenesis. The liver TG of ethanol-administered β-conglycinin-fed mice was significantly lower than that in those fed casein, although ethanol increased the amount of liver TG in mice fed β-conglycinin. The increased levels of PPARγ2 protein and its target gene CD36 in response to an ethanol were not observed in mice fed β-conglycinin. Moreover, β-conglycinin decreased the basal expression of de novo lipogenesis-related genes such as stearoyl-CoA desaturase-1, and therefore, the expressions of these genes were lower in the ethanol-administered β-conglycinin-fed mice than in the casein-fed mice. In conclusion, β-conglycinin supplementation appears to prevent the development of fatty liver in mice caused by ethanol consumption via the suppression of alcohol-induced activation of PPARγ2 and the downregulation of the basal expression of de novo lipogenesis. Copyright © 2017. Published by Elsevier Inc.

  6. Thymoquinone supplementation prevents the development of gentamicin-induced acute renal toxicity in rats.

    PubMed

    Sayed-Ahmed, Mohamed M; Nagi, Mahmoud N

    2007-01-01

    1. The present study investigated the possible protective effects of thymoquinone (TQ), a compound derived from Nigella sativa with strong anti-oxidant properties, against gentamicin (GM)-induced nephrotoxicity. 2. A total of 40 adult male Wistar albino rats was divided into four groups. Rats in the first group were injected daily with normal saline (2.5 mL/kg, i.p.) for 8 consecutive days, whereas rats in the second group received TQ (50 mg/L in drinking water) for 8 consecutive days. Animals in the third group were injected daily with GM (80 mg/kg, i.p.) for 8 consecutive days, whereas animals in the fourth group received a combination of GM (80 mg/kg, i.p.) and TQ (50 mg/L in drinking water) for 8 consecutive days. 3. Gentamicin resulted in a significant increase in serum creatinine, blood urea nitrogen (BUN), thiobarbituric acid-reactive substances (TBARS) and total nitrate/nitrite (NOx) and a significant decrease in reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT) and ATP levels in kidney tissues. 4. Interestingly, TQ supplementation resulted in a complete reversal of the GM-induced increase in BUN, creatinine, TBARS and NOx and decrease in GSH, GPx, CAT and ATP to control values. Moreover, histopathological examination of kidney tissues confirmed the biochemical data, wherein TQ supplementation prevents GM-induced degenerative changes in kidney tissues. 5. Data from the present study suggest that TQ supplementation prevents the development of GM-induced acute renal failure by a mechanism related, at least in part, to its ability to decrease oxidative stress and to preserve the activity of the anti-oxidant enzymes, as well as it ability to prevent the energy decline in kidney tissues.

  7. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.

    PubMed

    Doherty, Cailbhe; Bleakley, Chris; Delahunt, Eamonn; Holden, Sinead

    2017-01-01

    Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. Overview of intervention systematic reviews. Individuals with acute ankle sprain/CAI. The primary outcomes were injury/reinjury incidence and function. 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Inhibition of MDMA-induced increase in cortisol does not prevent acute impairment of verbal memory

    PubMed Central

    Kuypers, KPC; Torre, R; Farre, M; Pujadas, M; Ramaekers, JG

    2013-01-01

    Background Ecstasy use is commonly linked with memory deficits in abstinent ecstasy users. Similar impairments are being found during ecstasy intoxication after single doses of ± 3,4 metylenedioxymethamphetamine (MDMA). The concordance of memory impairments during intoxication and abstinence suggests a similar neuropharmacological mechanism underlying acute and chronic memory impairments. The mechanism underlying this impairment is to date not known. We hypothesized that cortisol might play an important role in this mechanism as cortisol, implicated in the regulation of memory performance, can be brought out of balance by stressors like MDMA. Methods In the present study, we aimed to block the MDMA-induced acute memory defect by giving participants a cortisol synthesis inhibitor (metyrapone) together with a single dose of MDMA. Seventeen polydrug MDMA users entered this placebo-controlled within subject study with four treatment conditions. The treatments consisted of MDMA (75 mg) and metyrapone (750 mg), alone and in combination, and double placebo. Pre-treatment with metyrapone or Placebo occurred 1 h prior to MDMA or Placebo administration. Memory performance was tested at peak drug concentrations by means of several memory tests. Cortisol levels were determined in blood and oral fluid; this served as a control measure to see whether manipulations were effective. Results Main findings indicated that whereas treatment with metyrapone blocked the expected MDMA-induced increase in cortisol levels in blood, it did not prevent the MDMA-induced memory deficit from happening. Conclusion We therefore conclude that MDMA-induced increments in cortisol concentrations are not related to MDMA-induced memory impairments. PMID:22946487

  9. Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy.

    PubMed Central

    Conger, J D; Falk, S A

    1977-01-01

    Tubular fluid flow, urine osmolality, and pH were selectively altered to determine the relative protective roles of these factors in a rat model of acute urate nephrophathy. Various prehyper uricemic conditions were established in five groups of animals: (a) normopenic Wistar rats given no pretreatment (Group I); (b) Wistar rats given acetazolamide, 20 mg/kg, and isotonic NaHCO3 to produce urine alkalinization (Group II); (c) Wistar rats in which a moderate diuresis, similar to that observed in Group II but without urine alkalinization, was induced with furosemide, 2 mg/kg (Group III); (d) Wistar rats in which a high-flow solute diuresis was induced with furosemide, 15 mg/kg (Group IV); (e) Brattleboro rats, homozygous for pituitary diabetes insipidus, that had a spontaneous high-flow water diuresis (Group V). A comparable level of hyperuricemia (19.4+/-2.2 mg/100 ml) was achieved in all animals with intravenous urate infusion. Clearance and micropuncture studies were performed before and 1 h after induction of hyperuicemia. Group I rats had mean falls in renal plasma flow and glomerular filtration rate of 83 and 86%, respectively; nephron filtration rate decreased 66%, and tubular and microvascular pressures increased twofold. In Group II there were 45 and 47% declines in renal plasma flow and glomerular filtration rate, respectively, a 66% fall in nephron filtration rate, and a 30% increase in tubular and vascular pressures. Moderate amounts of urate were seen in the kidneys. Group III had changes in renal function identical to Group II suggesting that the moderate prehyperuricemic diuresis in the latter group and not urine alkalinization produced the partial protection observed. Groups IV and V were completely and comparably protected with renal function studies unchanged from controls. It is concluded that high tubular fluid flow, whether induced by a solute or water diuresis, is the primary mechanism of protection in acute urate nephropathy. At most, urine

  10. Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people.

    PubMed

    Ardoino, Ilaria; Rossio, Raffaella; Di Blanca, Donnatella; Nobili, Alessandro; Pasina, Luca; Mannucci, Pier Mannuccio; Peyvandi, Flora; Franchi, Carlotta

    2017-07-19

    Antiplatelet therapy is recommended for the secondary prevention of cardio- and cerebrovascular disease, but for primary prevention it is advised only in patients at very high risk. With this background, this study aims to assess the appropriateness of antiplatelet therapy in acutely hospitalized older people according to their risk profile. Data were obtained from the REPOSI register held in Italian and Spanish internal medicine and geriatric wards in 2012 and 2014. Hospitalized patients aged ≥65 assessable at discharge were selected. Appropriateness of the antiplatelet therapy was evaluated according to their primary or secondary cardiovascular prevention profiles. Of 2535 enrolled patients, 2199 were assessable at discharge. Overall 959 (43.6%, 95% CI 41.5-45.7) were prescribed an antiplatelet drug, aspirin being the most frequently chosen. Among patients prescribed for primary prevention, just over half were inappropriately prescribed (52.1%), being mainly overprescribed (155/209 patients, 74.2%). On the other hand, there was also a high rate of inappropriate underprescription in the context of secondary prevention (222/726 patients, 30.6%, 95% CI 27.3-34.0%). This study carried out in acutely hospitalized older people shows a high degree of inappropriate prescription among patients prescribed with antiplatelets for primary prevention, mainly due to overprescription. Further, a large proportion of patients who had had overt cardio- or cerebrovascular disease were underprescribed, in spite of the established benefits of antiplatelet drugs in the context of secondary prevention. © 2017 The British Pharmacological Society.

  11. PREVENTIVE TRAINING PROGRAMME FOR PATIENTS AFTER ACUTE CORONARY EVENT-- CORRELATION BETWEEN SELECTED PARAMETERS AND AGE GROUPS.

    PubMed

    Vysoký, Robert; Fiala, Jindřich; Dosbaba, Filip; Bat'alik, Ladislav; Nehyba, Svatopluk; Ludka, Ondřej

    2015-09-01

    Interventional cardiovascular training programmes provide a prescription of optimal form and safe intensity. They are part of the second phase of cardiovascular rehabilitation which is a key point in the whole tertiary-preventive care for patients with coronary artery disease. The patients are hemodynamically adapted to a normal physical load, their aerobic capacity is gradually increased, and they learn principles of regular aerobic-resistance exercise. The aim of this study is to assess the impact of modified aerobic-resistance exercise on cardiorespiratory indicators in patients after acute coronary event, and evaluate the differences between monitored parameters in different age groups. The study was conducted on a group of 106 patients (85% of men) of an average age of 60.4 ± 10.9 years, with left ventricular ejec- tion fraction of 57.4 ± 7.2%. All subjects went through an acute coronary event. The time elapsed between the occurence of a coronary event and the beginning of the training programme was 35 ± 8 days. In patients after coronary artery bypass grafting, the time passed was 50 ± 16 days on average. All patients received a two-month aerobic-resistance training with a frequency of three times a week. The length of a training unit was set to 100 minutes (out of which 60 minutes were allocated to individual aerobic training). A significant negative correlation between age and average values of monitored parameters was observed. Even though the values of all parameters are decreasing with increasing age, a shift towards higher values in all parameters occurred after completing the training programme. The study reveals that there are interindividual differences between the parameter values. Asignificant difference in individual parameters was found between different age groups. The result of the study shows that a given parameter could characterize each age group. Completing the interventional training programme also led to a significant increase of

  12. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children.

    PubMed

    Dupuis, L Lee; Sung, Lillian; Molassiotis, Alexander; Orsey, Andrea D; Tissing, Wim; van de Wetering, Marianne

    2017-01-01

    To update the 2009 recommendations for the prevention of acute chemotherapy-induced emesis in children. We updated the original systematic literature search. Randomized studies were included in the evidence to support this guideline if they were primary studies fully published in full text in English or French; included only children less than 18 years old or, for mixed studies of adults and children, reported the pediatric results separately or the median or mean age was no more than 13 years; evaluated acute chemotherapy-induced nausea and vomiting (CINV) prophylaxis; provided sufficient information to permit determination of the emetogenicity of the antineoplastic therapy administered or the study investigators stated the emetogenicity of the chemotherapy administered; included an implicit or explicit definition of complete acute CINV response; described the antiemetic regimen in full; and reported the complete acute CINV response rate as a proportion. Twenty-five randomized studies, including eight published since 2009, met the criteria for inclusion in this systematic review. Prophylaxis with a 5-HT3 antagonist (granisetron or ondansetron or palonosetron or tropisetron) ± dexamethasone ± aprepitant is recommended for children receiving highly or moderately emetogenic chemotherapy. For children receiving chemotherapy of low emetogenicity, a 5-HT3 antagonist is recommended. The findings of several randomized trials were used to update recommendations for the prevention of acute CINV. However, significant research gaps remain and must be addressed before CINV control in children can be optimized.

  13. Can early effective anticoagulation prevent new lesions on magnetic resonance imaging in acute cardioembolic stroke?

    PubMed

    Nomura, Eiichi; Ohshita, Tomohiko; Imamura, Eiji; Wakabayashi, Shinichi; Kajikawa, Hiroshi; Matsumoto, Masayasu

    2014-09-01

    The timing of warfarin administration for acute ischemic stroke (AIS) patients with atrial fibrillation (Af) has not been established. We hypothesized that achieving targeted prothrombin time and international normalized ratio (PT-INR) at 2 weeks could prevent AIS patients with Af from developing a new lesion on diffusion-weighted magnetic resonance imaging (DW-MRI). Of consecutively enrolled AIS patients with Af between 2008 and 2011, we selected the patients who were given warfarin within 2 weeks of admission and had DW-MRI and blood test for PT-INR both on admission and at 2 weeks. Warfarin was started as early as possible and heparin was administered until the targeted PT-INR (2.0-3.0 for patients aged <70 years or 1.6-2.6 for those aged ≥70 years) was achieved. One hundred and twenty-three patients were selected, consisting of 88 patients without a new lesion and 35 patients with a new lesion. Patients with a new lesion had a significantly higher median score on National Institutes of Health Stroke Scale (11.0 vs. 5.5, P = .0053), a lower rate of achieving targeted PT-INR at 2 weeks (25.7% vs. 48.9%, P = .0190), and a lower median dosage of warfarin at 2 weeks (2.0 mg vs. 2.5 mg, P = .0209) than patients without a new lesion. Multivariate logistic regression analysis showed that failure to achieve targeted PT-INR (P = .0298) was significantly associated with the occurrence of a new lesion. Our findings suggest that achieving targeted PT-INR at 2 weeks by using warfarin prevents new lesions in AIS patients with Af. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Vitamin E pretreatment prevents histopathological effects in tilapia (Oreochromis niloticus) acutely exposed to cylindrospermopsin.

    PubMed

    Guzmán-Guillén, Remedios; Prieto Ortega, Ana I; Gutiérrez-Praena, Daniel; Moreno, Isabel M; Moyano, Rosario; Blanco, Alfonso; Cameán, Ana M

    2016-11-01

    Cylindrospermopsin (CYN) is a cyanotoxin frequently involved in blooms with a predominantly extracellular availability, which makes it easily taken up by a variety of aquatic organisms. CYN is a potent protein and glutathione synthesis inhibitor, and also induces genotoxicity, oxidative stress and several histopathological lesions. The present study investigates the protective role of a vitamin E pretreatment (700 mg vit E/kg fish bw/day, for 7 days) on the histopathological alterations induced in different organs of tilapia (Oreochromis niloticus) acutely exposed to a single oral dose of 400 µg pure CYN/kg bw fish. The major histological changes observed were degenerative glucogenic process and loss of the hepatic structure in the liver, glomerulopathy and tubular tumefaction in the kidney, myofibrolysis and edema in the heart, catarrhal enteritis and necrosis in the gastrointestinal tract, hyperemic processes in the gill lamellae, and high basophilia, degeneration and tumefaction of granular neurons in the brain. Vitamin E pretreatment was effective in preventing or ameliorating the abovementioned alterations induced by CYN. In addition, a morphometric study indicated that the average nuclear diameter of hepatocytes, and cross-sections of proximal and distal convoluted tubules, together with the cardiac fiber and capillaries diameters represent a useful tool to evaluate the damage induced by CYN. This is the first study reporting vitamin E prevention of histopathological damage in tissues (liver, kidney, heart, gastrointestinal tract, gills and brain) of fish intoxicated with CYN. Therefore, vitamin E can be considered a useful chemoprotectant in the treatment of histopathological changes induced in CYN-intoxicated fish. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1469-1485, 2016.

  15. Antiepileptic drugs prevent changes in adenosine deamination during acute seizure episodes in adult zebrafish.

    PubMed

    Siebel, Anna Maria; Piato, Angelo Luis; Schaefer, Isabel Costa; Nery, Laura Roesler; Bogo, Maurício Reis; Bonan, Carla Denise

    2013-03-01

    Adenosine is an endogenous modulator of brain functions, which presents anticonvulsant properties. In addition, its levels can be increased during neural injury. The modulation of extracellular adenosine levels by ectonucleotidase and adenosine deaminase (ADA) activities may represent a key mechanism in the control of epileptogenesis. In the present study, we investigated the effects of acute seizure episodes and antiepileptic drug (AED) treatments on ectonucleotidases and ADA activities in adult zebrafish brain. Our data have demonstrated that pentylenetetrazole (PTZ)-induced seizures did not alter ATP, ADP, and AMP hydrolysis in brain membrane fractions. However, there was a significant increase on ecto-ADA and soluble ADA activities in PTZ-treated animals immediately after a clonus-like convulsion and loss of posture, which are typical behavioral changes observed in Stage 3. Furthermore, our results have demonstrated that AED pretreatments prevented the stimulatory effect promoted by PTZ exposure on ADA activities. The PTZ and AED treatments did not promote alterations on ADA gene expression. Interestingly, when exposed to PTZ, animals pretreated with AEDs showed longer latency to reach the clonus-like seizure status, which is an effect that matches the suppression of the increase of ADA activity promoted by the AEDs. These data suggest that the adenosine deamination could be involved in the control of seizure development in zebrafish and may be modulated by AED treatments. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

    PubMed Central

    McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

    2015-01-01

    Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance. PMID:25793157

  17. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations.

    PubMed

    McCriskin, Brendan J; Cameron, Kenneth L; Orr, Justin D; Waterman, Brian R

    2015-03-18

    Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

  18. Therapy for triggered acute risk prevention in subjects at increased cardiovascular risk.

    PubMed

    Tofler, Geoffrey H; Spinaze, Monica; Shaw, Elizabeth; Buckley, Thomas

    2013-06-15

    Heavy physical exertion, emotional stress, heavy meals, and respiratory infection transiently increase the risk of myocardial infarction, sudden cardiac death, and stroke; however, it remains uncertain how to use this information for disease prevention. We determined whether it was feasible for those with either risk factors for cardiovascular disease (CVD) or known CVD to take targeted medication for the hazard duration of the triggering activity to reduce their risk. After a run-in of 1 month, 20 subjects (12 women and 8 men) aged 68.6 years (range 58 to 83) recorded for 2 months all episodes of physical and emotional stress, heavy meal consumption, and respiratory infection. For each episode, the subjects were instructed to take either aspirin 100 mg and propranolol 10 mg (for physical exertion and emotional stress) or aspirin 100 mg alone (for respiratory infection and heavy meal consumption) and to record their adherence. Adherence with taking the appropriate medication was 86% according to the diary entries, with 15 of 20 subjects (75%) achieving ≥80% adherence. Propranolol taken before exertion reduced the peak heart rate compared with similar exercise during the run-in period (118 ± 21 vs 132 ± 16 beats/min, p = 0.016). Most subjects (85%) reported that it was feasible to continue taking the medication in this manner. In conclusion, it is feasible for those with increased CVD risk to identify potential triggers of acute CVD and to take targeted therapy at the time of these triggers.

  19. TTC5 is required to prevent apoptosis of acute myeloid leukemia stem cells.

    PubMed

    Lynch, J T; Somerville, T D D; Spencer, G J; Huang, X; Somervaille, T C P

    2013-04-04

    Using a screening strategy, we identified the tetratricopeptide repeat (TPR) motif protein, Tetratricopeptide repeat domain 5 (TTC5, also known as stress responsive activator of p300 or Strap) as required for the survival of human acute myeloid leukemia (AML) cells. TTC5 is a stress-inducible transcription cofactor known to interact directly with the histone acetyltransferase EP300 to augment the TP53 response. Knockdown (KD) of TTC5 induced apoptosis of both murine and human AML cells, with concomitant loss of clonogenic and leukemia-initiating potential; KD of EP300 elicited a similar phenotype. Consistent with the physical interaction of TTC5 and EP300, the onset of apoptosis following KD of either gene was preceded by reduced expression of BCL2 and increased expression of pro-apoptotic genes. Forced expression of BCL2 blocked apoptosis and partially rescued the clonogenic potential of AML cells following TTC5 KD. KD of both genes also led to the accumulation of MYC, an acetylation target of EP300, and the form of MYC that accumulated exhibited relative hypoacetylation at K148 and K157, residues targeted by EP300. In view of the ability of excess cellular MYC to sensitize cells to apoptosis, our data suggest a model whereby TTC5 and EP300 cooperate to prevent excessive accumulation of MYC in AML cells and their sensitization to cell death. They further reveal a hitherto unappreciated role for TTC5 in leukemic hematopoiesis.

  20. TTC5 is required to prevent apoptosis of acute myeloid leukemia stem cells

    PubMed Central

    Lynch, J T; Somerville, T D D; Spencer, G J; Huang, X; Somervaille, T C P

    2013-01-01

    Using a screening strategy, we identified the tetratricopeptide repeat (TPR) motif protein, Tetratricopeptide repeat domain 5 (TTC5, also known as stress responsive activator of p300 or Strap) as required for the survival of human acute myeloid leukemia (AML) cells. TTC5 is a stress-inducible transcription cofactor known to interact directly with the histone acetyltransferase EP300 to augment the TP53 response. Knockdown (KD) of TTC5 induced apoptosis of both murine and human AML cells, with concomitant loss of clonogenic and leukemia-initiating potential; KD of EP300 elicited a similar phenotype. Consistent with the physical interaction of TTC5 and EP300, the onset of apoptosis following KD of either gene was preceded by reduced expression of BCL2 and increased expression of pro-apoptotic genes. Forced expression of BCL2 blocked apoptosis and partially rescued the clonogenic potential of AML cells following TTC5 KD. KD of both genes also led to the accumulation of MYC, an acetylation target of EP300, and the form of MYC that accumulated exhibited relative hypoacetylation at K148 and K157, residues targeted by EP300. In view of the ability of excess cellular MYC to sensitize cells to apoptosis, our data suggest a model whereby TTC5 and EP300 cooperate to prevent excessive accumulation of MYC in AML cells and their sensitization to cell death. They further reveal a hitherto unappreciated role for TTC5 in leukemic hematopoiesis. PMID:23559008

  1. Using Acute Flaccid Paralysis Surveillance as a Platform for Vaccine-Preventable Disease Surveillance.

    PubMed

    Wassilak, Steven G F; Williams, Cheryl L; Murrill, Christopher S; Dahl, Benjamin A; Ohuabunwo, Chima; Tangermann, Rudolf H

    2017-07-01

    Surveillance for acute flaccid paralysis (AFP) is a fundamental cornerstone of the global polio eradication initiative (GPEI). Active surveillance (with visits to health facilities) is a critical strategy of AFP surveillance systems for highly sensitive and timely detection of cases. Because of the extensive resources devoted to AFP surveillance, multiple opportunities exist for additional diseases to be added using GPEI assets, particularly because there is generally 1 district officer responsible for all disease surveillance. For this reason, integrated surveillance has become a standard practice in many countries, ranging from adding surveillance for measles and rubella to integrated disease surveillance for outbreak-prone diseases (integrated disease surveillance and response). This report outlines the current level of disease surveillance integration in 3 countries (Nepal, India, and Nigeria) and proposes that resources continue for long-term maintenance in resource-poor countries of AFP surveillance as a platform for surveillance of vaccine-preventable diseases and other outbreak-prone diseases. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  2. Prevention of reflex natriuresis after acute unilateral nephrectomy by neonatal administration of MSG

    SciTech Connect

    Lin, S.Y.; Wiedemann, E.; Deschepper, C.F.; Alper, R.H.; Humphreys, M.H.

    1987-02-01

    Acute unilateral nephrectomy (AUN) results in natriuresis from the remaining kidney through reflex pathways involving the central nervous system and requiring an intact pituitary gland. The natriuresis is accompanied by an increase in the plasma concentration of a peptide or peptides derived from the N-terminal fragment (NTF) of proopiomelanocortin. The authors measured plasma immunoreactive NTF-like material (IR-NTF) by radioimmunoassay, before and after AUN in control rats and rats treated neonatally with monosodium glutamate (MSG), a procedure that produces neuroendocrine dysfunction by destroying cell bodies in the hypothalamic arcuate nucleus, median eminence, and other brain regions. In control rats, IR-NTF increased from 85.8 +/- 54.9 (SD) to 207 +/- 98.1 fmol/ml after AUN as sodium excretion (U/sub Na/V) doubled. In MSG-treated rats, AUN produced no change in plasma IR-NTF concentration, nor did U/sub Na/V increase. Tissue content of IR-NTF was reduced in the arcuate nucleus and anterior lobe of pituitaries from MSG-treated rats compared with controls, but was no different in the neurointermediate lobe. These results indicate that the hypothalamic lesion produced by neonatal administration of MSG prevents both the increase in plasma IR-NTF concentration and the natruiuresis after AUN, and therefore lend further support to the concept of a casual relationship between these two consequences of AUN.

  3. Acute intestinal injury induced by acetic acid and casein: prevention by intraluminal misoprostol

    SciTech Connect

    Miller, M.J.; Zhang, x.J.; Gu, x.A.; Clark, D.A. )

    1991-07-01

    Acute injury was established in anesthetized rabbits by intraluminal administration of acetic acid with and without bovine casein, into loops of distal small intestine. Damage was quantified after 45 minutes by the blood-to-lumen movement of {sup 51}Cr-labeled ethylenediaminetetraacetic acid (EDTA) and fluorescein isothiocyanate-tagged bovine serum albumin as well as luminal fluid histamine levels. The amount of titratable acetic acid used to lower the pH of the treatment solutions to pH 4.0 was increased by the addition of calcium gluconate. Luminal acetic acid caused a 19-fold increase in {sup 51}Cr-EDTA accumulation over saline controls; casein did not modify this effect. In saline controls, loop fluid histamine levels bordered on the limits of detection (1 ng/g) but were elevated 19-fold by acetic acid exposure and markedly increased (118-fold) by the combination of acid and casein. Intraluminal misoprostol (3 or 30 micrograms/mL), administered 30 minutes before acetic acid, significantly attenuated the increase in epithelial permeability (luminal {sup 51}Cr-EDTA, fluorescein isothiocyanate-bovine serum albumin accumulation) and histamine release (P less than 0.05). Diphenhydramine, alone or in combination with cimetidine, and indomethacin (5 mg/kg IV) were not protective. It is concluded that exposure of the epithelium to acetic acid promotes the transepithelial movement of casein leading to enhanced mast cell activation and mucosal injury. Damage to the epithelial barrier can be prevented by misoprostol.

  4. Nephropathy in dietary hyperoxaluria: A potentially preventable acute or chronic kidney disease

    PubMed Central

    Glew, Robert H; Sun, Yijuan; Horowitz, Bruce L; Konstantinov, Konstantin N; Barry, Marc; Fair, Joanna R; Massie, Larry; Tzamaloukas, Antonios H

    2014-01-01

    Hyperoxaluria can cause not only nephrolithiasis and nephrocalcinosis, but also renal parenchymal disease histologically characterized by deposition of calcium oxalate crystals throughout the renal parenchyma, profound tubular damage and interstitial inflammation and fibrosis. Hyperoxaluric nephropathy presents clinically as acute or chronic renal failure that may progress to end-stage renal disease (ESRD). This sequence of events, well recognized in the past in primary and enteric hyperoxalurias, has also been documented in a few cases of dietary hyperoxaluria. Estimates of oxalate intake in patients with chronic dietary hyperoxaluria who developed chronic kidney disease or ESRD were comparable to the reported average oxalate content of the diets of certain populations worldwide, thus raising the question whether dietary hyperoxaluria is a primary cause of ESRD in these regions. Studies addressing this question have the potential of improving population health and should be undertaken, alongside ongoing studies which are yielding fresh insights into the mechanisms of intestinal absorption and renal excretion of oxalate, and into the mechanisms of development of oxalate-induced renal parenchymal disease. Novel preventive and therapeutic strategies for treating all types of hyperoxaluria are expected to develop from these studies. PMID:25374807

  5. Venous thromboembolism prevention during asparaginase-based therapy for acute lymphoblastic leukemia

    PubMed Central

    Sibai, H.; Seki, J.T.; Wang, T.Q.; Sakurai, N.; Atenafu, E.G.; Yee, K.W.L.; Schuh, A.C.; Gupta, V.; Minden, M.D.; Schimmer, A.D.; Brandwein, J.M.

    2016-01-01

    Background Venous thromboembolism (vte) is a recognized complication in patients treated with asparaginase-containing chemotherapy regimens; the optimal preventive strategy is unclear. We assessed the safety and efficacy of prophylaxis using low-dose low molecular weight heparin in adult patients with acute lymphoblastic leukemia in complete remission treated with an asparaginase-based post-remission chemotherapy regimen. Methods As part of the intensification phase of the Dana-Farber Cancer Institute 91-01 regimen, asparaginase was administered weekly to 41 consecutive patients for 21–30 weeks; these patients also received prophylaxis with enoxaparin 40 mg daily (60 mg for patients ≥80 kg). Outcomes were assessed against outcomes in a comparable cohort of 99 patients who received the same chemotherapy regimen without anticoagulation prophylaxis. Results The overall rate of symptomatic venous thrombosis was not significantly different in the prophylaxis and non-prophylaxis cohorts (18.92% and 21.74% respectively). Among patients receiving prophylaxis, vte occurred in higher proportion in those who weighed at least 80 kg (42.86% vs. 4.35%, p = 0.0070). No major bleeding complications occurred in the prophylaxis group (minor bleeding: 8.1%). Conclusions Prophylaxis with low-dose enoxaparin during the intensification phase was safe, but was not associated with a lower overall proportion of vte. PMID:27536184

  6. Pargyline reduces/prevents neuroleptic-induced acute dystonia in monkeys.

    PubMed

    Heintz, R; Casey, D E

    1987-01-01

    The neuropharmacologic mechanisms underlying neuroleptic-induced extrapyramidal syndromes (EPS) were studied using a nonhuman primate model. Twenty-six Cebus albifrons monkeys were given weekly challenges of haloperidol (0.025 mg/kg IM), and half of the animals received the monoamine oxidase (MAO) inhibitor pargyline (5 mg/kg PO) daily for 17 consecutive days during the protocol. Pargyline caused no changes in baseline behaviors, but significantly reduced haloperidol-induced acute dystonia (AD) (-67%, P less than 0.002) and parkinsonism (-56%, P less than 0.005). The majority (8 of 13) of the experimental group had complete prevention of neuroleptic-induced EPS during cotreatment with pargyline. Behavioral scores returned to baseline levels after stopping pargyline, and did not show the further sensitization to haloperidol-induced AD that occurred in the control group. The possible mechanisms by which an MAO inhibitor might influence neuroleptic-induced AD were considered. The most likely explanation would appear to involve facilitation of striatal dopamine (DA) neurotransmission by inhibition of intra- and extraneuronal MAO, thus supporting the hypothesis that AD is due to decreased striatal DA function with secondary cholinergic hyperfunction.

  7. Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in diabetic patients.

    PubMed

    Savaj, Shokoufeh; Savoj, Javad; Jebraili, Ismail; Sezavar, Seyed Hashem

    2014-11-01

    There are some clinical trials showing that short-term ischemia in one organ can protect different organs against higher intensity and longer ischemic insult. We designed a study to assess whether remote ischemic preconditioning (RIPC) on one organ can decrease the rate of contrast-induced acute kidney injury (AKI) in diabetic patients who undergo coronary artery angiography (CAA). This randomized control trial included 96 diabetic patients who were candidates for CAA. Exclusion criteria were congestive heart failure and complications during CAA. All of the patients received 1000 mL of normal saline before CAA. The RIPC group underwent 3 cycles of 5-minute ischemia in their right arm. Serum creatinine was measured before and 24 hours after CAA. Contrast-induced AKI was reported in 5 cases in the control group and 1 case in the RIPC group (P = .13, odds ratio, 5.4). The differences in serum creatinine level before and after the procedure was significantly lower in RIPC group than that in the control group (P = .04, odds ratio, 0.08). Serum creatinine rise significantly correlated with contrast dose (P = .02) and a history of hypertension (P = .02) in both groups. Ischemic preconditioning had a protective effect on contrast-induced AKI in our study. Since this method is harmless and cost effective, further studies on patients with chronic kidney disease is required to evaluate addition of ischemic preconditioning to our clinical practice for prevention of contrast-induced AKI.

  8. The preventive effect of linalool on acute and chronic UVB-mediated skin carcinogenesis in Swiss albino mice.

    PubMed

    Gunaseelan, Srithar; Balupillai, Agilan; Govindasamy, Kanimozhi; Muthusamy, Ganesan; Ramasamy, Karthikeyan; Shanmugam, Mohana; Prasad, N Rajendra

    2016-07-06

    In this study, we evaluated the role of linalool in acute ultraviolet-B (UVB; 280-320 nm) radiation-induced inflammation and chronic UVB-mediated photocarcinogenesis in mouse skin. Acute UVB-irradiation (180 mJ cm(-2)) causes hyperplasia, edema formation, lipid peroxidation, antioxidant depletion, and overexpression of cyclooxygenase-2 (COX-2) and ornithine decarboxylase (ODC) in mouse skin. Topical or intraperitoneal (i.p.) treatment of linalool prevented acute UVB-induced hyperplasia, edema formation, lipid peroxidation, and antioxidant depletion in mouse skin. Further, linalool treatment prevented UVB-induced overexpression of COX-2 and ODC in mouse skin. In the chronic study, mice were subjected to UVB-exposure thrice weekly for 30 weeks. Chronic UVB-exposure induced tumor incidence and expression of proliferative markers such as NF-κB, TNF-α, IL-6, COX-2, VEGF, TGF-β1, Bcl-2 and mutated p53 in mouse skin. Treatment with linalool before each UVB-exposure significantly prevented the expression of these proliferative markers and subsequently decreased the tumor incidence in mice skin. Histopathological studies confirmed the development of dysplasia and squamous cell carcinoma (SCC) in the chronic UVB-exposed mouse skin; and this was prevented by both topical and i.p. linalool treatment. Therefore, linalool may be considered as a photochemopreventive agent against UVB radiation induced skin carcinogenesis.

  9. Preventing Acute Malnutrition among Young Children in Crises: A Prospective Intervention Study in Niger

    PubMed Central

    Langendorf, Céline; Roederer, Thomas; de Pee, Saskia; Brown, Denise; Doyon, Stéphane; Mamaty, Abdoul-Aziz; Touré, Lynda W.-M.; Manzo, Mahamane L.; Grais, Rebecca F.

    2014-01-01

    Background Finding the most appropriate strategy for the prevention of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) in young children is essential in countries like Niger with annual “hunger gaps.” Options for large-scale prevention include distribution of supplementary foods, such as fortified-blended foods or lipid-based nutrient supplements (LNSs) with or without household support (cash or food transfer). To date, there has been no direct controlled comparison between these strategies leading to debate concerning their effectiveness. We compared the effectiveness of seven preventive strategies—including distribution of nutritious supplementary foods, with or without additional household support (family food ration or cash transfer), and cash transfer only—on the incidence of SAM and MAM among children aged 6–23 months over a 5-month period, partly overlapping the hunger gap, in Maradi region, Niger. We hypothesized that distributions of supplementary foods would more effectively reduce the incidence of acute malnutrition than distributions of household support by cash transfer. Methods and Findings We conducted a prospective intervention study in 48 rural villages located within 15 km of a health center supported by Forum Santé Niger (FORSANI)/Médecins Sans Frontières in Madarounfa. Seven groups of villages (five to 11 villages) were allocated to different strategies of monthly distributions targeting households including at least one child measuring 60 cm–80 cm (at any time during the study period whatever their nutritional status): three groups received high-quantity LNS (HQ-LNS) or medium-quantity LNS (MQ-LNS) or Super Cereal Plus (SC+) with cash (€38/month [US$52/month]); one group received SC+ and family food ration; two groups received HQ-LNS or SC+ only; one group received cash only (€43/month [US$59/month]). Children 60 cm–80 cm of participating households were assessed at each monthly distribution from

  10. Acute O-GlcNAcylation prevents inflammation-induced vascular dysfunction

    PubMed Central

    Hilgers, Rob H. P.; Xing, Dongqi; Gong, Kaizheng; Chen, Yiu-Fai; Chatham, John C.

    2012-01-01

    Acute increases in cellular protein O-linked N-acetyl-glucosamine (O-GlcNAc) modification (O-GlcNAcylation) have been shown to have protective effects in the heart and vasculature. We hypothesized that d-glucosamine (d-GlcN) and Thiamet-G, two agents that increase protein O-GlcNAcylation via different mechanisms, inhibit TNF-α-induced oxidative stress and vascular dysfunction by suppressing inducible nitric oxide (NO) synthase (iNOS) expression. Rat aortic rings were incubated for 3h at 37°C with d-GlcN or its osmotic control l-glucose (l-Glc) or with Thiamet-G or its vehicle control (H2O) followed by the addition of TNF-α or vehicle (H2O) for 21 h. After incubation, rings were mounted in a myograph to assess arterial reactivity. Twenty-four hours of incubation of aortic rings with TNF-α resulted in 1) a hypocontractility to 60 mM K+ solution and phenylephrine, 2) blunted endothelium-dependent relaxation responses to ACh and substance P, and 3) unaltered relaxing response to the Ca2+ ionophore A-23187 and the NO donor sodium nitroprusside compared with aortic rings cultured in the absence of TNF-α. d-GlcN and Thiamet-G pretreatment suppressed the TNF-α-induced hypocontractility and endothelial dysfunction. Total protein O-GlcNAc levels were significantly higher in aortic segments treated with d-GlcN or Thiamet-G compared with controls. Expression of iNOS protein was increased in TNF-α-treated rings, and this was attenuated by pretreatment with either d-GlcN or Thiamet-G. Dense immunostaining for nitrotyrosylated proteins was detected in the endothelium and media of the aortic wall, suggesting enhanced peroxynitrite production by iNOS. These findings demonstrate that acute increases in protein O-GlcNAcylation prevent TNF-α-induced vascular dysfunction, at least in part, via suppression of iNOS expression. PMID:22777418

  11. An early warning scoring system for the prevention of acute heart failure.

    PubMed

    Bian, Yuan; Xu, Feng; Lv, Rui-juan; Wang, Jia-li; Cao, Li-jun; Xue, Li; Zheng, Wen; Qiao, Yan-xiang; Yan, Xian-liang; Liu, Zhen-fang; Zhang, Yun; Chen, Yu-guo

    2015-03-15

    Early prediction and identification of the onset of acute heart failure (AHF) in high-risk patients are of great significance for preemptive treatment and a better prognosis. We sought to find a scoring system to predict the onset of AHF in patients in the acute heart failure unit (AHFU). Data for 433 patients at of AHF in the AHFU were analyzed. We recorded sex, age, history of coronary artery disease, hypertension, diabetes, and primary percutaneous coronary intervention. We also reviewed temperature, pulse, SpO₂, respiratory rate, urine volume, and emotional state every hour before the onset of AHF. All admission and follow-up data were retrieved from hospital charts. Factors were analyzed using a binary logistic regression model to create the SUPER (SpO₂, urine volume, pulse, emotional state, and respiratory rate) scoring model. We divided the scoring system into four levels: low-, intermediate-, high-, and extremely high-risk. Patients fitting the four risk levels were followed up for 6 to 24 months. SpO₂, hourly urine volume, pulse, emotional state and respiratory rates were associated with an independent increased risk for the onset of AHF. The SUPER score for the patients in the AHFU predicted the onset of AHF 3.90 ± 1.94 h (1-17 h) earlier. The areas under the ROC curve for the SUPER score and the modified early warning score were 0.811 and 0.662 (p<0.05), indicating that the SUPER score provided a better warning of the AHF. A low-, intermediate-, high-, and very high-risk SUPER predicted the likelihood of AHF at 17.3%, 61.3%, 84.4%, and 94.0%, respectively. The differences in mortality rates between the four levels were statistically significant (p<0.05). In patients at high risk of AHF, the SUPER scoring system could predict the onset of AHF 2 to 6h earlier. Preemptive treatment according to the SUPER score may prevent or delay AHF occurrence to improve quality of life and reduce mortality. Copyright © 2015 Elsevier Ireland Ltd. All rights

  12. Contrast-enhanced sonothrombolysis in a porcine model of acute peripheral arterial thrombosis and prevention of anaphylactic shock.

    PubMed

    Nederhoed, Johanna H; Slikkerveer, Jeroen; Meyer, Klaas W; Wisselink, Willem; Musters, René J P; Yeung, Kak K

    2014-03-01

    Acute peripheral arterial thrombosis can be threatening to life and limb. Dissolution of the thrombus local catheter-directed intra-arterial infusion of fibrinolytic agents such as urokinase is the standard therapy for thrombosis; however, this method is time-intensive, and amputation of the affected limb is still needed in 10-30% of cases. Furthermore, thrombolytic therapy carries the risk of bleeding complications. The use of small gas-filled bubbles, or ultrasound contrast agents (UCAs), in combination with ultrasound has been investigated as an improved thrombolytic therapy in acute coronary and cerebral arterial thrombosis. The authors describe a porcine model of acute peripheral arterial occlusion to test contrast-enhanced sonothrombolysis approaches that combine ultrasound, UCAs and fibrinolytic agents and recommend a strategy for preventing severe allergic reactions to UCAs in the pigs.

  13. Alteration in inflammatory/apoptotic pathway and histone modifications by nordihydroguaiaretic acid prevents acute pancreatitis in swiss albino mice.

    PubMed

    Mahajan, Ujwal Mukund; Gupta, Chanchal; Wagh, Preshit Ravindra; Karpe, Pinakin Arun; Tikoo, Kulbhushan

    2011-11-01

    Reactive oxygen radicals, pro-inflammatory mediators and cytokines have been implicated in caerulein induced acute pancreatitis. Nordihydroguaiaretic acid (NDGA), a plant lignin, has marked anti-inflammatory properties. The present study aimed to investigate the possible protective effect of NDGA against caerulein induced pancreatitis. Acute pancreatitis was induced by intraperitoneal administration of eight doses of caerulein in male swiss albino mice. NDGA was administered after 9 h of acute pancreatitis induction. Pancreatic damage and the protective effect of NDGA were assessed by oxidative stress parameters and histopathology of pancreas. The mRNA expression of heat shock proteins (DNAJ C15 and HSPD1) was examined by real-time RT-PCR analysis. Expression of HSP 27, NF-κB, TNF-α, p-p38, Bcl-2, p-PP2A, procaspase-3, caspase-3 and histone modifications were examined by western blotting. NDGA attenuated the oxidative stress, led to increased plasma α-amylase and decreased IGF-1 in AP mice. It modulated the mRNA and protein levels of heat shock proteins and reduced the expression of NF-κB, TNF-α and p-p38. It increased the number of TUNEL positive apoptotic cells in the pancreas of AP mice. In addition, NDGA prevented the changes in modifications of histone H3 in acute pancreatitis. To best of our knowledge, this is the first report which suggests that NDGA prevents the progression of acute pancreatitis by involving alteration of histone H3 modifications and modulating the expression of genes involved in inflammatory/apoptotic cascade, which may be responsible for decreased necrosis and increased apoptosis in this model of acute pancreatitis.

  14. Rhodiola crenulata extract for prevention of acute mountain sickness: a randomized, double-blind, placebo-controlled, crossover trial

    PubMed Central

    2013-01-01

    Background Rhodiola crenulata (R. crenulata) is widely used to prevent acute mountain sickness in the Himalayan areas and in Tibet, but no scientific studies have previously examined its effectiveness. We conducted a randomized, double-blind, placebo-controlled crossover study to investigate its efficacy in acute mountain sickness prevention. Methods Healthy adult volunteers were randomized to 2 treatment sequences, receiving either 800 mg R. crenulata extract or placebo daily for 7 days before ascent and 2 days during mountaineering, before crossing over to the alternate treatment after a 3-month wash-out period. Participants ascended rapidly from 250 m to 3421 m on two separate occasions: December 2010 and April 2011. The primary outcome measure was the incidence of acute mountain sickness, as defined by a Lake Louise score ≥ 3, with headache and at least one of the symptoms of nausea or vomiting, fatigue, dizziness, or difficulty sleeping. Results One hundred and two participants completed the trial. There were no demographic differences between individuals taking Rhodiola-placebo and those taking placebo-Rhodiola. No significant differences in the incidence of acute mountain sickness were found between R. crenulata extract and placebo groups (all 60.8%; adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) = 0.69–1.52). The incidence of severe acute mountain sickness in Rhodiola extract vs. placebo groups was 35.3% vs. 29.4% (AOR = 1.42, 95% CI = 0.90–2.25). Conclusions R. crenulata extract was not effective in reducing the incidence or severity of acute mountain sickness as compared to placebo. Trial registration ClinicalTrials.gov NCT01536288. PMID:24176010

  15. Antihyperalgesic efficacy of 5% lidocaine medicated plaster in capsaicin and sunburn pain models--two randomized, double-blinded, placebo-controlled crossover trials in healthy volunteers.

    PubMed

    Gustorff, Burkhard; Hauer, David; Thaler, Johannes; Seis, Astrid; Draxler, Julia

    2011-12-01

    The aim of this research is to analyze analgesic efficacy of the 5% lidocaine medicated plaster in two randomized, double-blinded, placebo-controlled, crossover studies in 16 healthy volunteers using capsaicin and sunburn pain models. Lidocaine and placebo plasters were simultaneously applied to forearms and thighs at contralateral body sites for three alternating 12-h plaster-on/plaster-off periods. Between the second and third plaster-on period, 4.2-cm circular spots on both pretreated thighs were irradiated with three times the individual minimal erythema dose of UVB light. After the last plaster-on period, 20 μl of 0.1% capsaicin was injected intradermally into both forearms. The study was repeated using a single 12-h plaster application. The area of pinprick hyperalgesia was diminished by 53% (p < 0.003) in the capsaicin model and by 84% (p < 0.0001) in the sunburn model; the intensity of mechanical hyperalgesia to rigid filaments (8 - 512 mN) was reduced in both models. Cold pain perception threshold was reduced (19.7°C ± 8.0 vs 21.8°C ± 6.8 for placebo, p < 0.05, sunburn). Similar effects were observed in the 12-h exposure study. No effect was seen on capsaicin-induced spontaneous pain and flare size, or blood flow in the sunburn area, and heat hyperalgesia in either study. Lidocaine plaster effectively treats mechanical hyperalgesia and cold pain.

  16. Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections.

    PubMed

    Shan, L-S; Hou, P; Wang, Z-J; Liu, F-R; Chen, N; Shu, L-H; Zhang, H; Han, X-H; Han, X-X; Cai, X-X; Shang, Y-X; Vandenplas, Y

    2013-12-01

    The aim of this study was to determine whether Saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (AAD) in children. A total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. During the 1st phase, all children received intravenous antibiotics (AB). They were randomly allocated to group A (S. boulardii 500 mg/day + AB, n=167) or group B (AB alone, n=166) and followed for 2 weeks. Diarrhoea was defined as ≥3 loose/watery stools/day during at least 2 days, occurring during treatment and/or up to 2 weeks after AB therapy had stopped. AAD was considered when diarrhoea was caused by Clostridium difficile or when stool cultures remained negative. In the 2nd phase of the study, group B patients who developed diarrhoea were randomly allocated to two sub-groups: group B1 (S. boulardii + oral rehydration solution (ORS)) and group B2 (ORS alone). Data from 283 patients were available for analysis. Diarrhoea prevalence was lower in group A than in group B (11/139 (7.9%) vs. 42/144 (29.2%); relative risk (RR): 0.27, 95% confidence interval (CI): 0.1-0.5). S. boulardii reduced the risk of AAD (6/139 (4.3%) vs. 28/144 (19.4%); RR: 0.22; 95% CI: 0.1-0.5). When group B patients developed diarrhoea (n=42), S. boulardii treatment during 5 days (group B1) resulted in lower stool frequency (P<0.05) and higher recovery rate (91.3% in group B1 vs. 21.1% in B2; P<0.001). The mean duration of diarrhoea in group B1 was shorter (2.31±0.95 vs. 8.97±1.07 days; P<0.001). No adverse effects related to S. boulardii were observed. S. boulardii appeared to be effective in the prevention and treatment of diarrhoea and AAD in children treated with intravenous antibiotics.

  17. Persistence with Secondary Prevention Medications after Acute Myocardial Infarction: Insights from the TRANSLATE-ACS Study

    PubMed Central

    Mathews, Robin; Wang, Tracy Y.; Honeycutt, Emily; Henry, Timothy D.; Zettler, Marjorie; Chang, Michael; Fonarow, Gregg C.; Peterson, Eric D.

    2016-01-01

    Background Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. Methods Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the TRANSLATE-ACS study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors (ADPRi), beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with non-persistence, defined as <80% persistence with all medication classes. Results Overall, 31% of MI patients stopped taking a least one medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), while financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.15–1.62), older age (OR 1.07; 95% CI 1.02–1.12), atrial fibrillation (OR 1.67, 95% CI 1.33–2.09), dialysis (OR 1.79; 95% CI 1.15–2.78), and depression (OR 1.22; 95% CI 1.02–1.45) were associated with lower likelihood of persistence. Private insurance (OR 0.85, 95% 0.76–0.95), prescription cost assistance (OR 0.63; 95% CI 0.54–0.75), and outpatient follow-up arranged prior to discharge (OR 0.89. 95% CI 0.80–0.99) were associated with higher persistence. Conclusions Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk of non-persistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies. PMID:26093865

  18. Pine needle extract prevents hippocampal memory impairment in acute restraint stress mouse model.

    PubMed

    Lee, Jin-Seok; Kim, Hyeong-Geug; Lee, Hye-Won; Kim, Won-Yong; Ahn, Yo-Chan; Son, Chang-Gue

    2017-07-31

    The Pinus densiflora leaf has been traditionally used to treat mental health disorders as a traditional Chinese medicine. Here we examined the ethnopharmacological relevance of pine needle on memory impairment caused by stress. To elucidate the possible modulatory actions of 30% ethanolic pine needle extract (PNE) on stress-induced hippocampal excitotoxicity, we adopted an acute restraint stress mouse model. Mice were orally administered with PNE (25, 50, or 100mg/kg) or ascorbic acid (100mg/kg) for 9 days, and were then subjected to restraint stress (6h/day) for 3 days (from experimental day 7-9). To evaluate spatial cognitive and memory function, the Morris water maze was performed during experimental days 5-9. Restraint stress induced the memory impairment (the prolonged escape latency and cumulative path-length, and reduced time spent in the target quadrant), and these effects were significantly prevented by PNE treatment. The levels of corticosterone and its receptor in the sera/hippocampus were increased by restraint stress, which was normalized by PNE treatment. Restraint stress elicited the hippocampal excitotoxicity, the inflammatory response and oxidative injury as demonstrated by the increased glutamate levels, altered levels of tumor necrosis factor (TNF)-α and imbalanced oxidant-antioxidant balance biomarkers. Two immunohistochemistry activities against glial fibrillary acidic protein (GFAP)-positive astrocytes and neuronal nuclei (NeuN)-positive neurons supported the finding of excitotoxicity especially in the cornu ammonis (CA)3 region of the hippocampus. Those alterations were notably attenuated by administration of PNE. The above findings showed that PNE has pharmacological properties that modulate the hippocampal excitotoxicity-derived memory impairment under severe stress conditions. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  19. Preventing cleavage of Mer promotes efferocytosis and suppresses acute lung injury in bleomycin treated mice

    SciTech Connect

    Lee, Ye-Ji; Lee, Seung-Hae; Youn, Young-So; Choi, Ji-Yeon; Song, Keung-Sub; Cho, Min-Sun; Kang, Jihee Lee

    2012-08-15

    Mer receptor tyrosine kinase (Mer) regulates macrophage activation and promotes apoptotic cell clearance. Mer activation is regulated through proteolytic cleavage of the extracellular domain. To determine if membrane-bound Mer is cleaved during bleomycin-induced lung injury, and, if so, how preventing the cleavage of Mer enhances apoptotic cell uptake and down-regulates pulmonary immune responses. During bleomycin-induced acute lung injury in mice, membrane-bound Mer expression decreased, but production of soluble Mer and activity as well as expression of disintegrin and metalloproteinase 17 (ADAM17) were enhanced . Treatment with the ADAM inhibitor TAPI-0 restored Mer expression and diminished soluble Mer production. Furthermore, TAPI-0 increased Mer activation in alveolar macrophages and lung tissue resulting in enhanced apoptotic cell clearance in vivo and ex vivo by alveolar macrophages. Suppression of bleomycin-induced pro-inflammatory mediators, but enhancement of hepatocyte growth factor induction were seen after TAPI-0 treatment. Additional bleomycin-induced inflammatory responses reduced by TAPI-0 treatment included inflammatory cell recruitment into the lungs, levels of total protein and lactate dehydrogenase activity in bronchoalveolar lavage fluid, as well as caspase-3 and caspase-9 activity and alveolar epithelial cell apoptosis in lung tissue. Importantly, the effects of TAPI-0 on bleomycin-induced inflammation and apoptosis were reversed by coadministration of specific Mer-neutralizing antibodies. These findings suggest that restored membrane-bound Mer expression by TAPI-0 treatment may help resolve lung inflammation and apoptosis after bleomycin treatment. -- Highlights: ►Mer expression is restored by TAPI-0 treatment in bleomycin-stimulated lung. ►Mer signaling is enhanced by TAPI-0 treatment in bleomycin-stimulated lung. ►TAPI-0 enhances efferocytosis and promotes resolution of lung injury.

  20. Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

    PubMed Central

    Bowblis, John R.; Levin, Carrie; Jan, Saira; Patel, Minalkumar; Crystal, Stephen

    2007-01-01

    BACKGROUND After acute myocardial infarction (AMI), treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) is widely recognized as crucial to reduce risk of a subsequent AMI. However, many patients fail to consistently remain on these treatments over time, and long-term adherence has not been well described. OBJECTIVE To examine the duration of treatment with beta-blockers and ACEI within the 24 months after an AMI. DESIGN A retrospective, observational study using medical and pharmacy claims from a large health plan operating in the Northeastern United States. SUBJECTS Enrollees with an inpatient claim for AMI who initiated beta-blocker (N = 499) or ACEI (N = 526) therapy. MEASUREMENT Time from initiation to discontinuation was measured with pharmacy refill records. Associations between therapy discontinuation and potential predictors were estimated using a Cox proportional hazards model. RESULTS ACEI discontinuation rates were high: 7% stopped within 1 month, 22% at 6 months, 32% at 1 year and 50% at 2 years. Overall discontinuation rates for beta-blockers were similar, but predictors of discontinuation differed for the two treatment types. For beta-blockers, the risk of discontinuation was highest among males and those from low-income neighborhoods; patients with comorbid hypertension and peripheral vascular disease were less likely to discontinue therapy. These factors were not associated with ACEI discontinuation. CONCLUSION Many patients initiating evidence-based secondary prevention therapies after an AMI fail to consistently remain on these treatments. Adherence is a priority area for development of better-quality measures and quality-improvement interventions. Barriers to beta-blocker adherence for low-income populations need particular attention. PMID:17922172

  1. Patent haemostasis prevents radial artery occlusion in patients with an acute coronary syndrome.

    PubMed

    Wilson, Simon J; Mitchell, Andrew; Gray, Timothy J M; Loh, Hoe Jun; Cruden, Nick L

    2017-08-01

    A haemostatic technique that maintains radial artery flow ("patent haemostasis") following transradial catheterization reduces rates of radial artery occlusion (RAO) in patients with stable coronary disease. It is unclear whether this benefit extends to patients with an acute coronary syndrome (ACS). Patients undergoing inpatient transradial catheterization for an ACS were prospectively enrolled in a consecutive cohort study (n=300). Radial haemostasis was obtained using standard radial compression (cohort 1; n=150) or patent haemostasis (cohort 2; n=150). An end-of-case activated clotting time (ACT) was recorded and radial artery patency assessed within 24 hours of sheath removal by reverse Barbeau's test. The incidence of RAO was 16.0% following standard radial compression and 5.3% following patent haemostasis (p=0.003). Univariate predictors of RAO were patent haemostasis (OR 0.30; [0.13-0.68], p=0.004), hyperlipidaemia (OR 0.46; [0.21-0.98], p=0.04), history of current smoking (OR 2.86; [1.3-6.0], p=0.015) and longer procedure times (OR 1.03/additional minute; [1.01-1.05], p=0.003). There was no association between the end-of-case ACT and RAO (OR 1.00; [0.9-1.01] p=1.00). After adjusting for covariates, patent haemostasis reduced the risk of RAO by 70% compared to standard compression (OR 0.30; [0.12-0.77], p=0.12). The c-statistic for model discrimination was 0.79 (95% CI [0.71-0.86], p<0.001). Inverse probability treatment weighted analysis also confirmed patent haemostasis as an independent predictor of reduced RAO (OR 0.38 [0.15-0.95], p=0.039). Patent haemostasis is highly effective in preventing early RAO in patients with ACS. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Antioxidant effect of Phyllanthus emblica extract prevents contrast-induced acute kidney injury

    PubMed Central

    2014-01-01

    Background Contrast-induced acute kidney injury (CI-AKI) occurs after the administration of intravenous iodinated contrast agents. Oxidative stress has been proposed as one of the most important mechanisms in the pathogenesis of CI-AKI. The objective of this study was to investigate the antioxidant effect of the extract from Phyllanthus emblica (PE) in preventing CI-AKI. Methods Male Sprague Dawley rats were subjected into eight groups, were given water (control) or PE extract (125 or 250 or 500 mg/kg/day) for 5 days before the induction of CI-AKI. Renal function and oxidative stress markers; malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD) and catalase (CAT) activity were determined in plasma and renal tissue. Kidney sections were performed for histopathological examination. Results In the contrast media (CM) group, increases in blood urea nitrogen and serum creatinine were demonstrated which correlated with severity of tubular necrosis, peritubular capillary congestion and interstitial edema. Moreover, an increase in MDA and a decrease in TAC SOD and CAT activity in CM group were significantly changed when compared with the control (P < 0.05). In contrast, CI-AKI-induced rats administrated with PE extract 250 and 500 mg/kg/day significantly preserved renal function and attenuated the severity of pathological damage (P < 0.05) as well as significantly lower MDA and higher TAC, SOD and CAT than the CM group (P < 0.05). Conclusions This study demonstrated the protective role of PE extract against CI-AKI. PMID:24755233

  3. [Association between sunburn in children and ultraviolet radiation and ozone layer, during six summers (1996-2001) in Santiago, Chile (33,5 degrees S)].

    PubMed

    Aranibar, Ligia; Cabrera, Sergio; Honeyman, Juan

    2003-09-01

    During the recent 10 years the ozone layer has decreased while ultraviolet radiation has increased in Santiago, Chile. To determine whether the number of sunburns in children correlate with ultraviolet radiation in Santiago. During six Austral Summers (1996-2001) children below 15 years old, consulting for sunburn, were evaluated at the "Corporation for the Aid of Burned Children" (COANIQUEM) in Santiago (33.5 degrees S). The number of children with sunburns during each Summer was compared with the corresponding UV-B radiation and the ozone thickness, to establish a probable relation between a geophysical change and its consequences in skin health. The ozone layer values were obtained from the NASA WEB-page and the ultraviolet radiation was measured with a four-channel medium resolution radiometer. In each Summer there was a predominance of sunburns among boys and among ages between 6 and 10 years. During the 96-97 Austral Summer, the highest number of children with sunburns (63) was diagnosed. That Summer also had the highest mean UV-305 nm radiation with an important amount of days with ozone < or = 260 Dobson Units. Only during that Summer an inverse correlation between ozone and UV-305 nm radiation was detected. At the same time the maximal values of Erythemal Dose Rate (33 muWatt cm2), UV Index (13) and Erythemal Daily Dose (7.500 Joule m2) were observed. In Santiago, Summers with a higher number of days with low ozone protection seem to reappear every 3 years. Understanding the interaction of physical processes that control the ozone layer, may help to design better photo-protection programs for human health.

  4. Targeting Neutrophils to Prevent Malaria-Associated Acute Lung Injury/Acute Respiratory Distress Syndrome in Mice

    PubMed Central

    Soeiro-Pereira, Paulo V.; Gomes, Eliane; Neto, Antonio Condino; D' Império Lima, Maria R.; Alvarez, José M.; Portugal, Silvia; Epiphanio, Sabrina

    2016-01-01

    Malaria remains one of the greatest burdens to global health, causing nearly 500,000 deaths in 2014. When manifesting in the lungs, severe malaria causes acute lung injury/acute respiratory distress syndrome (ALI/ARDS). We have previously shown that a proportion of DBA/2 mice infected with Plasmodium berghei ANKA (PbA) develop ALI/ARDS and that these mice recapitulate various aspects of the human syndrome, such as pulmonary edema, hemorrhaging, pleural effusion and hypoxemia. Herein, we investigated the role of neutrophils in the pathogenesis of malaria-associated ALI/ARDS. Mice developing ALI/ARDS showed greater neutrophil accumulation in the lungs compared with mice that did not develop pulmonary complications. In addition, mice with ALI/ARDS produced more neutrophil-attracting chemokines, myeloperoxidase and reactive oxygen species. We also observed that the parasites Plasmodium falciparum and PbA induced the formation of neutrophil extracellular traps (NETs) ex vivo, which were associated with inflammation and tissue injury. The depletion of neutrophils, treatment with AMD3100 (a CXCR4 antagonist), Pulmozyme (human recombinant DNase) or Sivelestat (inhibitor of neutrophil elastase) decreased the development of malaria-associated ALI/ARDS and significantly increased mouse survival. This study implicates neutrophils and NETs in the genesis of experimentally induced malaria-associated ALI/ARDS and proposes a new therapeutic approach to improve the prognosis of severe malaria. PMID:27926944

  5. N-Acetylcysteine Administration Prevents Nonthyroidal Illness Syndrome in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial

    PubMed Central

    Vidart, Josi; Wajner, Simone Magagnin; Leite, Rogério Sarmento; Manica, André; Schaan, Beatriz D.; Larsen, P. Reed

    2014-01-01

    Context: The acute phase of the nonthyroidal illness syndrome (NTIS) is characterized by low T3 and high rT3 levels, affecting up to 75% of critically ill patients. Oxidative stress has been implicated as a causative factor of the disturbed peripheral thyroid hormone metabolism. Objective: The objective of the study was to investigate whether N-acetylcysteine (NAC), a potent intracellular antioxidant, can prevent NTIS in patients with acute myocardial infarction. Design: This was a randomized, multicenter clinical trial. Settings: Consecutive patients admitted to the emergency and intensive care units of two tertiary hospitals in southern Brazil were recruited. Patients and intervention included 67 patients were randomized to receive NAC or placebo during 48 hours. Baseline characteristics and blood samples for thyroid hormones and oxidative parameters were collected. Main Outcome: Variation of serum T3 and rT3 levels was measured. Results: Baseline characteristics were similar between groups (all P > .05). T3 levels decreased in the placebo group at 12 hours of follow-up (P = .002) but not in NAC-treated patients (P = .10). Baseline rT3 levels were elevated in both groups and decreased over the initial 48 hours in the NAC-treated patients (P = .003) but not in the control group (P = .75). The free T4 and TSH levels were virtually identical between the groups throughout the study period (P > .05). Measurement of total antioxidant status and total carbonyl content demonstrated that oxidative balance was deranged in acute myocardial infarction patients, whereas NAC corrected these alterations (P < .001). Conclusions: NAC administration prevents the derangement in thyroid hormone concentrations commonly occurring in the acute phase of acute myocardial infarction, indicating that oxidative stress is involved in the NTIS pathophysiology. PMID:25148231

  6. N-acetylcysteine administration prevents nonthyroidal illness syndrome in patients with acute myocardial infarction: a randomized clinical trial.

    PubMed

    Vidart, Josi; Wajner, Simone Magagnin; Leite, Rogério Sarmento; Manica, André; Schaan, Beatriz D; Larsen, P Reed; Maia, Ana Luiza

    2014-12-01

    The acute phase of the nonthyroidal illness syndrome (NTIS) is characterized by low T3 and high rT3 levels, affecting up to 75% of critically ill patients. Oxidative stress has been implicated as a causative factor of the disturbed peripheral thyroid hormone metabolism. The objective of the study was to investigate whether N-acetylcysteine (NAC), a potent intracellular antioxidant, can prevent NTIS in patients with acute myocardial infarction. This was a randomized, multicenter clinical trial. Consecutive patients admitted to the emergency and intensive care units of two tertiary hospitals in southern Brazil were recruited. Patients and intervention included 67 patients were randomized to receive NAC or placebo during 48 hours. Baseline characteristics and blood samples for thyroid hormones and oxidative parameters were collected. Variation of serum T3 and rT3 levels was measured. Baseline characteristics were similar between groups (all P > .05). T3 levels decreased in the placebo group at 12 hours of follow-up (P = .002) but not in NAC-treated patients (P = .10). Baseline rT3 levels were elevated in both groups and decreased over the initial 48 hours in the NAC-treated patients (P = .003) but not in the control group (P = .75). The free T4 and TSH levels were virtually identical between the groups throughout the study period (P > .05). Measurement of total antioxidant status and total carbonyl content demonstrated that oxidative balance was deranged in acute myocardial infarction patients, whereas NAC corrected these alterations (P < .001). NAC administration prevents the derangement in thyroid hormone concentrations commonly occurring in the acute phase of acute myocardial infarction, indicating that oxidative stress is involved in the NTIS pathophysiology.

  7. Complete Suppression of the Gut Microbiome Prevents Acute Graft-Versus-Host Disease following Allogeneic Bone Marrow Transplantation

    PubMed Central

    Vossen, Jaak M.; Guiot, Harry F. L.; Lankester, Arjan C.; Vossen, Ann C. T. M.; Bredius, Robbert G. M.; Wolterbeek, Ron; Bakker, Hanny D. J.; Heidt, Peter J.

    2014-01-01

    The hypothesis that elimination of facultative and strict anaerobic microorganisms from the gastro-intestinal tract by antimicrobial drugs in the period of time around allogeneic bone marrow transplantation (BMT) prevents acute graft-versus-host disease (GVHD), was examined in a cohort of 112 children grafted between 1989 and 2002 for hematological malignancies. All patients received T-cell replete marrow from human leukocyte antigens (HLA) matched sibling donors under identical transplantation conditions. To eliminate microorganisms from the gastro-intestinal tract, total gastro-intestinal decontamination (GID) was applied by high doses of non-absorbable antimicrobial drugs while the graft recipient was maintained in strict protective isolation. About half of the children (51%) proved to be successfully decontaminated, and about half (49%) unsuccessfully. One recipient got acute GVHD in the first group and 8 in the second group (p = 0.013). The degree of success of total GID was decisive for the occurrence of acute GVHD, irrespective of the presence of other risk factors such as higher age of recipient and/or donor, female donor for male recipient and carriership or reactivation of herpesviruses. Our results demonstrate that successful total GID of the graft recipient prevents moderate to severe acute GVHD. We suppose that substantial translocation of gastro-intestinal microorganisms or parts of these, functioning as microbial-associated molecular patterns (MAMP's), triggering macrophages/dendritic cells via pattern recognizing receptors (PRR's) is prohibited. As a consequence the initiation and progression of an inflammatory process leading to acute GVHD is inhibited. PMID:25180821

  8. Daily vs twice daily enoxaparin in the prevention of venous thromboembolic disorders during rehabilitation following acute spinal cord injury.

    PubMed

    Hebbeler, Sara L; Marciniak, Christina M; Crandall, Susan; Chen, David; Nussbaum, Steven; Mendelewski, Susan

    2004-01-01

    Subcutaneous administration of low molecular weight heparin (eg, enoxaparin) has been shown to be safe and effective in the prevention of acute venous thromboembolic (TE) disease following acute spinal cord injury (SCI) in the rehabilitation setting. However, emerging evidence suggests that different dosing strategies may be equivalent. To determine whether subcutaneous enoxaparin, 40 mg once daily, when compared with subcutaneous enoxaparin, 30 mg twice daily, is equally safe and effective in the prevention of venous TE disease in patients with SCI. Retrospective chart review. A freestanding, inpatient, acute, rehabilitation hospital. One hundred and twenty-nine patients admitted from June 2000 through June 2002 for inpatient rehabilitation following an acute SCI who received either enoxaparin, 40 mg once daily, or enoxaparin, 30 mg twice daily, for prophylaxis for TE disease. Equivalent prophylaxis efficacy was seen in both enoxaparin groups. Symptomatic venous thromboembolism did not differ, with deep vein thromboses occurring in 1 of 49 (2.0%) patients receiving twice-daily enoxaparin, and 1 of 80 (1.25%) patients receiving once-daily enoxaparin (chi2 = 0.125, NS). Pulmonary embolism was seen in 1 of 49 (2.0%) patients treated with twice-daily enoxaparin and in none of the patients in the once-daily group (chi2 = 1.64, NS). Bleeding complications also did not differ between the 2 treatment groups; these were observed in 2 of 49 (4.1%) patients receiving twice-daily enoxaparin and in 5 of 80 (6.3%) patients receiving once-daily enoxaparin (chi2 = 0.228, NS). Subcutaneous enoxaparin administered once or twice daily is equally effective for the prevention of venous TE disease. Both dosing strategies are associated with a low incidence of bleeding in patients with SCI who are undergoing rehabilitation.

  9. Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events.

    PubMed

    Simmons, D; Hartnell, S; Watts, J; Ward, C; Davenport, K; Gunn, E; Jenaway, A

    2015-10-01

    To describe the effect of a combined diabetes specialist/mental health team approach to prevent readmissions for acute glycaemic events among patients with diabetes. Consecutive patients with diabetes, readmitted to a single hospital for an acute glycaemic condition, were offered one or more diabetes (including assessment, education, medication, technology use and intensive support) and mental health (including assessment, training and therapies) interventions. The pilot service took place over 11 months, with the preceding 24 months and subsequent 8 months serving as control periods. Of the 58 patients admitted, 50 had Type 1 diabetes and were from within the hospital catchment area, and were discharged home. Of these, 32 (64%) had a pre-existing mental health issue and 14 (28%) had a complex social situation. In all, 96% of patients were met as an inpatient by a team member, and 94% accepted at least one intervention. The mean ±sd number of admissions per patient/month dropped from 0.12 ± 0.10 to 0.05 ± 0.10 (P < 0.001) during the intervention, increasing, once the intervention ended, to 0.16 ± 0.36 (P = 0.002). The mean ± sd length of stay similarly decreased and increased (0.6 ± 0.9 to 0.2 ± 0.7 days; P < 0.001 to 0.006) to 0.6 ± 1.4 days (P = 0.003) per patient/month) across the three periods, as did the mean ±sd tariff paid per patient/month (₤258.0 ± 374.0 vs ₤92.1 ± 245.0 vs ₤287.3 ± 563.8; P < 0.001 and P = 0.018, respectively). The mean ± sd HbA1c level dropped from 99 ± 22 to 92 ± 24 mmol/mol (11.2 ± 4.2% vs 10.6 ± 4.3%; P = 0.014) but did not increase after the intervention [89 ± 26 mmol/mol (10.4 ± 4.5%)]. The cost and long-term risks of hospitalization among patients with Type 1 diabetes and recurrent admissions can be reduced by a combined specialist diabetes/mental health team approach. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  10. Levofloxacin in Preventing Infection in Young Patients With Acute Leukemia Receiving Chemotherapy or Undergoing Stem Cell Transplantation

    ClinicalTrials.gov

    2017-09-05

    Acute Leukemias of Ambiguous Lineage; Bacterial Infection; Diarrhea; Fungal Infection; Musculoskeletal Complications; Neutropenia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  11. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux.

    PubMed

    Di Nisio, Marcello; Porreca, Ettore

    2013-01-01

    Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux.

  12. Prior exercise training does not prevent acute cardiac alterations after myocardial infarction in female rats

    PubMed Central

    Veiga, Eduardo C A; Antonio, Ednei L; Bocalini, Danilo S; Murad, Neif; Abreu, Luiz C; Tucci, Paulo J F; Sato, Monica A

    2011-01-01

    OBJECTIVE: This study aimed to investigate whether previous exercise training could prevent or attenuate acute cardiac alterations after myocardial infarction. METHODS: Female rats were submitted to swim training (1 h/day; 5 days/week) or allowed to remain sedentary for 8 weeks. Afterwards, they were randomly assigned to left coronary artery occlusion or sham surgery. After this procedure, the rats remained sedentary for one week until euthanasia. Cardiac structural and functional analyses were performed using Doppler echocardiography. The rats that had a moderate or large infarct size were included in the evaluations. The data (mean ± SEM) were analyzed using a two-way ANOVA model followed by Tukey's post-hoc test. RESULTS: After the surgery, no significant difference between the exercise and sedentary groups was observed in the left ventricular infarct sizes (34.58±3.04 vs. 37.59±3.07). In another group of rats evaluated with Evans blue 1 h after myocardial infarction, no siginificant difference in the area at risk was observed between the exercised and sedentary rats (49.73±1.52 vs. 45.48±3.49). The changes in the left ventricular fractional areas for the exercised and sedentary myocardial infarction groups (36±2% and 39±3%, respectively) were smaller than those for the exercise sham surgery (ES, 67±1%) and sedentary sham surgery (SS, 69±2%) groups. The E/A was higher in the sedentary myocardial infarction (4.4±0.3) and exercised myocardial infarction (5.5±0.3) rats than in the SS (2.4±0.1) and ES (2.2±0.1) rats. CONCLUSION: Previous swim training of female rats does not attenuate systolic and diastolic function alterations after myocardial infarction induced by left coronary artery occlusion, suggesting that cardioprotection cannot be provided by exercise training in this experimental model. PMID:21789396

  13. Ozone therapy prevents renal inflammation and fibrosis in a rat model of acute pyelonephritis.

    PubMed

    Caliskan, Bahadir; Guven, Ahmet; Ozler, Mehmet; Cayci, Tuncer; Ozcan, Ayhan; Bedir, Orhan; Surer, Ilhami; Korkmaz, Ahmet

    2011-10-01

    Not only bacterial characteristics but also oxidative/nitrosative stress could play a significant role in renal parenchymal inflammatory processes in acute pyelonephritis (APN). This study was conducted to evaluate the effect of ozone therapy (OT), as an immunomodulator and antioxidant, on the renal function, morphology and biochemical parameters of oxidative stress in an experimental model of APN in rats. Forty rats were divided equally into five groups as control, APN, APN + Antibiotic, APN + OT, and APN + Antibiotic + OT. APN was induced by 0.1 ml of freshly prepared Escherichia coli (ATCC 25922) solution containing 10(10) colony-forming unit/ml into the kidney. A control group was administered 0.1 ml of 0.9 % NaCl solution. Treatment was begun 72 h after bacterial inoculation. Control and APN groups were given 0.9% NaCl solution, APN + Antibiotic and APN + OT were given either antibiotic (ciprofloxacine 150 mg/kg intramuscular/twice daily) or OT. APN + Antibiotic + OT group was given both antibiotic and OT for five consecutive days. At the end of the seventh day, animals were killed via decapitation and trunk blood was collected. Both kidneys were harvested and one half of each kidney were immediately stored for antioxidant enzyme activity, tissue lipid peroxidation and protein carbonyl content. The remainder was fixed for histopathologic examination. E. coli-induced APN increased the renal glomerular and tubular dysfunction, oxidative stress parameters and antioxidant enzyme activities. Either antibiotherapy or OT markedly ameliorated renal dysfunction, the antioxidant status of the kidneys and histopathological injuries subjected to E. coli-induced APN. Interestingly, the combination of antibiotherapy and OT was much more effective than either of the treatment modalities alone. The combination of antibiotherapy and OT markedly ameliorated renal dysfunction and improved antioxidant status and histopathologic modalities in rats subjected to E. coli-induced APN

  14. Preventive effect of N-acetylcysteine in a mouse model of steroid resistant acute exacerbation of asthma

    PubMed Central

    Eftekhari, Parivash; Hajizadeh, Sohrab; Raoufy, Mohammad Reza; Masjedi, Mohammad Reza; Yang, Ming; Hansbro, Nicole; Li, Jing Jing; Foster, Paul S

    2013-01-01

    Oxidative stress appears to have an important role in glucocorticoid insensitivity, as a crucial problem in asthma therapy. We studied the preventive effect of antioxidant N-acetylcysteine (NAC) on the airway hyper-responsiveness (AHR) and the accumulation of inflammatory cells in the airways in an animal model of steroid resistant acute exacerbation of asthma. Systemically sensitized Balb/C mice were exposed to Ovalbumin aerosol on days 13, 14, 15 and 16, followed by intratracheal lipopolysaccharide (LPS) to induce acute exacerbation. NAC (intraperitoneal, 320 mg/kg 30 min before and 12 hours after each challenge) reduced hyper-responsiveness with/out dexamethasone. LPS application caused neutrophilia in bronchoalveolar lavage fluid (BALF) and eosinophil count was higher than respective control in BALF as well as neutrophils after dexamethasone treatment. NAC significantly decreased neutrophil and eosinophil count in BALF as well as inflammatory cytokines (IL-13 and IL-5).We concluded that addition of NAC to asthma therapy has beneficial preventive effects in an animal model of steroid resistant acute exacerbation of asthma. PMID:26417226

  15. Efficacy of low dose gabapentin in acute herpes zoster for preventing postherpetic neuralgia: a prospective controlled study.

    PubMed

    Lee, Eo G; Lee, Hee J; Hyun, Dong J; Min, Kyunghoon; Kim, Dong H; Yoon, Moon S

    2016-05-01

    Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow-up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low-dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN. © 2016 Wiley Periodicals, Inc.

  16. Developing an intervention to prevent acute kidney injury: using the Plan, Do, Study, Act (PDSA) service improvement approach.

    PubMed

    Byrne, Jo; Xu, Gang; Carr, Sue

    2015-03-01

    In the UK, recent National Institute for Health and Care Excellence guidelines for acute kidney injury point to the need for interventions to help prevent this condition. Effective medicines management is of prime importance in reducing the risk of AKI. Part of this challenge is to increase patients' awareness of their medicines and the possible need to temporarily withhold certain medications when acutely unwell. The objectives were to use a service improvement approach (the Plan, Do, Study, Act cycle) to develop an intervention and to evaluate current delivery of acute kidney injury management and to test and generate new ideas relating to patients' needs. A postal feedback form sent to a random sample of over 200 patients with chronic kidney disease. The feedback form collected information on: what patients know about acute kidney injury and managing medicines; where patients get their information from; whether patients want more information and where from; and what patients feel about self-managing their medicines. Completed feedback forms were received from 113 participants. Of these, 92% said they had received no advice, 77% of respondents wanted more advice but only 17% said they would feel comfortable to stop their own medication without medical consent. The PDSA cycle offered a very useful framework to evaluate the current service delivery and to test and generate new ideas for the development of an AKI intervention. Our findings highlighted that the current service is limited and more robust research is needed. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  17. Preventive effect of teprenone on acute gastric mucosal lesion progression in compound 48/80-treated rats.

    PubMed

    Ohta, Yoshiji; Kobayashi, Takashi; Inui, Kazuo; Yoshino, Junji; Kitagawa, Akira; Nakazawa, Saburo

    2004-03-08

    The preventive effect of teprenone (6,10,14,18-teramethyl-5,9,13,17-nonadecatetaene-2-one), an anti-ulcer drug, on acute gastric mucosal lesion progression was examined in rats with a single intraperitoneal (i.p.) injection of compound 48/80 (0.75 mg/kg). Teprenone (20, 100 or 200 mg/kg), which was orally administered 0.5 h after compound 48/80 treatment at which time gastric mucosal lesions appeared, prevented gastric mucosal lesion development at 3 h after the treatment dose-dependently. Gastric mucosal tissues of compound 48/80-treated rats showed increases in myeloperoxidase (an index of neutrophil infiltration) and xanthine oxidase activities and thiobarbituric acid reactive substances (an index of lipid peroxidation) content and decreases in Se-glutathione peroxidase activity and hexosamine and vitamin E contents at 3 h after the treatment. Post-administered teprenone attenuated all these changes dose-dependently. These results indicate that teprenone prevents acute gastric mucosal lesion progression in compound 48/80-treated rats possibly by suppressing gastric mucus depletion, neutrophil infiltration and oxidative stress in the gastric mucosal tissue.

  18. Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: blind, randomized, placebo-controlled clinical trial.

    PubMed

    Siqueira, Camila Monteiro; Homsani, Fortune; da Veiga, Venício Féo; Lyrio, Carlos; Mattos, Haroldo; Passos, Sonia Regina Lambert; Couceiro, José Nelson; Quaresma, Carla Holandino

    2016-02-01

    Influenza and its complications are common at all ages, especially in children. Vaccines and anti-influenza drugs aim to prevent it. Preventative approaches with favorable risk profiles should be considered for flu, particularly since the evidence of the efficacy of anti-viral drugs is debated. This pragmatic clinical trial was conducted in the Brazilian Public Health System in Petrópolis (BPHSP) with children aged from 1 to 5 years old. The medications used were mainly selected based on in vitro experiments (InfluBio), and in successful qualitative clinical experiences (Homeopathic Complex). Following informed parental consent, subjects were randomly distributed, in a blind manner, to three experimental groups: Homeopathic Complex, Placebo, and InfluBio. BPHSP health agents collected flu and acute respiratory infection symptomatic episodes monthly following the established protocol. The number of these episodes was registered in one year (2009-2010). Out of the 600 children recruited, 445 (74.17%) completed the study (149: Homeopathic complex; 151: Placebo; 145: InfluBio). The number of flu and acute respiratory infection symptomatic episodes detected in this clinical trial was low; however, it was different between homeopathic groups and placebo (p < 0.001). In the first year post-intervention, 46/151 (30.5%) of children in the placebo group developed 3 or more flu and acute respiratory infection episodes, while there was no episode in the group of 149 children who used Homeopathic Complex, and only 1 episode in the group of 145 (1%) children who received InfluBio. These results suggested that the use of homeopathic medicines minimized the number of flu and acute respiratory infection symptomatic episodes in children, signalizing that the homeopathic prophylactic potential should be investigated in further studies. Copyright © 2015 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  19. Dabigatran etexilate: a review of its use in the treatment of acute venous thromboembolism and prevention of venous thromboembolism recurrence.

    PubMed

    Greig, Sarah L; McKeage, Kate

    2014-10-01

    Dabigatran etexilate (Pradaxa(®), Prazaxa(®)) has recently been approved for the treatment of acute venous thromboembolism (VTE) and prevention of VTE recurrence. Dabigatran etexilate is an oral prodrug of dabigatran, a selective, reversible, competitive, direct thrombin inhibitor. Dabigatran etexilate has a wide therapeutic range that allows for fixed-dose administration without the need for routine monitoring, a requirement of standard vitamin K antagonist (VKA) therapy. In randomized phase III trials in patients with acute VTE (RE-COVER and RE-COVER II), long-term treatment with oral dabigatran etexilate 150 mg twice daily for 6 months after initial parenteral anticoagulation was noninferior to dose-adjusted warfarin with regard to the incidence of recurrent symptomatic VTE or related death. In randomized trials of patients with previously treated VTE, extended dabigatran etexilate treatment was noninferior to warfarin (RE-MEDY) and significantly more effective than placebo (RE-SONATE) with regard to the incidence of recurrent VTE or related death. Dabigatran etexilate was generally well tolerated, with a similar incidence of major bleeding to that with warfarin in individual studies (although pooled data showed a significantly lower incidence in patients with acute VTE), and significantly lower incidences of the combined endpoint of major or clinically relevant nonmajor bleeding and of any bleeding than with warfarin. However, in the RE-SONATE trial, dabigatran etexilate was associated with a higher risk of bleeding than placebo. In conclusion, dabigatran etexilate is a valuable treatment option for acute VTE and prevention of VTE recurrence, providing an effective and convenient alternative to standard VKA therapy with the potential for a lower overall rate of bleeding.

  20. Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush victims.

    PubMed

    Sagheb, Mohammad Mahdi; Sharifian, Maryam; Roozbeh, Jamshid; Moini, Maryam; Gholami, Khodakaram; Sadeghi, Hossein

    2008-01-01

    At 5:28 a.m. (local time) on December 26, 2003, an earthquake measuring 6.51 on the Richter scale struck the city of Bam in the Kerman Province in southeastern Iran. Among the most important morbid events in survivors were acute renal problems. Clinical findings, laboratory data, and management of the renal victims, all of whom were transferred to Shiraz Hospitals, have been the subject of this analysis. Medical records of twenty patients with acute renal failure admitted to three university hospitals and one community hospital were reviewed. Overall, 801 patients were transferred to Shiraz hospitals, of whom 20 (mean age 36.2 +/- 14.8 years, 15 males) developed acute renal failure with mean duration of 14.5 +/- 9.6 days. Total mortality was 21 (2.6%) and acute renal failure mortality was 3 (15%). Seven patients received standard fluid therapy and 13 patients received variable volume treatment. In total, 79 dialysis sessions were performed in 15 patients (mean 5.2, 3.3 +/- 1 sessions per patients). There was a positive correlation between time spent under rubble and peak serum CK (creatine phosphokinase) level (p = 0.035), acute renal failure duration (p = 0.047), and admission potassium levels (p = 0.033). Serum CK level was positively correlated with acute renal failure duration (p = 0.008). Patients who had received standard treatment had significantly shorter duration of acute renal failure (7.1 versus 9.4 days, p = 0.008) and less need for dialysis (1 versus 6, p = 0.007) than patients who were treated variably. In victims of earthquake, time spent under rubble and peak serum CK level can serve to estimate morbidity, and early standard treatment may decrease renal morbidity.

  1. Persistence of secondary prevention medication and related factors for acute ischemic stroke and transient ischemic attack in China.

    PubMed

    Jiang, Yue; Yang, Xiaomeng; Li, Zixiao; Pan, Yuesong; Wang, Yilong; Wang, Yongjun; Ji, Ruijun; Wang, Chen

    2017-06-01

    We recently measured the longitudinal use of secondary prevention medication following hospital discharge and the factors influencing persistence in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) in China. Patients with AIS and TIA who were enrolled in the China National Stroke Registry II from June 2012 to January 2013 were surveyed to determine persistence. The medications included antiplatelet therapies, warfarin, antihypertensive therapies, statins, and diabetes medications. We determined persistence for a three-month period following discharge. Persistence was defined as the continuation of all secondary preventive medications prescribed upon hospital discharge. The factors associated with medication persistence 3 months after discharge were examined using a multivariable logistic regression. Of the 21,592 patients with AIS and TIA, 18,344 (91.2%) were eligible for analysis. After 3 months post-discharge, 46.2% of the subjects continued to take all secondary prevention medications prescribed at discharge. Independent predictors of three-month medication persistence included younger age, absence of a history of diabetes or atrial fibrillation, higher family income, less severe stroke, index cerebrovascular event of ischemic stroke, and being treated in a hospital with a stroke unit and more beds in the neurology department. More than half of patients with AIS and TIA reported discontinuing one or more secondary prevention medications within 3 months of hospital discharge. Several factors associated with medication persistence were identified. Here, we propose strategies that could be implemented to improve the quality of secondary prevention.

  2. Acute upper thermal limits of three aquatic invasive invertebrates: hot water treatment to prevent upstream transport of invasive species.

    PubMed

    Beyer, Jessica; Moy, Philip; De Stasio, Bart

    2011-01-01

    Transport of aquatic invasive species (AIS) by boats traveling up rivers and streams is an important mechanism of secondary spread of AIS into watersheds. Because physical barriers to AIS movement also prevent navigation, alternate methods for preventing spread are necessary while allowing upstream navigation. One promising approach is to lift boats over physical barriers and then use hot water immersion to kill AIS attached to the hull, motor, or fishing gear. However, few data have been published on the acute upper thermal tolerance limits of potential invaders treated in this manner. To test the potential effectiveness of this approach for a planned boat lift on the Fox River of northeastern WI, USA, acute upper thermal limits were determined for three AIS, adult zebra mussels (Dreissena polymorpha), quagga mussels (Dreissena rostriformis bugensis), and spiny water fleas (Bythotrephes longimanus) from the local area employing temperatures from 32 to 54°C and immersion times from 1 to 20 min. Mortality was determined after immersion followed by a 20-min recovery period. Immersion at 43°C for at least 5 min was required to ensure 100% mortality for all three species, but due to variability in the response by Bythotrephes a 10 min immersion would be more reliable. Overall there were no significant differences between the three species in acute upper thermal limits. Heated water can be an efficient, environmentally sound, and cost effective method of controlling AIS potentially transferred by boats, and our results should have both specific and wide-ranging applications in the prevention of the spread of aquatic invasive species.

  3. K+ channel blockade in the prevention of ventricular fibrillation in dogs with acute ischemia and enhanced sympathetic activity.

    PubMed

    Vanoli, E; Hull, S S; Adamson, P B; Foreman, R D; Schwartz, P J

    1995-12-01

    The value of K+ channel blockade in preventing lethal arrhythmias, and specifically those triggered by acute myocardial ischemia and sympathetic hyperactivity, remains unproven. To address this issue, we tested the antifibrillatory effect of d-sotalol, and Ikr blocker, d,l-sotalol, its racemic compound which blocks Ikr, and beta-adrenoreceptors, and propranolol. Ten dogs with a healed anterior myocardial infarction (MI) had ventricular fibrillation (VF) during a 2-min occlusion of the circumflex coronary artery performed toward the end of a submaximal exercise stress test. In successive trials in the same animals, d-sotalol (three injections of 8 mg/kg, one every 12 h), d,l-sotalol (8 mg/kg), and propranolol (1 mg/kg) were tested. All three interventions significantly reduced heart rate (HR) response to exercise, but only d,l-sotalol and propranolol also blunted the reflex HR increase during acute myocardial ischemia. With d-sotalol, HR at 30 s of coronary occlusion was similar (253 +/- 28 beats/min) to that observed in the control tests (259 +/- 35 beats/min). d-Sotalol prevented recurrence of VF in only 1 of 10 dogs tested. One dog was lost to the continuation of the study after occurrence of VF with d-sotalol. Six of 9 dogs (67%) tested with d,l-sotalol and 5 (56%) of the same 9 dogs tested with propranolol were protected from VF. d-Sotalol does not reduce risk of VF during acute myocardial ischemia associated with sympathetic hyperactivity, and lethal events can be prevented by antiadrenergic interventions.

  4. Acute Upper Thermal Limits of Three Aquatic Invasive Invertebrates: Hot Water Treatment to Prevent Upstream Transport of Invasive Species

    NASA Astrophysics Data System (ADS)

    Beyer, Jessica; Moy, Philip; de Stasio, Bart

    2011-01-01

    Transport of aquatic invasive species (AIS) by boats traveling up rivers and streams is an important mechanism of secondary spread of AIS into watersheds. Because physical barriers to AIS movement also prevent navigation, alternate methods for preventing spread are necessary while allowing upstream navigation. One promising approach is to lift boats over physical barriers and then use hot water immersion to kill AIS attached to the hull, motor, or fishing gear. However, few data have been published on the acute upper thermal tolerance limits of potential invaders treated in this manner. To test the potential effectiveness of this approach for a planned boat lift on the Fox River of northeastern WI, USA, acute upper thermal limits were determined for three AIS, adult zebra mussels ( Dreissena polymorpha), quagga mussels ( Dreissena rostriformis bugensis), and spiny water fleas ( Bythotrephes longimanus) from the local area employing temperatures from 32 to 54°C and immersion times from 1 to 20 min. Mortality was determined after immersion followed by a 20-min recovery period. Immersion at 43°C for at least 5 min was required to ensure 100% mortality for all three species, but due to variability in the response by Bythotrephes a 10 min immersion would be more reliable. Overall there were no significant differences between the three species in acute upper thermal limits. Heated water can be an efficient, environmentally sound, and cost effective method of controlling AIS potentially transferred by boats, and our results should have both specific and wide-ranging applications in the prevention of the spread of aquatic invasive species.

  5. Caspofungin Acetate or Fluconazole in Preventing Invasive Fungal Infections in Patients With Acute Myeloid Leukemia Who Are Undergoing Chemotherapy

    ClinicalTrials.gov

    2017-01-31

    Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myeloid Leukemia in Remission; Childhood Acute Myelomonocytic Leukemia (M4); Fungal Infection; Neutropenia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  6. Prevention

    MedlinePlus

    ... Error processing SSI file About Heart Disease & Stroke Prevention Heart disease and stroke are an epidemic in ... secondhand smoke. Barriers to Effective Heart Disease & Stroke Prevention Many people with key risk factors for heart ...

  7. Prevention and Therapeutic Effects and Mechanisms of Tanshinone IIA Sodium Sulfonate on Acute Liver Injury Mice Model

    PubMed Central

    Lu, Lunjie; Zhou, Jun; Zhang, Jingying; Che, Jun; Jiao, Yang; Zhang, Yusong

    2016-01-01

    Tanshinone IIA sodium sulfonate (TSS) is a water-soluble derivative of tanshinone IIA, which is the main pharmacologically active component of Salvia miltiorrhiza. This study aimed to verify the preventive and therapeutic effects of TSS and its combined therapeutic effects with magnesium isoglycyrrhizinate (MI) in D-galactosamine- (D-Gal-) induced acute liver injury (ALI) in mice. The potential regulatory mechanisms of TSS on ALI were also examined. Our results may provide a basis for the development of novel therapeutics for ALI. PMID:27274751

  8. Influenza vaccines for preventing acute otitis media in infants and children.

    PubMed

    Norhayati, Mohd N; Ho, Jacqueline J; Azman, Mohd Y

    2015-03-24

    Acute otitis media (AOM) is one of the most common infectious diseases in children. It has been reported that 64% of infants have an episode of AOM by the age of six months and 86% by one year. Although most cases of AOM are due to bacterial infection, it is commonly triggered by a viral infection. In most children it is self limiting, but it does carry a risk of complications. Since antibiotic treatment increases the risk of antibiotic resistance, influenza vaccines might be an effective way of reducing this risk by preventing the development of AOM. To assess the effectiveness of influenza vaccine in reducing the occurrence of acute otitis media (AOM) in infants and children. We searched CENTRAL (2014, Issue 6), MEDLINE (1946 to July week 1, 2014), EMBASE (2010 to July 2014), CINAHL (1981 to July 2014), LILACS (1982 to July 2014), Web of Science (1955 to July 2014) and reference lists of articles to July 2014. Randomised controlled trials (RCTs) comparing influenza vaccine with placebo or no treatment in infants and children aged younger than six years old. We included children of either sex and of any ethnicity, with or without a history of recurrent AOM. Two review authors independently screened studies, assessed trial quality and extracted data. We performed statistical analyses using the random-effects and fixed-effect models and expressed the results as risk ratio (RR), risk difference (RD) and number needed to treat to benefit (NNTB) for dichotomous outcomes, with 95% confidence intervals (CI). We included 10 trials (six trials in high-income countries and four multicentre trials in high-, middle- and low-income countries) involving 16,707 children aged six months to six years. Eight trials recruited participants from a healthcare setting. Nine trials (and all five trials that contributed to the primary outcome) declared funding from vaccine manufacturers. Four trials reported adequate allocation concealment and nine trials reported adequate blinding of

  9. Prevention of acute immunological lung lesion in rats by decomplementing treatment

    PubMed Central

    Carvalho, I. F. De; Oliveira, H. L. De; Laus-Filho, J. A.; Sarti, W.

    1969-01-01

    The intravenous administration of nephrotoxic antibody serum to rats produced a rapid and pronounced reduction in the serum complement level; this was observed before lung lesions became apparent. A total suppression of the acute immune lung change was observed in animals depleted of complement by treatment with heat-aggregated human γ-globulin or zymosan. Albeit the experimental evidence presented is of indirect nature, it suggests that the complement system is involved in the mediation of the acute pulmonary injury following injection of nephrotoxic antibody serum. PMID:4182457

  10. Predicting Inadequate Response to Acute Migraine Medication: Results From the American Migraine Prevalence and Prevention (AMPP) Study.

    PubMed

    Lipton, Richard B; Munjal, Sagar; Buse, Dawn C; Fanning, Kristina M; Bennett, Alix; Reed, Michael L

    2016-11-01

    Pain freedom at 2 hours and sustained pain response at 24 hours are important outcomes of acute migraine therapy. Some studies have examined rates and predictors of successful treatment outcomes for single attacks in clinical trials. However, little is known about predictors of typical response to acute treatment over multiple attacks in the population. To identify sociodemographic features, headache characteristics, comorbidities and treatment-related factors that predict acute treatment success or failure at 2 hours and 24 hours post dose in a US population sample of persons with episodic migraine. Eligible respondents completed the 2006 American Migraine Prevalence and Prevention Study survey, met criteria for episodic migraine, reported the use of acute treatment for migraine and answered questions on acute treatment outcomes from the Migraine Treatment Optimization Questionnaire (mTOQ). One question focused on 2 hour pain free (2hPF) response and the other focused on pain relief at 2 hours and 24 hours (24hPR). For each question, responses were considered adequate if they were achieved "half the time or more" and inadequate if they were achieved "never," "rarely," or "less than half the time." Models were run to identify predictors of outcomes in relation to usual acute treatment: (1) Inadequate 2hPF response; (2) Inadequate 24hPR response; and (3) Inadequate 24 hour Sustained Pain Freedom (24hSPF), which was a conditional analysis of pain freedom at 24 hours among those who initially had an adequate pain freedom response at 2 hours. Binary logistic regression models were used to separately predict each of the 3 outcomes adjusting for covariates. Potential predictor variables were analyzed independently and variables that did not contribute significantly to outcome prediction were trimmed. The retained variables were entered into a final multivariable binary logistic regression that included age, sex, and the covariates that survived the trimming process. Odds

  11. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome.

    PubMed

    Galvin, Imelda M; Steel, Andrew; Pinto, Ruxandra; Ferguson, Niall D; Davies, Mark W

    2013-07-23

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe respiratory failure that are associated with substantial mortality and morbidity. Artifical ventilatory support is commonly required and may exacerbate lung injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form of ventilatory support for these patients. Although PLV has been shown to improve gas exchange and to reduce inflammation in experimental models of ALI, a previous systematic review did not find any evidence to support or refute its use in humans with ALI and ARDS. The primary objective of this review was to assess whether PLV reduced mortality (at 28 d, at discharge from the intensive care unit (ICU), at discharge from hospital and at one, two and five years) in adults with ALI or ARDS when compared with conventional ventilatory support.Secondary objectives were to determine how PLV compared with conventional ventilation with regard to duration of invasive mechanical ventilation, duration of respiratory support, duration of oxygen therapy, length of ICU stay, length of hospital stay, incidence of infection, long-term cognitive impairment, long-term health related quality of life, long- term lung function, long-term morbidity costs and adverse events. The following adverse events were considered: hypoxia (arterial PO2 <80 mm Hg), pneumothorax (any air leak into the pleural space requiring therapeutic intervention), hypotension (systolic blood pressure < 90 mm Hg sustained for longer than two minutes or requiring treatment with fluids or vasoactive drugs), bradycardia (heart rate < 50 beats per minute sustained for longer than one minute or requiring therapeutic intervention) and cardiac arrest (absence of effective cardiac output). In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 10, 2012, in The Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2012); EMBASE (Ovid SP, 1980 to

  12. Chronic and acute adenosine A2A receptor blockade prevents long-term episodic memory disruption caused by acute cannabinoid CB1 receptor activation.

    PubMed

    Mouro, Francisco M; Batalha, Vânia L; Ferreira, Diana G; Coelho, Joana E; Baqi, Younis; Müller, Christa E; Lopes, Luísa V; Ribeiro, Joaquim A; Sebastião, Ana M

    2017-05-01

    Cannabinoid-mediated memory impairment is a concern in cannabinoid-based therapies. Caffeine exacerbates cannabinoid CB1 receptor (CB1R)-induced memory deficits through an adenosine A1 receptor-mediated mechanism. We now evaluated how chronic or acute blockade of adenosine A2A receptors (A2ARs) affects long-term episodic memory deficits induced by a single injection of a selective CB1R agonist. Long-term episodic memory was assessed by the novel object recognition (NOR) test. Mice received an intraperitoneal (i.p.) injection of the CB1/CB2 receptor agonist WIN 55,212-2 (1 mg/kg) immediately after the NOR training, being tested for novelty recognition 24 h later. Anxiety levels were assessed by the Elevated Plus Maze test, immediately after the NOR. Mice were also tested for exploratory behaviour at the Open Field. For chronic A2AR blockade, KW-6002 (istradefylline) (3 mg/kg/day) was administered orally for 30 days; acute blockade of A2ARs was assessed by i.p. injection of SCH 58261 (1 mg/kg) administered either together with WIN 55,212-2 or only 30 min before the NOR test phase. The involvement of CB1Rs was assessed by using the CB1R antagonist, AM251 (3 mg/kg, i.p.). WIN 55,212-2 caused a disruption in NOR, an action absent in mice also receiving AM251, KW-6002 or SCH 58261 during the encoding/consolidation phase; SCH 58251 was ineffective if present during retrieval only. No effects were detected in the Elevated Plus maze or Open Field Test. The finding that CB1R-mediated memory disruption is prevented by antagonism of adenosine A2ARs, highlights a possibility to prevent cognitive side effects when therapeutic application of CB1R drugs is desired.

  13. Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

    PubMed

    Stephenson, Matthew; Mcarthur, Alexa; Giles, Kristy; Lockwood, Craig; Aromataris, Edoardo; Pearson, Alan

    2016-02-01

    To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  14. The pattern and time course of somatosensory changes in the human UVB sunburn model reveal the presence of peripheral and central sensitization.

    PubMed

    Gustorff, Burkhard; Sycha, Thomas; Lieba-Samal, Doris; Rolke, Roman; Treede, Rolf-Detlef; Magerl, Walter

    2013-04-01

    The ultraviolet B (UVB) sunburn model was characterized with a comprehensive battery of quantitative sensory testing (QST). Primary hyperalgesia in UVB-irradiated skin and secondary hyperalgesia in adjacent nonirradiated skin were studied in 22 healthy subjects 24h after irradiation with UVB at 3-fold minimal erythema dose of a skin area 5 cm in diameter at the thigh and compared to mirror-image contralateral control areas. The time course of hyperalgesia over 96 h was studied in a subgroup of 12 subjects. Within the sunburn area, cold hyperesthesia (P=.01), profound generalized hyperalgesia to heat (P<.001), cold (P<.05), pinprick and pressure (P<.001), and mild dynamic mechanical allodynia (P<.001) were present. The finding of cold hyperalgesia and cold hyperesthesia is new in this model. The sunburn was surrounded by large areas of pinprick hyperalgesia (mean±SEM, 218±32 cm(2)) and a small rim of dynamic mechanical allodynia but no other sensory changes. Although of smaller magnitude, secondary hyperalgesia and dynamic mechanical allodynia adjacent to the UVB-irradiated area were statistically highly significant. Primary and secondary hyperalgesia developed in parallel within hours, peaked after 24-32 h, and lasted for more than 96 h. These data reveal that the UVB sunburn model activates a broad spectrum of peripheral and central sensitization mechanisms and hence is a useful human surrogate model to be used as a screening tool for target engagement in phases 1 and 2a of drug development. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. Treatment and Prevention of Acute Diarrhoea. Guidelines for the Trainers of Health Workers.

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    This booklet, intended primarily for the trainers of middle-level community health workers in underdeveloped countries, is designed to help such workers present the topic of diarrhea treatment and prevention in training courses. Divided into five sections, the booklet gives guidelines on treatment and prevention, with particular emphasis on the…

  16. Prevention of comorbidity and acute attack of gout by uric acid lowering therapy.

    PubMed

    Joo, Kowoon; Kwon, Seong-Ryul; Lim, Mie-Jin; Jung, Kyong-Hee; Joo, Hoyeon; Park, Won

    2014-05-01

    The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA≥6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.

  17. Anti-inflammatory and antioxidant effects of Aloe saponaria Haw in a model of UVB-induced paw sunburn in rats.

    PubMed

    Silva, Mariane Arnoldi; Trevisan, Gabriela; Hoffmeister, Carin; Rossato, Mateus Fortes; Boligon, Aline Augusti; Walker, Cristiani Isabel Banderò; Klafke, Jonatas Zeni; Oliveira, Sara Marchesan; Silva, Cássia Regina; Athayde, Margareth Linde; Ferreira, Juliano

    2014-04-05

    Ultraviolet B (UVB) irradiation mainly affects biological tissues by inducing an increase in reactive oxygen species (ROS) production which leads to deleterious outcomes for the skin, including pain and inflammation. As a protective strategy, many studies have focused on the use of natural products. The aim of this study was to investigate the effects of Aloe saponaria on nociceptive, inflammatory, and oxidative parameters in a model of UVB-induced sunburn in adult male Wistar rats. Sunburned animals were topically treated with vehicle (base cream), 1% silver sulfadiazine (positive control) or A. saponaria (10%) once a day for 6days. UVB-induced nociception (allodynia and hyperalgesia), inflammation (edema and leukocyte infiltration) and oxidative stress (increases in H2O2, protein carbonyl levels and lipid peroxidation and a decrease in non protein thiol content) were reduced by both A. saponaria and sulfadiazine topical treatment. Furthermore, A. saponaria or its constituents aloin and rutin reduced the oxidative stress induced by H2O2 in skin homogenates in vitro. Our results demonstrate that topical A. saponaria treatment displayed anti-nociceptive and anti-inflammatory effects in a UVB-induced sunburn model, and these effects seem to be related to its antioxidant components.

  18. [Probiotics, prebiotics and zinc in the therapy and prevention of acute infectious diarrhoea in children: state of the art].

    PubMed

    Salvatore, S; Luini, C; Arrigo, S; Salmaso, M; Morando, L; Nespoli, L; Vandenplas, Y

    2007-12-01

    Selected probiotics (mainly Lactobacilli, and particularly LGG, and Saccharomyces boulardii) have recently demonstrated a therapeutic efficacy in acute diarrhoea, if used in the early phase of infection and at high concentration. Further data are needed to clarify their effect for prevention and travellers' diarrhoea. The mechanisms of action of probiotics need to be fully elucidated but seem to include a complex interaction of epithelial, molecular, metabolic and immune responses. There is an increasing evidence that different micro-organisms show different properties and efficacy. An accurate identification and selection of the strains, the dose and the patients are thus crucial for a correct therapeutic approach. Prebiotics can modify the intestinal flora and interact with the immune system of the host against specific pathogens. However, clinical trials are currently limited and a beneficial effect of prebiotics in acute diarrhoea is still lacking. In developing countries zinc supplementation demonstrated a significant reduction of fecal excretion, duration, severity and persistency of diarrhoea. Moreover, zinc may improve immune status, intestinal permeability, epithelial and enzymatic functions, and transport of electrolytes. The use of zinc in addition to oral rehydration solution (ORS) could thus theoretically improve the treatment and reduce the complications of diarrhoea worldwide. However, in developed countries, no trial using zinc supplementation in patients with acute diarrhoea has been published yet and the cost-benefit ratio of zinc supplementation needs to be assessed.

  19. Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

    PubMed

    Wilkinson, Krista; Gravel, Denise; Taylor, Geoffrey; McGeer, Allison; Simor, Andrew; Suh, Kathryn; Moore, Dorothy; Kelly, Sharon; Boyd, David; Mulvey, Michael; Mounchili, Aboubakar; Miller, Mark

    2011-04-01

    Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  20. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier.

    PubMed Central

    Ellsworth, A. J.; Meyer, E. F.; Larson, E. B.

    1991-01-01

    Eighteen climbers actively ascended Mount Rainier (elevation 4,392 m) twice during a randomized, double-blind, concurrent, placebo-controlled, crossover trial comparing the use of acetazolamide, 250 mg, dexamethasone, 4 mg, and placebo every 8 hours as prophylaxis for acute mountain sickness. Each subject was randomly assigned to receive placebo during one ascent and one of the active medications during the other ascent. Assessment of acute mountain sickness was performed using the Environmental Symptoms Questionnaire and a clinical interview. At the summit or high point attained above base camp, the use of dexamethasone significantly reduced the incidence of acute mountain sickness and the severity of symptoms. Cerebral and respiratory symptom severity scores for subjects receiving dexamethasone (0.26 +/- 0.16 and 0.20 +/- 0.19, respectively) were significantly lower than similar scores for both acetazolamide (0.80 +/- 0.80 and 1.20 +/- 1.05; P = 0.25) and placebo (1.11 +/- 1.02 and 1.45 +/- 1.27; P = .025). Neither the use of dexamethasone nor that of acetazolamide measurably affected other physical or mental aspects. Compared with placebo, dexamethasone appears to be effective for prophylaxis of symptoms associated with acute mountain sickness accompanying rapid ascent. The precise role of dexamethasone for the prophylaxis of acute mountain sickness is not known, but it can be considered for persons without contraindications who are intolerant of acetazolamide, for whom acetazolamide is ineffective, or who must make forced, rapid ascent to high altitude for a short period of time with a guaranteed retreat route. PMID:2028586

  1. Acetazolamide or dexamethasone use versus placebo to prevent acute mountain sickness on Mount Rainier.

    PubMed

    Ellsworth, A J; Meyer, E F; Larson, E B

    1991-03-01

    Eighteen climbers actively ascended Mount Rainier (elevation 4,392 m) twice during a randomized, double-blind, concurrent, placebo-controlled, crossover trial comparing the use of acetazolamide, 250 mg, dexamethasone, 4 mg, and placebo every 8 hours as prophylaxis for acute mountain sickness. Each subject was randomly assigned to receive placebo during one ascent and one of the active medications during the other ascent. Assessment of acute mountain sickness was performed using the Environmental Symptoms Questionnaire and a clinical interview. At the summit or high point attained above base camp, the use of dexamethasone significantly reduced the incidence of acute mountain sickness and the severity of symptoms. Cerebral and respiratory symptom severity scores for subjects receiving dexamethasone (0.26 +/- 0.16 and 0.20 +/- 0.19, respectively) were significantly lower than similar scores for both acetazolamide (0.80 +/- 0.80 and 1.20 +/- 1.05; P = 0.25) and placebo (1.11 +/- 1.02 and 1.45 +/- 1.27; P = .025). Neither the use of dexamethasone nor that of acetazolamide measurably affected other physical or mental aspects. Compared with placebo, dexamethasone appears to be effective for prophylaxis of symptoms associated with acute mountain sickness accompanying rapid ascent. The precise role of dexamethasone for the prophylaxis of acute mountain sickness is not known, but it can be considered for persons without contraindications who are intolerant of acetazolamide, for whom acetazolamide is ineffective, or who must make forced, rapid ascent to high altitude for a short period of time with a guaranteed retreat route.

  2. Lycopene treatment prevents hematological, reproductive and histopathological damage induced by acute zearalenone administration in male Swiss mice.

    PubMed

    Boeira, Silvana Peterini; Filho, Carlos Borges; Del'Fabbro, Lucian; Roman, Silvane Souza; Royes, Luiz Fernando Freire; Fighera, Michele Rechia; Jessé, Cristiano Ricardo; Oliveira, Mauro Schneider; Furian, Ana Flávia

    2014-07-01

    Zearalenone (ZEA) is a mycotoxin commonly found as a contaminant in cereals. ZEA toxicity targets mainly the reproductive system, and oxidative stress plays an etiological role in its toxic effects. Therefore, the present study aimed to investigate the effect of lycopene, a potent carotenoid antioxidant, on markers of oxidative stress in liver, kidney and testes, and on reproductive, hematological and histopathological parameters after ZEA administration. Adult Swiss albino male mice received lycopene (20mg/kg, p.o.) for ten days before a single oral administration of ZEA (40mg/kg, p.o.), and 48h thereafter tissues (liver, kidney, testes and blood) were collected for biochemical, hematological and histological analyses. Lycopene prevented ZEA-induced changes in hematological parameters (increased number of leukocytes, segmented neutrophils, sticks, eosinophils and monocytes and decreased number of red blood cells (RBC), number of lymphocytes and platelets). Moreover, lycopene prevented the reduction in the number and motility of spermatozoa and the testicular tissue damage induced by ZEA. In addition, lycopene prevented the decrease in glutathione-S-transferase activity in kidney and testes and increased glutathione-S-transferase activity per se in the liver, kidneys and testes as well as superoxide dismutase activity in the liver. In summary, lycopene was able to prevent ZEA-induced acute toxic effects in male mice, suggesting that this antioxidant carotenoid may represent a promising prophylactic strategy against ZEA toxicity.

  3. Design of clinical trials in acute kidney injury: a report from an NIDDK workshop--prevention trials.

    PubMed

    Okusa, Mark D; Molitoris, Bruce A; Palevsky, Paul M; Chinchilli, Vernon M; Liu, Kathleen D; Cheung, Alfred K; Weisbord, Steven D; Faubel, Sarah; Kellum, John A; Wald, Ron; Chertow, Glenn M; Levin, Adeera; Waikar, Sushrut S; Murray, Patrick T; Parikh, Chirag R; Shaw, Andrew D; Go, Alan S; Chawla, Lakhmir S; Kaufman, James S; Devarajan, Prasad; Toto, Robert M; Hsu, Chi-yuan; Greene, Tom H; Mehta, Ravindra L; Stokes, John B; Thompson, Aliza M; Thompson, B Taylor; Westenfelder, Christof S; Tumlin, James A; Warnock, David G; Shah, Sudhir V; Xie, Yining; Duggan, Emily G; Kimmel, Paul L; Star, Robert A

    2012-05-01

    AKI is an important clinical problem that has become increasingly more common. Mortality rates associated with AKI remain high despite advances in supportive care. Patients surviving AKI have increased long-term mortality and appear to be at increased risk of developing CKD and progressing to ESRD. No proven effective pharmacologic therapies are currently available for the prevention or treatment of AKI. Advances in addressing this unmet need will require the development of novel therapeutic agents based on precise understanding of key pathophysiological events and the implementation of well designed clinical trials. To address this need, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored the "Clinical Trials in Acute Kidney Injury: Current Opportunities and Barriers" workshop in December 2010. The event brought together representatives from academia, industry, the National Institutes of Health, and the US Food and Drug Administration. We report the discussions of workgroups that developed outlines of clinical trials for the prevention of AKI in two patient populations: patients undergoing elective surgery who are at risk for or who develop AKI, and patients who are at risk for contrast-induced AKI. In both of these populations, primary prevention or secondary therapy can be delivered at an optimal time relative to kidney injury. The workgroups detailed primary and secondary endpoints for studies in these groups, and explored the use of adaptive clinical trial designs for trials of novel preventive strategies to improve outcomes of patients with AKI.

  4. The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study.

    PubMed

    Ireland, Sandra; Kirkpatrick, Helen; Boblin, Sheryl; Robertson, Kim

    2013-05-01

    Globally, falls are the second leading cause of unintentional injury. In Canada, falls that occur in hospitals have been ranked second as an area of patient safety concern. Many Canadian hospitals seeking to achieve patient safety, accreditation and resource containment goals are implementing evidence-based practices in fall prevention. However, best practices are reported to be only variably effective in reducing hospital fall rates, indicating a potential gap in our understanding of the implementation process. This study was designed to provide insight into the real world of implementation of best practices in fall prevention in acute care Canadian hospitals. Using case study methodology, ninety-five administrative and point-of-care nurses at three hospitals participated in interviews or focus groups and provided documents and artifacts that described their implementation of a falls prevention guideline. Four recommendations with potential to guide others in fall prevention were identified: (1) the need to listen to and recognize the expertise and clinical realities of staff, (2) the importance of keeping the implementation process simple, (3) the need to recognize that what seems simple becomes complex when meeting individual patient needs, and (4) the need to view the process as one of continuous quality improvement. © Sigma Theta Tau International.

  5. Prebiotics in healthy infants and children for prevention of acute infectious diseases: a systematic review and meta-analysis.

    PubMed

    Lohner, Szimonetta; Küllenberg, Daniela; Antes, Gerd; Decsi, Tamás; Meerpohl, Joerg J

    2014-08-01

    Prebiotics, defined as nondigestible dietary ingredients resistant to gastric acidity and fermented by the intestinal flora, are used to positively influence the composition of intestinal flora, thereby promoting health benefits. The objective of this systematic review was to assess the efficacy of prebiotics in the prevention of acute infectious diseases in children. A systematic literature search was conducted using the Ovid Medline, Scopus, Web of Science, and Cochrane Library's Central databases. Finally, five randomized controlled trials, all of them investigating infants and children 0-24 months of age, were included in the review. Pooled estimates from three studies revealed a statistically significant decrease in the number of infectious episodes requiring antibiotic therapy in the prebiotic group as compared with the placebo group (rate ratio 0.68; 95% confidence interval 0.61-0.77). Studies available indicate that prebiotics may also be effective in decreasing the rate of overall infections in infants and children 0-24 months of age. Further studies in the age group 3-18 years are required to determine whether prebiotics can be considered for the prevention of acute infectious diseases in the older pediatric population.

  6. Affinity maturation of a broadly neutralizing human monoclonal antibody that prevents acute hepatitis C virus infection in mice.

    PubMed

    Keck, Zhen-Yong; Wang, Yong; Lau, Patrick; Lund, Garry; Rangarajan, Sneha; Fauvelle, Catherine; Liao, Grant C; Holtsberg, Frederick W; Warfield, Kelly L; Aman, M Javad; Pierce, Brian G; Fuerst, Thomas R; Bailey, Justin R; Baumert, Thomas F; Mariuzza, Roy A; Kneteman, Norman M; Foung, Steven K H

    2016-12-01

    Direct-acting antivirals (DAAs) have led to a high cure rate in treated patients with chronic hepatitis C virus (HCV) infection, but this still leaves a large number of treatment failures secondary to the emergence of resistance-associated variants (RAVs). To increase the barrier to resistance, a complementary strategy is to use neutralizing human monoclonal antibodies (HMAbs) to prevent acute infection. However, earlier efforts with the selected antibodies led to RAVs in animal and clinical studies. Therefore, we identified an HMAb that is less likely to elicit RAVs for affinity maturation to increase potency and, more important, breadth of protection. Selected matured antibodies show improved affinity and neutralization against a panel of diverse HCV isolates. Structural and modeling studies reveal that the affinity-matured HMAb mediates virus neutralization, in part, by inducing conformational change to the targeted epitope, and that the maturated light chain is responsible for the improved affinity and breadth of protection. A matured HMAb protected humanized mice when challenged with an infectious HCV human serum inoculum for a prolonged period. However, a single mouse experienced breakthrough infection after 63 days when the serum HMAb concentration dropped by several logs; sequence analysis revealed no viral escape mutation. The findings suggest that a single broadly neutralizing antibody can prevent acute HCV infection without inducing RAVs and may complement DAAs to reduce the emergence of RAVs. (Hepatology 2016;64:1922-1933). © 2016 by the American Association for the Study of Liver Diseases.

  7. Resident dendritic cells prevent postischemic acute renal failure by help of single Ig IL-1 receptor-related protein.

    PubMed

    Lech, Maciej; Avila-Ferrufino, Alejandro; Allam, Ramanjaneyulu; Segerer, Stephan; Khandoga, Alexander; Krombach, Fritz; Garlanda, Cecilia; Mantovani, Alberto; Anders, Hans-Joachim

    2009-09-15

    Ischemia-reperfusion (IR) triggers tissue injury by activating innate immunity, for example, via TLR2 and TLR4. Surprisingly, TLR signaling in intrinsic renal cells predominates in comparison to intrarenal myeloid cells in the postischemic kidney. We hypothesized that immune cell activation is specifically suppressed in the postischemic kidney, for example, by single Ig IL-1-related receptor (SIGIRR). SIGIRR deficiency aggravated postischemic acute renal failure in association with increased renal CXCL2/MIP2, CCL2/MCP-1, and IL-6 mRNA expression 24 h after IR. Consistent with this finding interstitial neutrophil and macrophage counts were increased and tubular cell necrosis was aggravated in Sigirr-deficient vs wild-type IR kidneys. In vivo microscopy revealed increased leukocyte transmigration in the postischemic microvasculature of Sigirr-deficient mice. IL-6 and CXCL2/MIP2 release was much higher in Sigirr-deficient renal myeloid cells but not in Sigirr-deficient tubular epithelial cells after transient hypoxic culture conditions. Renal IR studies with chimeric mice confirmed this finding, as lack of SIGIRR in myeloid cells largely reproduced the phenotype of renal IR injury seen in Sigirr(-/-) mice. Additionally, clodronate depletion of dendritic cells prevented the aggravated renal failure in Sigirr(-/-) mice. Thus, loss of function mutations in the SIGIRR gene predispose to acute renal failure because SIGIRR prevents overshooting tissue injury by suppressing the postischemic activation of intrarenal myeloid cells.

  8. Chronic Desipramine Prevents Acute Stress-Induced Reorganization of Medial Prefrontal Cortex Architecture by Blocking Glutamate Vesicle Accumulation and Excitatory Synapse Increase

    PubMed Central

    Treccani, Giulia; Liebenberg, Nico; Chen, Fenghua; Popoli, Maurizio; Wegener, Gregers; Nyengaard, Jens Randel

    2015-01-01

    Background: Although a clear negative influence of chronic exposure to stressful experiences has been repeatedly demonstrated, the outcome of acute stress on key brain regions has only just started to be elucidated. Although it has been proposed that acute stress may produce enhancement of brain plasticity and that antidepressants may prevent such changes, we still lack ultrastructural evidence that acute stress-induced changes in neurotransmitter physiology are coupled with structural synaptic modifications. Methods: Rats were pretreated chronically (14 days) with desipramine (10mg/kg) and then subjected to acute foot-shock stress. By means of serial section electron microscopy, the structural remodeling of medial prefrontal cortex glutamate synapses was assessed soon after acute stressor cessation and stress hormone levels were measured. Results: Foot-shock stress induced a remarkable increase in the number of docked vesicles and small excitatory synapses, partially and strongly prevented by desipramine pretreatment, respectively. Acute stress-induced corticosterone elevation was not affected by drug treatment. Conclusions: Since desipramine pretreatment prevented the stress-induced structural plasticity but not the hormone level increase, we hypothesize that the preventing action of desipramine is located on pathways downstream of this process and/or other pathways. Moreover, because enhancement of glutamate system remodeling may contribute to overexcitation dysfunctions, this aspect could represent a crucial component in the pathophysiology of stress-related disorders. PMID:25522419

  9. The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients.

    PubMed

    Fil, Ayla; Armutlu, Kadriye; Atay, Ahmet Ozgur; Kerimoglu, Ulku; Elibol, Bulent

    2011-01-01

    To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. A prospective randomized controlled trial. Intensive care unit and inpatient clinics of neurology in a university hospital. Forty-eight patients with acute stroke, divided equally into control and study groups. Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.

  10. Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity

    PubMed Central

    Katsinelos, Panagiotis; Kountouras, Jannis; Paroutoglou, George; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Zavos, Christos; Katsinelos, Taxiarchis; Papaziogas, Basilis

    2006-01-01

    AIM: To investigate the efficacy of topical application of 0.5% nifedipine ointment in healing acute anal fissue and preventing its progress to chronicity. METHODS: Thirty-one patients (10 males, 21 females) with acute anal fissure from September 1999 to January 2005 were treated topically with 0.5% nifedipine ointment (t.i.d.) for 8 wk. The patients were encouraged to follow a high-fiber diet and assessed at 2, 4 and 8 wk post-treatment. The healing of fissure and any side effects were recorded. The patients were subsequently followed up in the outpatient clinic for one year and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred. RESULTS: Twenty-seven of the 31 patients completed the 8-wk treatment course, of them 23 (85.2%) achieved a complete remission indicated by resolution of symptoms and healing of fissure. Of the remaining four unhealed patients (14.8%), 2 opted to undergo lateral sphincterotomy and the other 2 to continue therapy for four additional weeks, resulting in healing of fissure. All the 25 patients with complete remission had a mean follow-up of 22.9 ± 14 (range 6-52) mo. Recurrence of symptoms occurred in four of these 25 patients (16%) who were successfully treated with an additional 4-wk course of 0.5% nifedipine ointment. Two of the 27 (7.4%) patients who completed the 8-wk treatment presented with moderate headache as a side effect of nifedipine. CONCLUSION: Topical 0.5% nifedipine ointment, used as an agent in chemical sphincterotomy, appears to offer a significant healing rate for acute anal fissure and might prevent its evolution to chronicity. PMID:17036396

  11. Intravenous Immunoglobulin Prevents Murine Antibody-Mediated Acute Lung Injury at the Level of Neutrophil Reactive Oxygen Species (ROS) Production

    PubMed Central

    Semple, John W.; Kim, Michael; Hou, Jing; McVey, Mark; Lee, Young Jin; Tabuchi, Arata; Kuebler, Wolfgang M.; Chai, Zhong-Wei; Lazarus, Alan H.

    2012-01-01

    Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality that can occur with any type of transfusion and is thought to be primarily due to donor antibodies activating pulmonary neutrophils in recipients. Recently, a large prospective case controlled clinical study of cardiac surgery patients demonstrated that despite implementation of male donors, a high incidence of TRALI still occurred and suggested a need for additional interventions in susceptible patient populations. To examine if intravenous immunoglobulin (IVIg) may be effective, a murine model of antibody-mediated acute lung injury that approximates human TRALI was examined. When BALB/c mice were injected with the anti-major histocompatibility complex class I antibody 34-1-2s, mild shock (reduced rectal temperature) and respiratory distress (dyspnea) were observed and pre-treatment of the mice with 2 g/kg IVIg completely prevented these symptoms. To determine IVIg's usefulness to affect severe lung damage, SCID mice, previously shown to be hypersensitive to 34-1-2s were used. SCID mice treated with 34-1-2s underwent severe shock, lung damage (increased wet/dry ratios) and 40% mortality within 2 hours. Treatment with 2 g/kg IVIg 18 hours before 34-1-2s administration completely protected the mice from all adverse events. Treatment with IVIg after symptoms began also reduced lung damage and mortality. While the prophylactic IVIg administration did not affect 34-1-2s-induced pulmonary neutrophil accumulation, bone marrow-derived neutrophils from the IVIg-treated mice displayed no spontaneous ROS production nor could they be stimulated in vitro with fMLP or 34-1-2s. These results suggest that IVIg prevents murine antibody-mediated acute lung injury at the level of neutrophil ROS production and thus, alleviating tissue damage. PMID:22363629

  12. Severe acute dehydration in a desert rodent elicits a transcriptional response that effectively prevents kidney injury.

    PubMed

    MacManes, Matthew David

    2017-08-01

    Animals living in desert environments are forced to survive despite severe heat, intense solar radiation, and both acute and chronic dehydration. These animals have evolved phenotypes that effectively address these environmental stressors. To begin to understand the ways in which the desert-adapted rodent Peromyscus eremicus survives, reproductively mature adults were subjected to 72 h of water deprivation, during which they lost, on average, 23% of their body weight. The animals reacted via a series of changes in the kidney, which included modulating expression of genes responsible for reducing the rate of transcription and maintaining water and salt balance. Extracellular matrix turnover appeared to be decreased, and apoptosis was limited. In contrast to the canonical human response, serum creatinine and other biomarkers of kidney injury were not elevated, suggesting that changes in gene expression related to acute dehydration may effectively prohibit widespread kidney damage in the cactus mouse. Copyright © 2017 the American Physiological Society.

  13. [Probiotics for the treating acute diarrhea and preventing antibiotic-associated diarrhea in children].

    PubMed

    Pérez, Carlos

    2015-02-07

    Probiotics are helpful in the treatment of acute diarrhea. Several systematic reviews show that the use of probiotics shortens the duration of diarrhea in one day and reduces by 59% the risk of diarrhea lasting longer than 4 days. Hospital stay is 24 hours shorter in children treated with probiotics. The benefitial effect of probiotics is species-specific; Lactobacillus rhamnosus GG and Saccharomyces boulardii are the two species with proven efficacy in the treatment of acute diarrhea. The use of probiotics reduces by 50% the risk of antibiotic-associated diarrhea. No significant side effects were found in the clinical trials but rare cases of invasive infections have been reported in immunosuppressed children or those with indwelling central venous catheters.

  14. Infection prevention and control measures for acute respiratory infections in healthcare settings: an update.

    PubMed

    Seto, W H; Conly, J M; Pessoa-Silva, C L; Malik, M; Eremin, S

    2013-01-01

    Viruses account for the majority of the acute respiratory tract infections (ARIs) globally with a mortality exceeding 4 million deaths per year. The most commonly encountered viruses, in order of frequency, include influenza, respiratory syncytial virus, parainfluenza and adenovirus. Current evidence suggests that the major mode of transmission of ARls is through large droplets, but transmission through contact (including hand contamination with subsequent self-inoculation) and infectious respiratory aerosols of various sizes and at short range (coined as "opportunistic" airborne transmission) may also occur for some pathogens. Opportunistic airborne transmission may occur when conducting highrisk aerosol generating procedures and airborne precautions will be required in this setting. General infection control measures effective for all respiratory viral infections are reviewed and followed by discussion on some of the common viruses, including severe acute respiratory syndrome (SARS) coronavirus and the recently discovered novel coronavirus.

  15. Preventive Effect of Cichorium Intybus L. Two Extracts on Cerulein-induced Acute Pancreatitis in Mice

    PubMed Central

    Minaiyan, Mohsen; Ghannadi, Ali-Reza; Mahzouni, Parvin; Abed, Ali-Reza

    2012-01-01

    Objectives: Acute pancreatitis is an inflammatory condition of pancreas with sudden onset, high mortality rate and multiple organ failure characteristics. It has been shown that oxygen free radicals have an important role in development of pancreatitis and its complications. Antioxidant, anti-inflammatory, anti-hepatotoxicity and gastroprotective properties of Cichorium intybus L. suggest that this plant may have beneficial effects in the management of acute pancreatitis. Methods: Five intraperitoneal (i.p.) injection of cerulean (50 μg/ kg at 1 h intervals) in mice resulted in acute pancreatitis, which was characterized by edema, neutrophil infiltration, as well as increases in the serum levels of amylase and lipase in comparison to normal mice. Different doses of C. intybus root (CRE) and aerial parts hydroalcoholic extract (CAPE) orally (50, 100, 200 mg/kg) and intraperitoneally (50, 100, 200 mg/kg) were administrated 1.0 and 0.5 h respectively before pancreatitis induction on separate groups of male mice (n=6). Control groups treated with normal saline (5 ml/ kg) similarly. Results: Both extracts in greater test doses (100 mg/kg and 200 mg/kg, i.p.) were effective to decrease amylase (23-36%) and lipase (27-35%) levels. In oral route, the dose of 200 mg/ kg showed a significant decrease in levels of amylase (16%) and lipase (24%) activity while the greatest dose (200 mg/kg, i.p.) was only effective to diminish inflammatory features like edema and leukocyte infiltration in pancreatitis tissue (P<0.01). Vacuolization was not significantly reduced in extracts treated groups. Conclusions: These data suggest that C. intybus hydroalcoholic extracts were effective to protect against experimental acute pancreatitis and the efficacy was partly dependent to the dose and was more significant after parenteral administration. PMID:22708031

  16. Prevention

    Treesearch

    Kerry Britton; Barbara Illman; Gary Man

    2010-01-01

    Prevention is considered the most cost-effective element of the Forest Service Invasive Species Strategy (USDA Forest Service 2004). What makes prevention difficult is the desire to maximize free trade and the resulting benefits to society while, at the same time, protecting natural resources. The role of science is to first identify which commodities pose an...

  17. Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals.

    PubMed

    Lahmann, Nils A; Halfens, Ruud J G; Dassen, Theo

    2010-02-01

    The study aimed to give a description analysis of pressure ulcer-related structures, processes and outcomes in nursing homes and acute-care hospitals that participated once, twice and thrice in prevalence surveys. Repeated nationwide, multicentre, cross sectional surveys have been conducted. A total of 7377 residents in 60 nursing homes and 28,102 patients in 82 acute-care hospitals in Germany participated in annual point prevalence surveys. Because of their strong differences in sampling and in order to be able to display the differences occurring during the repeated (first, second and third) participation of the institutions, they were arranged according to their frequency and order of participation. The percentage of used guidelines and risk assessment scales (structures), prevention devices and measures (processes), and prevalence and nosocomial prevalence (outcomes) among all persons at risk was calculated. The samples within the arranged groups showed no clinically relevant demographical differences. Nosocomial prevalence rates in hospitals dropped from 26.3% in the first year to 11.3% in the last year (nursing homes from 13.7% to 6.4%). The use of pressure ulcer-related structures remarkably increased during each repetition to more than 90%. Regarding the use of preventive measures and devices as an indicator for pressure ulcer-related processes results were more incoherent. Repeated participation in pressure ulcer surveys led to a decrease in outcomes (lower pressure ulcer prevalence rates), to high opposite effects regarding pressure ulcer-related structures (increased use of all guidelines/risk assessment scales) and to moderate adverse effects regarding pressure ulcer-related processes (increased use of most preventive measures and devices).

  18. Acute hepatitis A in Italy: incidence, risk factors and preventive measures.

    PubMed

    Tosti, M E; Spada, E; Romanò, L; Zanetti, A; Mele, A

    2008-10-01

    The incidence of, and risk factors for, acute hepatitis A (AHA) were assessed by using data collected from the Italian surveillance system of acute viral hepatitis (SEIEVA). To this end, a case-control study within a population-based surveillance for acute viral hepatitis was performed. AHA incidence has been estimated since 1991; the association with considered risk factors was analysed from 2001 to 2006 employing cases of acute hepatitis B (AHB) as controls. The incidence of AHA declined from 4 / 100 000 in 1991 to 1.4/100 000 in 2006, with a peak during 1996-1998 due to an outbreak in southern Italy. The incidence of AHA was highest among persons aged 15-24 years. The case-fatality rate was 2.9 / 10 000. Contact with individuals with AHA [adjusted OR (OR(adj)) = 3.8, 95% CI 2.7-5.5; population-attributable risk (PAR) = 7.5%], travelling to endemic areas (OR(adj) = 3.1, 95% CI = 2.6-3.8; PAR = 19.5%), ingestion of raw shellfish (OR(adj) = 1.8, 95% CI = 1.6-2.1; PAR = 26.6%), and cohabitation with day care children (OR(adj) = 1.3, 95% CI = 1.01-1.7; PAR = 2.3%) were the main important risk factors. In 2003, an outbreak, with high case-fatality rate occurred among intravenous drug users, in a central Italian town. A weak association was found for male homosexuality when acute hepatitis C cases were employed as controls (OR(adj) = 1.4 CI, 95% CI = 1.1-1.9). Hepatitis A virus infections are currently occurring more frequently in adults, in whom the disease is most severe. In conclusion, looking at the attributable risks, at present most of the AHA infections are due to shellfish consumption, travel to endemic areas and contact with patients with AHA. Vaccination of individuals at increased risk of infection, as well as persons with underling liver disease and those at increased risk of complications, combined with surveillance of shellfish retail outlets are efficient control measures.

  19. Bcl-2 overexpression in type II epithelial cells does not prevent hyperoxia-induced acute lung injury in mice.

    PubMed

    Métrailler-Ruchonnet, Isabelle; Pagano, Alessandra; Carnesecchi, Stéphanie; Khatib, Karim; Herrera, Pedro; Donati, Yves; Bron, Camille; Barazzone, Constance

    2010-09-01

    Bcl-2 is an anti-apoptotic molecule preventing oxidative stress damage and cell death. We have previously shown that Bcl-2 is able to prevent hyperoxia-induced cell death when overexpressed in a murine fibrosarcoma cell line L929. We hypothesized that its specific overexpression in pulmonary epithelial type II cells could prevent hyperoxia-induced lung injury by protecting the epithelial side of the alveolo-capillary barrier. In the present work, we first showed that in vitro Bcl-2 can rescue murine pulmonary epithelial cells (MLE12) from oxygen-induced cell apoptosis, as shown by analysis of LDH release, annexin V/propidium staining, and caspase-3 activity. We then generated transgenic mice overexpressing specifically Bcl-2 in lung epithelial type II cells under surfactant protein C (SP-C) promoter (Tg-Bcl-2) and exposed them to hyperoxia. Bcl-2 did not hinder hyperoxia-induced mitochondria and DNA oxidative damage of type II cell in vivo. Accordingly, lung damage was identical in both Tg-Bcl-2 and littermate mice strains, as measured by lung weight, bronchoalveolar lavage, and protein content. Nevertheless, we observed a significant lower number of TUNEL-positive cells in type II cells isolated from Tg-Bcl-2 mice exposed to hyperoxia compared with cells isolated from littermate mice. In summary, these results show that although Bcl-2 overexpression is able to prevent hyperoxia-induced cell death at single cell level in vitro and ex vivo, it is not sufficient to prevent cell death of parenchymal cells and to protect the lung from acute damage in mice.

  20. Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis.

    PubMed

    Luo, Jian; Wang, Mao-yun; Zhu, Hui; Liang, Bin-miao; Liu, Dan; Peng, Xia-ying; Wang, Rong-chun; Li, Chun-tao; He, Chen-yun; Liang, Zong-an

    2014-11-01

    The role of non-invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed- and random-effects models were used to calculate pooled relative risks. This meta-analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44-0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45-1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17-1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra-pulmonary, and neither showed statistical heterogeneity (I(2)  = 0%, χ(2)  = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35-9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients. © 2014 Asian Pacific Society of Respirology.

  1. Follow-up research in primary prevention: a model of adjustment in acute grief.

    PubMed

    Williams, W V; Polak, P R

    1979-01-01

    Investigated the effects of preventive intervention that followed the life crisis of sudden death in the family. Two bereaved groups of families (one of which received preventive intervention service) and one non-bereaved group were compared in an outcome design and were assessed for indices of illness, psycho-social disturbance, and general quality of life. The results revealed that sudden death has a two-stage impact upon family survivors and that subsequent adjustment can be predicted from a knowledge of facts at the time of death. A preventive intervention service had little or no impact and may have been harmful. Discussion centered on possible intervention strategies with a focus upon the complex determinants of environmental stresses and family/individual variables.

  2. AT1 receptor antagonism before ischemia prevents the transition of acute kidney injury to chronic kidney disease.

    PubMed

    Rodríguez-Romo, Roxana; Benítez, Kenia; Barrera-Chimal, Jonatan; Pérez-Villalva, Rosalba; Gómez, Arturo; Aguilar-León, Diana; Rangel-Santiago, Jesús F; Huerta, Sara; Gamba, Gerardo; Uribe, Norma; Bobadilla, Norma A

    2016-02-01

    Despite clinical recovery of patients from an episode of acute kidney injury (AKI), progression to chronic kidney disease (CKD) is possible on long-term follow-up. However, mechanisms of this are poorly understood. Here, we determine whether activation of angiotensin-II type 1 receptors during AKI triggers maladaptive mechanisms that lead to CKD. Nine months after AKI, male Wistar rats develop CKD characterized by renal dysfunction, proteinuria, renal hypertrophy, glomerulosclerosis, tubular atrophy, and tubulointerstitial fibrosis. Renal injury was associated with increased oxidative stress, inflammation, α-smooth muscle actin expression, and activation of transforming growth factor β; the latter mainly found in epithelial cells. Although administration of losartan prior to the initial ischemic insult did not prevent or reduce AKI severity, it effectively prevented eventual CKD. Three days after AKI, renal dysfunction, tubular structural injury, and elevation of urinary biomarkers were present. While the losartan group had similar early renal injury, renal perfusion was completely restored as early as day 3 postischemia. Further, there was increased vascular endothelial growth factor expression and an early activation of hypoxia-inducible factor 1 α, a transcription factor that regulates expression of many genes that help reduce renal injury. Thus, AT1 receptor antagonism prior to ischemia prevented AKI to CKD transition by improving early renal blood flow recovery, lesser inflammation, and increased hypoxia-inducible factor 1 α activity.

  3. A randomized, placebo-controlled trial of patient education for acute low back pain (PREVENT Trial): statistical analysis plan.

    PubMed

    Traeger, Adrian C; Skinner, Ian W; Hübscher, Markus; Lee, Hopin; Moseley, G Lorimer; Nicholas, Michael K; Henschke, Nicholas; Refshauge, Kathryn M; Blyth, Fiona M; Main, Chris J; Hush, Julia M; Pearce, Garry; Lo, Serigne; McAuley, James H

    Statistical analysis plans increase the transparency of decisions made in the analysis of clinical trial results. The purpose of this paper is to detail the planned analyses for the PREVENT trial, a randomized, placebo-controlled trial of patient education for acute low back pain. We report the pre-specified principles, methods, and procedures to be adhered to in the main analysis of the PREVENT trial data. The primary outcome analysis will be based on Mixed Models for Repeated Measures (MMRM), which can test treatment effects at specific time points, and the assumptions of this analysis are outlined. We also outline the treatment of secondary outcomes and planned sensitivity analyses. We provide decisions regarding the treatment of missing data, handling of descriptive and process measure data, and blinded review procedures. Making public the pre-specified statistical analysis plan for the PREVENT trial minimizes the potential for bias in the analysis of trial data, and in the interpretation and reporting of trial results. ACTRN12612001180808 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612001180808). Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Brain death provokes very acute alteration in myocardial morphology detected by echocardiography: preventive effect of beta-blockers.

    PubMed

    Ferrera, René; Hadour, Guylaine; Tamion, Fabienne; Henry, Jean-Paul; Mulder, Paul; Richard, Vincent; Thuillez, Christian; Ovize, Michel; Derumeaux, Geneviève

    2011-03-01

    Our objective was to evaluate immediate acute changes in myocardial function during the autonomic storm of brain death (BD). Wistar rats were divided into four groups (n = 8/group): controls without any treatment, β-blocker (Esmolol®, 10 mg/kg), calcium channel blocker (Diltiazem®, 10 mg/kg), or alpha-blocker (Prazosin®, 0.3 mg/kg). Treatments were administered intravenously 5 min before BD induction. Echocardiography (ATL-5000, 8 MHz) was performed to measure left ventricular (LV) dimensions and fractional shortening at baseline, during BD induction and 5 min and 15 min after BD. In controls, BD was immediately associated with an increase in wall thickness and a decrease in LV cavity dimension. This myocardial wall hypertrophy was completely prevented by β-blockers, but not with calcium- and alpha-blockers. Extensive myocardial interstitial edema was found in all groups, except in the β-blocker group. Myocardial wall hypertrophy was also prevented during a longer follow-up of 180 min after BD in β-blocker group as opposed to controls. In conclusion, BD is associated with an immediate and severe myocardial damage related to an important interstitial edema which is prevented by β-blockers.

  5. Nrf2 Activation: A potential strategy for the prevention of Acute Mountain Sickness

    PubMed Central

    Lisk, Christina; McCord, Joe; Bose, Swapan; Sullivan, Tim; Loomis, Zoe; Nozik-Grayck, Eva; Schroeder, Thies; Hamilton, Karyn; Irwin, David C.

    2014-01-01

    Introduction Reactive oxygen species (ROS) formed during acute high altitude exposure contributes to cerebral vascular leak and development of acute mountain sickness (AMS). Nuclear factor (erythroid-derived 2)-related factor 2 (Nrf2) is a transcription factor that regulates expression of greater than 90% of antioxidant genes, but prophylactic treatment with Nrf2 activators has not yet been tested as an AMS therapy. We hypothesized that prophylactic activation of the antioxidant genome with Nrf2 activators would attenuate high altitude-induced ROS formation and cerebral vascular leak, and that some drugs currently used to treat AMS symptoms have an additional trait of Nrf2 activation. Methods Drugs commonly used to treat AMS were screened with a luciferase reporter cell system for their effectiveness to activate Nrf2, as well as tested for their ability to decrease high altitude cerebral vascular leak in vivo. Compounds that showed favorable results for Nrf2 activation from our screen and attenuated high altitude cerebral vascular leak in vivo were further tested in brain microvascular endothelial cells (BMEC) to determine if they attenuated hypoxia-induced ROS production and monolayer permeability. Results Of 9 drugs tested, with the exception of dexamethasone, only drugs that showed the ability to activate Nrf2 (Protandim, methazolamide, nifedipine, amlodipine, ambrisentan, and sitaxentan) decreased high altitude-induced cerebral vascular leak in vivo. In vitro, Nrf2 activation in BMEC prior to 24 h hypoxia exposure attenuated hypoxic-induced hydrogen peroxide production and permeability. Conclusions Prophylactic Nrf2 activation is effective at reducing brain vascular leak from acute high altitude exposures. Compared to acetazolamide, methazolamide may offer better protection against AMS. Nifedipine, in addition to its known vasodilatory activities in the lung and protection against high altitude pulmonary edema, may provide protection against brain vascular leak

  6. Nrf2 activation: a potential strategy for the prevention of acute mountain sickness.

    PubMed

    Lisk, Christina; McCord, Joe; Bose, Swapan; Sullivan, Tim; Loomis, Zoe; Nozik-Grayck, Eva; Schroeder, Thies; Hamilton, Karyn; Irwin, David C

    2013-10-01

    Reactive oxygen species (ROS) formed during acute high altitude exposure contribute to cerebral vascular leak and development of acute mountain sickness (AMS). Nuclear factor (erythroid-derived 2)-related factor 2 (Nrf2) is a transcription factor that regulates expression of greater than 90% of antioxidant genes, but prophylactic treatment with Nrf2 activators has not yet been tested as an AMS therapy. We hypothesized that prophylactic activation of the antioxidant genome with Nrf2 activators would attenuate high-altitude-induced ROS formation and cerebral vascular leak and that some drugs currently used to treat AMS symptoms have an additional trait of Nrf2 activation. Drugs commonly used to treat AMS were screened with a luciferase reporter cell system for their effectiveness to activate Nrf2, as well as being tested for their ability to decrease high altitude cerebral vascular leak in vivo. Compounds that showed favorable results for Nrf2 activation from our screen and attenuated high altitude cerebral vascular leak in vivo were further tested in brain microvascular endothelial cells (BMECs) to determine if they attenuated hypoxia-induced ROS production and monolayer permeability. Of nine drugs tested, with the exception of dexamethasone, only drugs that showed the ability to activate Nrf2 (Protandim, methazolamide, nifedipine, amlodipine, ambrisentan, and sitaxentan) decreased high-altitude-induced cerebral vascular leak in vivo. In vitro, Nrf2 activation in BMECs before 24h hypoxia exposure attenuated hypoxic-induced hydrogen peroxide production and permeability. Prophylactic Nrf2 activation is effective at reducing brain vascular leak from acute high altitude exposures. Compared to acetazolamide, methazolamide may offer better protection against AMS. Nifedipine, in addition to its known vasodilatory activities in the lung and protection against high altitude pulmonary edema, may provide protection against brain vascular leak as well. Copyright © 2013

  7. Effectiveness of a Multimodal Intervention Program for Restraint Prevention in an Acute Spanish Psychiatric Ward.

    PubMed

    Guzman-Parra, Jose; Aguilera Serrano, Carlos; García-Sánchez, Juan A; Pino-Benítez, Isabel; Alba-Vallejo, Mercedes; Moreno-Küstner, Berta; Mayoral-Cleries, Fermin

    2016-05-01

    International recommendations have called to implement strategies to reduce the use of coercion in psychiatric settings. However, in Spain there is a lack of research about intervention programs to reduce mechanical restraint in acute psychiatric units. The aim of this study was to evaluate the effectiveness of a multimodal intervention program based on the principles of six core strategies to reduce the frequency of use of mechanical restraint in an acute psychiatric ward. The design was a retrospective analysis of the frequency and duration of episodes of mechanical restraint prior to the intervention program (2012) and during the intervention program (2013) in one acute psychiatric ward. The intervention was governed by four strategies: (1) leadership and organizational changes, (2) registration and monitoring of risk patients, (3) staff training, and (4) involving patients in the treatment program. There was a significant difference between the mean number of monthly episodes of mechanical restraint per 1,000 patient days, pre-intervention (18.54 ± 8.78) compared with postintervention (8.53 ± 7.00; p = .005). We found the probability that mechanical restraint would occur in a hospital admission decreased after performing the intervention (odds ratio = .587; confidence interval = 0.411-0.838; p = .003) after adjusting for confounding variables. The total percentage of restrained patients fell from 15.07% to 9.74%. The main implication of the study is to support the effectiveness of specific intervention programs based on different measures to reduce mechanical restraint and without contemplating all the strategies that are considered effective. © The Author(s) 2016.

  8. Changing Paradigms for Acute Dental Pain: Prevention Is Better Than PRN.

    PubMed

    Dionne, Raymond A; Gordon, Sharon M

    2015-11-01

    A B S T R A C T The drugs available for the management of acute orofacial pain have changed very little since the introduction of ibuprofen into practice 40 years ago. Orally effective opioids, acetaminophen, aspirin and NSAIDs remain the mainstay of analgesic therapy. Increased recognition of the societal and personal impact of opioid diversion and abuse requires re-examination of the traditional approach of prescribing an opioid-containing analgesic combination to be administered by the patient "as needed" (PRN) starting postoperatively.

  9. Pressure injury prevention strategies in acute medical inpatients: an observational study.

    PubMed

    Latimer, Sharon; Chaboyer, Wendy; Gillespie, Brigid

    2016-01-01

    Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients' pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning. An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The sample comprised adult medical inpatients with reduced mobility. A subsample of participants assessed at pressure injury risk on admission was drawn from this sample. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility. There was suboptimal planning and implementation of pressure injury prevention strategies for the sample and subsample. There was a significant relationship between planned and implemented support surfaces at both hospitals; however, no relationship existed between the planned and implemented of regular repositioning at either site. The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces; however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.

  10. O-Methylated flavonol isorhamnetin prevents acute inflammation through blocking of NF-κB activation.

    PubMed

    Yang, Ji Hye; Kim, Sang Chan; Shin, Bo Yeon; Jin, So Hee; Jo, Mi Jeong; Jegal, Kyung Hwan; Kim, Young Woo; Lee, Jong Rok; Ku, Sae Kwang; Cho, Il Je; Ki, Sung Hwan

    2013-09-01

    Here, we isolated isorhamnetin, a natural 3'-O-methylated flavonoid, from water dropwort (Oenanthe javanica, Umbelliferae) and investigated its ability to protect against acute inflammation in vivo and in vitro. To induce paw swelling, the hind paw of each rat was injected with a carrageenan 1h after vehicle or isorhamnetin treatment. In vitro effect and mechanism studies were performed in lipopolysaccharide (LPS)-activated macrophages. Administration of isorhamnetin markedly inhibited the swelling volume and the thickness of hind paws. Moreover, isorhamnetin significantly reduced inflammatory cell infiltration and pro-inflammatory gene expression in rats. Isorhamnetin pretreatment inhibited inducible nitric oxide synthase (iNOS) expression and NO release in LPS-stimulated cells. Activation of nuclear factor-kappa B (NF-κB) and activating protein-1 (AP-1) is the key step in the iNOS gene induction. Isorhamnetin specifically inhibited NF-κB luciferase activity, but not AP-1. Pretreatment with isorhamnetin suppressed NF-κB nuclear translocation in accordance with decreased phosphorylation and degradation of inhibitory-κB. Consistently, TNF-α, IL-1β and IL-6 expression, representative NF-κB target genes, were almost completely prohibited by isorhamnetin. Furthermore, isorhamnetin inhibited LPS-induced JNK and AKT/IKKα/β phosphorylation. Our results suggest that isorhamnetin inhibited JNK, and AKT/IKKα/β activation, leading to NF-κB inactivation, which might contribute to the inhibition of the acute inflammatory response.

  11. Kynurenine-3-monooxygenase inhibition prevents multiple organ failure in rodent models of acute pancreatitis.

    PubMed

    Mole, Damian J; Webster, Scott P; Uings, Iain; Zheng, Xiaozhong; Binnie, Margaret; Wilson, Kris; Hutchinson, Jonathan P; Mirguet, Olivier; Walker, Ann; Beaufils, Benjamin; Ancellin, Nicolas; Trottet, Lionel; Bénéton, Véronique; Mowat, Christopher G; Wilkinson, Martin; Rowland, Paul; Haslam, Carl; McBride, Andrew; Homer, Natalie Z M; Baily, James E; Sharp, Matthew G F; Garden, O James; Hughes, Jeremy; Howie, Sarah E M; Holmes, Duncan S; Liddle, John; Iredale, John P

    2016-02-01

    Acute pancreatitis (AP) is a common and devastating inflammatory condition of the pancreas that is considered to be a paradigm of sterile inflammation leading to systemic multiple organ dysfunction syndrome (MODS) and death. Acute mortality from AP-MODS exceeds 20% (ref. 3), and the lifespans of those who survive the initial episode are typically shorter than those of the general population. There are no specific therapies available to protect individuals from AP-MODS. Here we show that kynurenine-3-monooxygenase (KMO), a key enzyme of tryptophan metabolism, is central to the pathogenesis of AP-MODS. We created a mouse strain that is deficient for Kmo (encoding KMO) and that has a robust biochemical phenotype that protects against extrapancreatic tissue injury to the lung, kidney and liver in experimental AP-MODS. A medicinal chemistry strategy based on modifications of the kynurenine substrate led to the discovery of the oxazolidinone GSK180 as a potent and specific inhibitor of KMO. The binding mode of the inhibitor in the active site was confirmed by X-ray co-crystallography at 3.2 Å resolution. Treatment with GSK180 resulted in rapid changes in the levels of kynurenine pathway metabolites in vivo, and it afforded therapeutic protection against MODS in a rat model of AP. Our findings establish KMO inhibition as a novel therapeutic strategy in the treatment of AP-MODS, and they open up a new area for drug discovery in critical illness.

  12. Kynurenine–3–monooxygenase inhibition prevents multiple organ failure in rodent models of acute pancreatitis

    PubMed Central

    Mole, Damian J; Webster, Scott P; Uings, Iain; Zheng, Xiaozhong; Binnie, Margaret; Wilson, Kris; Hutchinson, Jonathan P; Mirguet, Olivier; Walker, Ann; Beaufils, Benjamin; Ancellin, Nicolas; Trottet, Lionel; Bénéton, Véronique; Mowat, Christopher G; Wilkinson, Martin; Rowland, Paul; Haslam, Carl; McBride, Andrew; Homer, Natalie ZM; Baily, James E; Sharp, Matthew GF; Garden, O James; Hughes, Jeremy; Howie, Sarah EM; Holmes, Duncan S; Liddle, John; Iredale, John P

    2015-01-01

    Acute pancreatitis (AP) is a common and devastating inflammatory condition of the pancreas that is considered to be a paradigm of sterile inflammation leading to systemic multiple organ dysfunction syndrome (MODS) and death1,2 Acute mortality from AP-MODS exceeds 20%3 and for those who survive the initial episode, their lifespan is typically shorter than the general population4. There are no specific therapies available that protect individuals against AP-MODS. Here, we show that kynurenine-3-monooxygenase (KMO), a key enzyme of tryptophan metabolism5, is central to the pathogenesis of AP-MODS. We created a mouse strain deficient for Kmo with a robust biochemical phenotype that protected against extrapancreatic tissue injury to lung, kidney and liver in experimental AP-MODS. A medicinal chemistry strategy based on modifications of the kynurenine substrate led to the discovery of GSK180 as a potent and specific inhibitor of KMO. The binding mode of the inhibitor in the active site was confirmed by X-ray co-crystallography at 3.2 Å resolution. Treatment with GSK180 resulted in rapid changes in levels of kynurenine pathway metabolites in vivo and afforded therapeutic protection against AP-MODS in a rat model of AP. Our findings establish KMO inhibition as a novel therapeutic strategy in the treatment of AP-MODS and open up a new area for drug discovery in critical illness. PMID:26752518

  13. Melatonin prevents acute kidney injury in severely burned rats via the activation of SIRT1

    PubMed Central

    Bai, Xiao-Zhi; He, Ting; Gao, Jian-Xin; Liu, Yang; Liu, Jia-Qi; Han, Shi-Chao; Li, Yan; Shi, Ji-Hong; Han, Jun-Tao; Tao, Ke; Xie, Song-Tao; Wang, Hong-Tao; Hu, Da-Hai

    2016-01-01

    Acute kidney injury (AKI) is a common complication after severe burns. Melatonin has been reported to protect against multiple organ injuries by increasing the expression of SIRT1, a silent information regulator that regulates stress responses, inflammation, cellular senescence and apoptosis. This study aimed to investigate the protective effects of melatonin on renal tissues of burned rats and the role of SIRT1 involving the effects. Rat severely burned model was established, with or without the administration of melatonin and SIRT1 inhibitor. The renal function and histological manifestations were determined to evaluate the severity of kidney injury. The levels of acetylated-p53 (Ac-p53), acetylated-p65 (Ac-p65), NF-κB, acetylated-forkhead box O1 (Ac-FoxO1), Bcl-2 and Bax were analyzed to study the underlying mechanisms. Our results suggested that severe burns could induce acute kidney injury, which could be partially reversed by melatonin. Melatonin attenuated oxidative stress, inflammation and apoptosis accompanied by the increased expression of SIRT1. The protective effects of melatonin were abrogated by the inhibition of SIRT1. In conclusion, we demonstrate that melatonin improves severe burn-induced AKI via the activation of SIRT1 signaling. PMID:27599451

  14. Theanine prevents doxorubicin-induced acute hepatotoxicity by reducing intrinsic apoptotic response.

    PubMed

    Nagai, Katsuhito; Oda, Ayano; Konishi, Hiroki

    2015-04-01

    Doxorubicin (DOX) is widely used as an antitumor agent with topoisomerase II inhibiting activity; however, its dosage and duration of administration have been strictly limited due to dose-related organ damage. The present study investigated whether theanine, an amino acid found in green tea leaves, could reduce DOX-induced acute hepatotoxicity and the apoptotic response in mice. Activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum, biomarkers of hepatic impairment, were markedly increased after the administration of 20 mg/kg DOX, whereas the degree of these elevations was significantly attenuated by 10 mg/kg theanine, which was consistent with histological hepatic images assessed by microscopic examination. The hepatic expression of Bax and Fas, representative intrinsic and extrinsic apoptotic molecules, respectively, was significantly increased by dosing with DOX. However, the elevation in the hepatic expression of Bax, but not Fas, was suppressed to control levels by theanine. The formation of cleaved caspase-3 protein in the group given DOX with theanine was significantly lower than that in the group treated with DOX alone. These results suggest that theanine can protect against acute hepatic damage induced by DOX, which is attributed to the suppression of intrinsic caspase-3-dependent apoptotic signaling.

  15. Skin cancer history, sun-related attitudes, behaviour and sunburn among renal transplant recipients versus general population.

    PubMed

    Leung, Vivian Ka Ying; Dobbinson, Suzanne Jane; Goodman, David Josef; Kanellis, John; Chong, Alvin Heong

    2017-03-23

    Renal transplant recipients (RTR) have both an excessive skin cancer incidence and a high mortality rate. In Australia RTR receive extensive public education on skin cancer and many undergo further education pre/post-transplant. This study examines whether RTR have sufficiently rigorous sun protection behaviour compared with the general population. Altogether 179 RTR from two large Melbourne hospitals involving skin clinic teams in patient care were recruited to undergo cross-sectional telephone interviews. Comparisons were made with residents (25-69 years) surveyed using equivalent measures and methods in adjacent summers (2006-2007, n = 904; 2010-2011, n = 942) for regular population monitoring surveys. Multivariate analyses of weekend behaviour were adjusted for related ambient temperature records. RTR were more compliant with sun protection behaviour on the weekend prior to interview than the residents surveyed. For example, for 2006-2007 and 2010-2011, the odds ratio and confidence intervals (CI 95%) were respectively: used sunscreen: 2.0 (1.1-3.8) and 2.8 (1.4-5.3); wore a long-sleeved top: 4.5 (2.4-8.5) and 3.6 (1.9-7.0). RTR sunburn prevalence (5%) appeared similar to that of residents (odds ratios comparing 2006-2007 and 2010-2011 0.6 [95% CI, 0.2-1.6] and 0.7 [95% CI, 0.3-1.9]). Despite generally good sun protection behaviour, many RTR (47%) had skin cancers treated. The intensive education of RTR may have contributed to their better sun protection. Some RTR with excessive exposure to UV radiation introduction of may benefit from implementation of further photoprotection strategies. These findings may be particularly relevant to other RTR groups receiving education about sun protection. © 2017 The Australasian College of Dermatologists.

  16. Reduced hepatic mitochondrial respiration following acute high-fat diet is prevented by PGC-1α overexpression

    PubMed Central

    Morris, E. Matthew; Jackman, Matthew R.; Meers, Grace M. E.; Johnson, Ginger C.; Lopez, Jordan L.; MacLean, Paul S.

    2013-01-01

    Changes in substrate utilization and reduced mitochondrial respiratory capacity following exposure to energy-dense, high-fat diets (HFD) are putatively key components in the development of obesity-related metabolic disease. We examined the effect of a 3-day HFD on isolated liver mitochondrial respiration and whole body energy utilization in obesity-prone (OP) rats. We also examined if hepatic overexpression of peroxisomal proliferator-activated receptor-γ coactivator-1α (PGC-1α), a master regulator of mitochondrial respiratory capacity and biogenesis, would modify liver and whole body responses to the HFD. Acute, 3-day HFD (45% kcal) in OP rats resulted in increased daily energy intake, energy balance, weight gain, and adiposity, without an increase in liver triglyceride (triacylglycerol) accumulation. HFD-fed OP rats also displayed decreased whole body substrate switching from the dark to the light cycle, which was paired with reductions in hepatic mitochondrial respiration of multiple substrates in multiple respiratory states. Hepatic PGC-1α overexpression was observed to protect whole body substrate switching, as well as maintain mitochondrial respiration, following the acute HFD. Additionally, liver PGC-1α overexpression did not alter whole body dietary fatty acid oxidation but resulted in greater storage of dietary free fatty acids in liver lipid, primarily as triacylglycerol. Together, these data demonstrate that a short-term HFD can result in a decrease in metabolic flexibility and hepatic mitochondrial respiratory capacity in OP rats that is completely prevented by hepatic overexpression of PGC-1α. PMID:24091599

  17. The efficacy of oral glutamine in prevention of acute radiotherapy-induced esophagitis in patients with lung cancer

    PubMed Central

    Tutanc, Oznur Donmez; Aydogan, Akin; Sunbul, Ahmet Taner; Zincircioglu, Seyit Burhanedtin; Alpagat, Gulistan; Erden, Ersin Sukru

    2013-01-01

    Aim of the study This study explores the efficacy of oral glutamine in the prevention of acute radiotherapy-induced esophagitis in patients with lung cancer who are treated with thoracic radiotherapy. Material and methods This study was planned as a retrospective randomized experimental study. Forty-six patients with lung cancer, who were treated and kept under control between January 2008 and January 2010, were included in the study by the Department of Radiation Oncology, Faculty of Medicine, Dicle University. The patients were divided into two groups. The first group (n = 21) was given prophylactic oral powder glutamine (daily 30 g), while the second group (n = 25) was not given oral glutamine. Results There were 21 patients in Group 1 (45.7%) and 25 patients in Group 2 (54.3%). No significant statistical difference was observed between the two groups in terms of age, gender, stage, histopathological type, treatment choice, received radiation doses, esophagus length in RT field, or location of the tumor (p > 0.05). A significant statistical difference was observed between the glutamine-supplemented group (first group) and the glutamine-free group (second group) according to the grade of esophagitis (p < 0.0001). Conclusions In our retrospective randomized experimental study, we determined that the severity of acute radiotherapy-induced esophagitis might be decreased with oral glutamine in patients with lung cancer who were treated with thoracic radiotherapy. PMID:24592140

  18. [Gender-specific risk factors for acute low back pain: starting points for target-group-specific prevention].

    PubMed

    Ochsmann, E; Rüger, H; Kraus, T; Drexler, H; Letzel, S; Münster, E

    2009-08-01

    Women complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified. Secondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (chi(2)) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals). Women (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment. The present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.

  19. New program set to intervene to prevent readmissions, repeat ED visits due to acute exacerbations of asthma.

    PubMed

    2013-12-01

    Faculty at Indiana University School of Medicine are set to launch a community paramedicine program aimed at preventing repeat hospital and ED visits for acute exacerbations of asthma in children. Under the program, all children who are treated in the hospital or ED for asthma will receive home visits by specially trained paramedics within a few days of discharge. Paramedics will conduct a comprehensive assessment and make referrals as necessary for followup care. Nearly 30% of children who have been hospitalized for asthma require readmission to the hospital not long after discharge, and as many as 25% of children who have been treated in the ED for asthma will return to the ED within 30 days for another asthma-related visit. The one-time home visits will be comprehensive, enabling EMS providers to initiate stop-gap measures so that if a child is starting to get sick, paramedics can make sure the appropriate medicines are started and that acute care needs are met. Developers will monitor 30-day, 90-day, and one-year readmission metrics among patients who have received home visits.They hope that resulting cost-savings will sustain the program beyond the initial period, which is being funded through a grant from the Department of Health and Human Services.

  20. Reduced hepatic mitochondrial respiration following acute high-fat diet is prevented by PGC-1α overexpression.

    PubMed

    Morris, E Matthew; Jackman, Matthew R; Meers, Grace M E; Johnson, Ginger C; Lopez, Jordan L; MacLean, Paul S; Thyfault, John P

    2013-12-01

    Changes in substrate utilization and reduced mitochondrial respiratory capacity following exposure to energy-dense, high-fat diets (HFD) are putatively key components in the development of obesity-related metabolic disease. We examined the effect of a 3-day HFD on isolated liver mitochondrial respiration and whole body energy utilization in obesity-prone (OP) rats. We also examined if hepatic overexpression of peroxisomal proliferator-activated receptor-γ coactivator-1α (PGC-1α), a master regulator of mitochondrial respiratory capacity and biogenesis, would modify liver and whole body responses to the HFD. Acute, 3-day HFD (45% kcal) in OP rats resulted in increased daily energy intake, energy balance, weight gain, and adiposity, without an increase in liver triglyceride (triacylglycerol) accumulation. HFD-fed OP rats also displayed decreased whole body substrate switching from the dark to the light cycle, which was paired with reductions in hepatic mitochondrial respiration of multiple substrates in multiple respiratory states. Hepatic PGC-1α overexpression was observed to protect whole body substrate switching, as well as maintain mitochondrial respiration, following the acute HFD. Additionally, liver PGC-1α overexpression did not alter whole body dietary fatty acid oxidation but resulted in greater storage of dietary free fatty acids in liver lipid, primarily as triacylglycerol. Together, these data demonstrate that a short-term HFD can result in a decrease in metabolic flexibility and hepatic mitochondrial respiratory capacity in OP rats that is completely prevented by hepatic overexpression of PGC-1α.

  1. The design and rationale for the Acute Medically Ill Venous Thromboembolism Prevention with Extended Duration Betrixaban (APEX) study.

    PubMed

    Cohen, Alexander T; Harrington, Robert; Goldhaber, Samuel Z; Hull, Russell; Gibson, C Michael; Hernandez, Adrian F; Kitt, Michael M; Lorenz, Todd J

    2014-03-01

    Randomized clinical trials have identified a population of acute medically ill patients who remain at risk for venous thromboembolism (VTE) beyond the standard duration of therapy and hospital discharge. The aim of the APEX study is to determine whether extended administration of oral betrixaban (35-42 days) is superior to a standard short course of prophylaxis with subcutaneous enoxaparin (10 ± 4 days followed by placebo) in patients with known risk factors for post-discharge VTE. Patients initially are randomized to receive either betrixaban or enoxaparin (and matching placebo) in a double dummy design. Following a standard duration period of enoxaparin treatment (with placebo tablets) or betrixaban (with placebo injections), patients receive only betrixaban (or alternative matching placebo). Patients are considered for enrollment if they are older than 40 years, have a specified medical illness, and restricted mobility. They must also meet the APEX criteria for increased VTE risk (aged ≥75 years, baseline D-Dimer ≥2× upper the limit of "normal", or 2 additional ancillary risk factors for VTE). The primary efficacy end point is the composite of asymptomatic proximal deep venous thrombosis, symptomatic deep venous thrombosis, non-fatal (pulmonary embolus) pulmonary embolism, or VTE-related death through day 35. The primary safety outcome is the occurrence of major bleeding. We hypothesize that extended duration betrixaban VTE prophylaxis will be safe and more effective than standard short duration enoxaparin in preventing VTE in acute medically ill patients with known risk factors for post hospital discharge VTE.

  2. One compound of saponins from Disocorea zingiberensis protected against experimental acute pancreatitis by preventing mitochondria-mediated necrosis

    PubMed Central

    Zhang, Rui; Wen, Li; Shen, Yan; Shi, Na; Xing, Zhihua; Xia, Qing; Niu, Hai; Huang, Wen

    2016-01-01

    Acute pancreatitis (AP) is a painful inflammatory disorder of the exocrine pancreas, ranking as the most common gastrointestinal reasons for hospitalization with no specific therapy currently. Diosgenyl saponins extracted from natural products and diosgenin or its derivatives have been shown to exert anti-inflammatory effects in various diseases. However, the therapeutic effects of diosgenyl saponins from Dioscorea zingiberensis C. H. Wright in AP have not yet been determined. Five compounds were extracted and screened for taurocholate-induced necrosis in mouse pancreatic acinar cells. Particularly, 26-O-β-d-glucopyranosyl-3β, 22α, 26-trihydroxy-25(R)-furosta-5-en-3-O-[α-L-rhamnopyranosyl-(1 → 4)]-β-d-glucopyranoside (compound 1) exhibited the best protective effects with no toxicity observed. Next, we showed compound 1 concentration-dependently inhibited necrotic cell death pathway activation and 2.5 mM compound 1 also prevented the loss of mitochondrial membrane potential, adenosine triphosphate production, and reactive oxygen species generation in mouse pancreatic acinar cells. Finally, we showed compound 1 protected against three clinically representative murine models of AP and significantly improved pancreatitis-associated acute lung injury. These data provide in vitro and in vivo evidence that one compound of diosgenyl saponins can be potential treatment for AP. This study suggests natural saponins may serve as fruitful sources for exploring/identifying potential therapies for inflammatory diseases. PMID:27779235

  3. Remote ischemic preconditioning for prevention of acute kidney injury: a meta-analysis of randomized controlled trials.

    PubMed

    Yang, Yi; Lang, Xia-Bing; Zhang, Ping; Lv, Rong; Wang, Yong-Fei; Chen, Jiang-Hua

    2014-10-01

    Remote ischemic preconditioning (RIPC) to prevent acute kidney injury (AKI) following cardiac and vascular interventions is a controversial practice. We conducted a systematic review and meta-analysis using the MEDLINE database (1966 through November 2013), EMBASE (1988 through November 2013), and Cochrane Library database. Patients undergoing cardiac and vascular interventions. Randomized controlled trials comparing patient outcome with or without RIPC for prevention of AKI following cardiac and vascular interventions. RIPC using an inflatable tourniquet around the limb or cross-clamping the iliac arteries versus non-RIPC. AKI, need for renal replacement therapy, postoperative kidney biomarkers, in-hospital mortality, and length of intensive care unit and hospital stay. 13 trials (1,334 participants) were included. RIPC decreased the risk of AKI for patients undergoing cardiac and vascular interventions compared with the control group (11 trials; 1,216 participants; risk ratio [RR], 0.70; 95% CI, 0.48-1.02; P = 0.06; I(2) = 45%) with marginal statistical significance. There were no differences in levels of postoperative kidney biomarkers (serum creatinine and glomerular filtration rate), incidence of renal replacement therapy, in-hospital mortality, hospital stay, or intensive care unit stay between the 2 groups. Metaregression analysis indicated that contrast intervention was not a covariate contributing significantly to heterogeneity on the risk estimate for AKI incidence; also, there was no dose effect of RIPC using tourniquet cuff around the limb on AKI prevention based on different ischemia duration. Different AKI definitions adopted in the trials included. RIPC might be beneficial for the prevention of AKI following cardiac and vascular interventions, but the current evidence is not robust enough to make a recommendation. Adequately powered trials are needed to provide more evidence in the future. Copyright © 2014 National Kidney Foundation, Inc. Published

  4. Haemophilus influenzae oral vaccination for preventing acute exacerbations of chronic bronchitis and chronic obstructive pulmonary disease.

    PubMed

    Teo, Edward; Lockhart, Kathleen; Purchuri, Sai Navya; Pushparajah, Jennifer; Cripps, Allan W; van Driel, Mieke L

    2017-06-19

    Chronic bronchitis and chronic obstructive pulmonary disease (COPD) are serious conditions in which patients are predisposed to viral and bacterial infections resulting in potentially fatal acute exacerbations. Chronic obstructive pulmonary disease is defined as a lung disease characterised by obstruction to lung airflow that interferes with normal breathing. Antibiotic therapy has not been particularly useful in eradicating bacteria such as non-typeable Haemophilus influenzae (NTHi) because they are naturally occurring flora of the upper respiratory tract in many people. However, they can cause opportunistic infection. An oral NTHi vaccine has been developed to protect against recurrent infective acute exacerbations in chronic bronchitis. To assess the effectiveness of an oral, whole-cell NTHi vaccine in protecting against recurrent episodes of acute exacerbations of chronic bronchitis and COPD in adults. To assess the effectiveness of NTHi vaccine in reducing NTHi colonising the respiratory tract during recurrent episodes of acute exacerbations of COPD. We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2017, Issue 1), MEDLINE (1946 to January 2017), Embase (1974 to January 2017), CINAHL (1981 to January 2017), LILACS (1985 to January 2017), and Web of Science (1955 to January 2017). We also searched trials registries and contacted authors of trials requesting unpublished data. We included randomised controlled trials comparing the effects of an oral monobacterial NTHi vaccine in adults with recurrent acute exacerbations of chronic bronchitis or COPD when there was overt matching of the vaccine and placebo groups on clinical grounds. The selection criteria considered populations aged less than 65 years and those older than 65 years. Two review authors independently assessed trial quality and extracted data from original records and publications for incidence and severity of bronchitis episodes and carriage rate of

  5. Assessment and prevention of acute health effects of weather conditions in Europe, the PHEWE project: background, objectives, design

    PubMed Central

    Michelozzi, Paola; Kirchmayer, Ursula; Katsouyanni, Klea; Biggeri, Annibale; McGregor, Glenn; Menne, Bettina; Kassomenos, Pavlos; Anderson, Hugh Ross; Baccini, Michela; Accetta, Gabriele; Analytis, Antonis; Kosatsky, Tom

    2007-01-01

    Background The project "Assessment and prevention of acute health effects of weather conditions in Europe" (PHEWE) had the aim of assessing the association between weather conditions and acute health effects, during both warm and cold seasons in 16 European cities with widely differing climatic conditions and to provide information for public health policies. Methods The PHEWE project was a three-year pan-European collaboration between epidemiologists, meteorologists and experts in public health. Meteorological, air pollution and mortality data from 16 cities and hospital admission data from 12 cities were available from 1990 to 2000. The short-term effect on mortality/morbidity was evaluated through city-specific and pooled time series analysis. The interaction between weather and air pollutants was evaluated and health impact assessments were performed to quantify the effect on the different populations. A heat/health watch warning system to predict oppressive weather conditions and alert the population was developed in a subgroup of cities and information on existing prevention policies and of adaptive strategies was gathered. Results Main results were presented in a symposium at the conference of the International Society of Environmental Epidemiology in Paris on September 6th 2006 and will be published as scientific articles. The present article introduces the project and includes a description of the database and the framework of the applied methodology. Conclusion The PHEWE project offers the opportunity to investigate the relationship between temperature and mortality in 16 European cities, representing a wide range of climatic, socio-demographic and cultural characteristics; the use of a standardized methodology allows for direct comparison between cities. PMID:17456236

  6. Protective mechanism of sodium molybdate against the acute toxicity of cadmium in rats. II. Prevention of cytoplasmic acidification.

    PubMed

    Koizumi, T; Yokota, T; Fukuchi, M; Tatsumoto, H; Yamane, Y

    1991-10-01

    In order to clarify the protective mechanism of sodium molybdate against the acute toxicity of cadmium chloride in rat, the effect of in vivo sodium molybdate pretreatment on the cytotoxic action of cadmium in isolated hepatocytes was studied. The cytosolic pH of hepatocytes isolated from untreated rats immediately decreased with incubation in either neutral Hank's balanced salt solution (HBS), pH 7.4, containing 5 microM cadmium chloride minimum or acidic HBS (pH 7.1, 6.8, 6.5, and 6.2). The presence of 5 microM cadmium in HBS adjusted to pH 7.1 aggravated cytosolic acidification induced by the acidic medium alone. Cell viability of hepatocytes incubated in HBS at pH 6.2 was significantly reduced as compared to that of control cells in HBS at pH 7.4, but the presence of cadmium in the acidic HBS had no aggravating action against such a toxic action of the acidic medium although cellular uptake of the metal in the medium increased, as compared to that in HBS at pH 7.4. Molybdenum pretreatment alleviated cytoplasmic acidification induced by the treatment with HBS at pH 7.4 or 7.1 containing cadmium or by extracellular acid load without cadmium. This pretreatment also prevented the loss of cell viability induced by the treatment with HBS at pH 6.2 but could not attenuate that when cadmium was present in the medium. These facts suggest that molybdenum pretreatment alleviated the acute toxicity of cadmium in rat by preventing cytoplasmic acidification caused by the harmful metal.

  7. Silymarin Prevents Restraint Stress-Induced Acute Liver Injury by Ameliorating Oxidative Stress and Reducing Inflammatory Response.

    PubMed

    Kim, Sou Hyun; Oh, Dal-Seok; Oh, Ji Youn; Son, Tae Gen; Yuk, Dong Yeon; Jung, Young-Suk

    2016-04-01

    Silymarin is a flavonoid extracted from the milk thistle Silybum marianum. It has been reported to prevent liver injuries induced by various chemicals or toxins. Our recent study suggested that silymarin induces hepatic synthesis of glutathione by increasing cysteine availability, which may consequently contribute to increased antioxidant capacity of the liver. In the present study, we investigated the effects of silymarin on acute liver injury induced by restraint stress. Silymarin (100 mg/kg) was orally administered to BALB/c mice every 12 h (3 times in total). After the last dose, mice were subjected to restraint stress for 6 h, and serum levels of aspartate and alanine aminotransferases, and hepatic levels of lipid peroxidation were determined. Hepatic levels of sulfur-containing metabolites such as methionine, S-adenosylmethionine, cysteine, and glutathione were also measured. The level of pro-inflammatory mediators in both liver and serum was determined. To study the mechanism of the effects of silymarin, we assessed Jun N-terminal kinase (JNK) activation and apoptotic signaling. Restraint stress induced severe oxidative stress and increased mRNA levels of pro-inflammatory mediators; both effects of restraint stress were significantly inhibited by silymarin. Moreover, administration of silymarin significantly prevented acute liver injury induced by restraint stress by blocking JNK activation and subsequently apoptotic signaling. In conclusion, these results suggest that the inhibition of restraint stress-induced liver injury by silymarin is due at least in part to its anti-oxidant activity and its ability to suppress the inflammatory response.

  8. Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media.

    PubMed

    Marchisio, P; Esposito, S; Bianchini, S; Desantis, C; Galeone, C; Nazzari, E; Pignataro, L; Principi, N

    2010-01-01

    Recurrent acute otitis media (rAOM) is frequently encountered in infants and children and the lack of any definitive treatment has led parents and physicians to try complementary and alternative therapies. We evaluated the efficacy of a propolis and zinc suspension in preventing AOM in 122 children aged 1-5 years with a documented history of rAOM, who were prospectively, blindly, randomized 1:1 to receive the suspension plus elimination of environmental risk factors or elimination of environmental risk factors only. AOM- and respiratory-related morbidity were assessed at study entry and every four weeks. In the 3-month treatment period AOM was diagnosed in 31 (50.8%) children given the propolis and zinc suspension and in 43 (70.5%) controls (p=0.04). The mean number of episodes of AOM per child/month was 0.23+/-0.26 in the propolis and zinc group and 0.34+/-0.29 in controls (reduction 32.0%, p=0.03). The administration of a propolis and zinc suspension to children with a history of rAOM can significantly reduce the risk of new AOM episodes and AOM-related antibiotic courses, with no problem of safety or tolerability, and with a very good degree of parental satisfaction. No effect can be expected on respiratory infections other than AOM.

  9. Evaluation of Sensor Technology to Detect Fall Risk and Prevent Falls in Acute Care.

    PubMed

    Potter, Patricia; Allen, Kelly; Costantinou, Eileen; Klinkenberg, William Dean; Malen, Jill; Norris, Traci; O'Connor, Elizabeth; Roney, Wilhemina; Tymkew, Heidi Hahn; Wolf, Laurie

    2017-08-01

    Sensor technology that dynamically identifies hospitalized patients' fall risk and detects and alerts nurses of high-risk patients' early exits out of bed has potential for reducing fall rates and preventing patient harm. During Phase 1 (August 2014-January 2015) of a previously reported performance improvement project, an innovative depth sensor was evaluated on two inpatient medical units to study fall characteristics. In Phase 2 (April 2015-January 2016), a combined depth and bed sensor system designed to assign patient fall probability, detect patient bed exits, and subsequently prevent falls was evaluated. Fall detection depth sensors remained in place on two medicine units; bed sensors used to detect patient bed exits were added on only one of the medicine units. Fall rates and fall with injury rates were evaluated on both units. During Phase 2, the designated evaluation unit had 14 falls, for a fall rate of 2.22 per 1,000 patient-days-a 54.1% reduction compared with the Phase 1 fall rate. The difference in rates from Phase 1 to Phase 2 was statistically significant (z = 2.20; p = 0.0297). The comparison medicine unit had 30 falls-a fall rate of 4.69 per 1,000 patient-days, representing a 57.9% increase as compared with Phase 1. A fall detection sensor system affords a level of surveillance that standard fall alert systems do not have. Fall prevention remains a complex issue, but sensor technology is a viable fall prevention option. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  10. The Prevention and Control of Epidemics of Acute Undifferentiated Diarrhea of Beef Calves in Western Canada

    PubMed Central

    Radostits, O. M.; Acres, S. D.

    1980-01-01

    It is frequently evident that outbreaks of diarrhea occur in spite of apparent “good management” and “good calving conditions”. This observation underlies the fact that we still do not understand many of the epidemiological factors which contribute to calf diarrhea outbreaks. For example, we still lack biological criteria by which to judge the degree of crowding and the degree of stress. Nevertheless, application of the principles described above will prevent or decrease the severity of many annual epidemics. To be successful, a program of prevention and control should be discussed with producers long before the calving season, preferably during the preceding summer or fall. Implementation of a complete program may take several calving seasons and producers should be made aware that prevention by improved management is an on-going, evolutionary process. More and improved vaccines are becoming available; however, as is the case with most biologicals, their impact cannot be determined until after they have been used for several years. They should be recognized as only one of several managent tools at the disposal of the veterinarian and livestock producer. PMID:7438007

  11. Preventive effect of the microalga Chlamydomonas debaryana on the acute phase of experimental colitis in rats.

    PubMed

    Avila-Román, Javier; Talero, Elena; Alcaide, Antonio; Reyes, Carolina de Los; Zubía, Eva; García-Mauriño, Sofía; Motilva, Virginia

    2014-10-14

    Inflammatory bowel diseases (IBD) are characterised by chronic uncontrolled inflammation of intestinal mucosa. Diet and nutritional factors have emerged as possible interventions for IBD. Microalgae are rich sources of n-3 PUFA and derived oxylipins. Oxylipins are lipid mediators involved in the resolution of many inflammatory disorders. The aim of the present study was to investigate the effects of the oxylipin-containing biomass of the microalga Chlamydomonas debaryana and its major oxylipin constituent, (9Z,11E,13S,15Z)-13-hydroxyoctadeca-9,11,15-trienoic acid ((13S)-HOTE), on acute 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis in rats. Lyophilised microalgal biomass and (13S)-HOTE were administered by oral route 48, 24 and 1 h before the induction of colitis and 24 h later, and the rats were killed after 48 h. The treatment with the lyophilised microalga and (13S)-HOTE improved body-weight loss and colon shortening, as well as attenuated the extent of colonic damage and increased mucus production. Cellular neutrophil infiltration, with the subsequent increase in myeloperoxidase levels induced by TNBS, were also reduced after the administration of the lyophilised microalga or (13S)-HOTE. The anti-inflammatory effects of these treatments were confirmed by the inhibition of colonic TNF-α production. Moreover, lyophilised microalga or (13S)-HOTE down-regulated cyclo-oxygenase-2 and inducible nitric oxide synthase expression. The present study was the first to show the prophylactic effects of a lyophilised biomass sample of the microalga C. debaryana and the oxylipin (13S)-HOTE on TNBS-induced acute colitis in rats. Our findings suggest that the microalga C. debaryana or derived oxylipins could be used as nutraceuticals in the treatment of the active phase of IBD.

  12. Blood soluble drag-reducing polymers prevent lethality from hemorrhagic shock in acute animal experiments.

    PubMed

    Kameneva, Marina V; Wu, Zhongjun J; Uraysh, Arkady; Repko, Brandon; Litwak, Kenneth N; Billiar, Timothy R; Fink, Mitchell P; Simmons, Richard L; Griffith, Bartley P; Borovetz, Harvey S

    2004-01-01

    Over the past several decades, blood-soluble drag reducing polymers (DRPs) have been shown to significantly enhance hemodynamics in various animal models when added to blood at nanomolar concentrations. In the present study, the effects of the DRPs on blood circulation were tested in anesthetized rats exposed to acute hemorrhagic shock. The animals were acutely resuscitated either with a 2.5% dextran solution (Control) or using the same solution containing 0.0005% or 5 parts per million (ppm) concentration of one of two blood soluble DRPs: high molecular weight (MW=3500 kDa) polyethylene glycol (PEG-3500) or a DRP extracted from Aloe vera (AVP). An additional group of animals was resuscitated with 0.0075% (75 ppm) polyethylene glycol of molecular weight of 200 kDa (PEG-200), which possesses no drag-reducing ability. All of the animals were observed for two hours following the initiation of fluid resuscitation or until they expired. We found that infusion of the DRP solutions significantly improved tissue perfusion, tissue oxygenation, and two-hour survival rate, the latter from 19% (Control) and 14% (PEG-200) to 100% (AVP) and 100% (PEG-3500). Furthermore, the Control and PEG-200 animals that survived required three times more fluid to maintain their blood pressure than the AVP and PEG-3500 animals. Several hypotheses regarding the mechanisms underlying these observed beneficial hemodynamic effects of DRPs are discussed. Our findings suggest that the drag-reducing polymers warrant further investigation as a potential clinical treatment for hemorrhagic shock and possibly other microcirculatory disorders.

  13. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial

    PubMed Central

    Atroshi, Isam; Magnusson, Henrik; Wagner, Philippe; Hägglund, Martin

    2012-01-01

    Objective To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players. Design Stratified cluster randomised controlled trial with clubs as the unit of randomisation. Setting 230 Swedish football clubs (121 in the intervention group, 109 in the control group) were followed for one season (2009, seven months). Participants 4564 players aged 12-17 years (2479 in the intervention group, 2085 in the control group) completed the study. Intervention 15 minute neuromuscular warm-up programme (targeting core stability, balance, and proper knee alignment) to be carried out twice a week throughout the season. Main outcome measures The primary outcome was rate of anterior cruciate ligament injury; secondary outcomes were rates of severe knee injury (>4 weeks’ absence) and any acute knee injury. Results Seven players (0.28%) in the intervention group, and 14 (0.67%) in the control group had an anterior cruciate ligament injury. By Cox regression analysis according to intention to treat, a 64% reduction in the rate of anterior cruciate ligament injury was seen in the intervention group (rate ratio 0.36, 95% confidence interval 0.15 to 0.85). The absolute rate difference was −0.07 (95% confidence interval −0.13 to 0.001) per 1000 playing hours in favour of the intervention group. No significant rate reductions were seen for secondary outcomes. Conclusions A neuromuscular warm-up programme significantly reduced the rate of anterior cruciate ligament injury in adolescent female football players. However, the absolute rate difference did not reach statistical significance, possibly owing to the small number of events. Trial registration Clinical trials NCT00894595. PMID:22556050

  14. Preventive Effects of a Natural Anti-Inflammatory Agent, Astragaloside IV, on Ischemic Acute Kidney Injury in Rats

    PubMed Central

    Tan, Shufeng; Wang, Guofu; Guo, Yongping; Gui, Dingkun; Wang, Niansong

    2013-01-01

    This study investigated the anti-inflammatory effects of astragaloside IV(AS-IV) on ischemia/reperfusion (IR) induced acute kidney injury (AKI) in rats. Experimental model of ischemic AKI was induced in rats by bilateral renal artery clamp for 45 min followed by reperfusion of 12 h and 24 h, respectively. AS-IV was orally administered once a day to rats at 10 and 20 mg·kg−1·d−1 for 7 days prior to ischemia. AS-IV pretreatment significantly decreased serum urea, creatinine, and cystatin C levels at 12 h and 24 h of reperfusion in AKI rats. AS-IV pretreatment also ameliorated tubular damage and suppressed the phosphorylation of p65 subunit of NF-κB in AKI rats. Moreover, NF-κB and MPO activity as well as serum and tissue levels of TNF-α, MCP-1, and ICAM-1 were elevated in AKI rats. All of these abnormalities were prevented by AS-IV. Furthermore, AS-IV downregulated the mRNA expression of NF-κB, TNF-α, MCP-1, and ICAM-1 in AKI rats. These results suggest that AS-IV might be developed as a novel therapeutic approach to prevent ischemic AKI through inhibition of NF-κB mediated inflammatory genes expression. PMID:23853656

  15. Retrospective comparison of long-term ten-day/month rifaximin or mesalazine in prevention of relapse in acute diverticulitis.

    PubMed

    Festa, V; Spila Alegiani, S; Chiesara, F; Moretti, A; Bianchi, M; Dezi, A; Traversa, G; Koch, M

    2017-03-01

    Diverticular disease (DD) of the colon has an increasing burden on health services. The effectiveness of rifaximin for the treatment of DD, is not yet established. The aim of this study is to assess the impact of long-term treatment with rifaximin or mesalazine in a 10-day schedule for the prevention of recurrent diverticulitis. This is a retrospective study. We identified all consecutive patients with DD and previous acute diverticulitis (AD) in our outpatients' database; 124 patients, were included. The recommended therapy consisted of a ten-day/month treatment with either rifaximin (400 mg bid), or mesalazine (2.4 g/daily). Primary end point was AD recurrence. Between 2010 and 2014, 72 patients were treated with rifaximin and 52 with mesalazine. During a median follow-up of 15 months (range 1-50), we observed 21 episodes of AD among users of either rifaximin (n=7; 0.54 per 100 person-months), or mesalazine group (n=14; 1.46 per 100 person-months). Kaplan-Meier survival estimates of recurrent AD significantly differed between rifaximin and mesalazine groups (p=0.015). The multivariate Cox regression analysis showed that AD recurrence was significantly associated with therapy (rifaximin vs. mesalazine, adjusted HR 0.27; 95% CI: 0.10 to 0.72), age and gender. Long-term treatment with rifaximin in a 10-day schedule appears more effective than mesalazine in preventing recurrent AD.

  16. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects

    PubMed Central

    Weersing, V. Robin; Shamseddeen, Wael; Garber, Judy; Hollon, Steven D.; Clarke, Gregory N.; Beardslee, William R.; Gladstone, Tracy R.; Lynch, Frances L.; Porta, Giovanna; Iyengar, Satish; Brent, David A.

    2016-01-01

    Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This four-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As reported by Garber et al., a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current paper expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Results Depression onset was predicted by lower functioning (HR=0.95, 95% CI: 0.92-0.98) and higher hopelessness (hazard ratio [HR]=1.06, 95% CI: 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR=6.38, 95% CI: 2.38-17.1) or had a history of hypomania (HR=67.5, 95% CI: 10.9-417.1), or when adolescents reported higher depressive symptoms (HR=1.04, 95% CI: 1.00-1.08), higher anxiety (HR=1.05, 95% CI: 1.01-1.08), higher hopelessness (HR=1.10, 95% CI: 1.01-1.20), or lower functioning (HR=0.94, 95% CI: 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0% to 57%). Conclusion Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. PMID:26903255

  17. Evidence based prevention of acute injuries during physical exercise in a WHO safe community

    PubMed Central

    Timpka, T; Lindqvist, K

    2001-01-01

    Objective—To evaluate a community based programme for evidence based prevention of injuries during physical exercise. Design—Quasi-experimental evaluation using an intervention population and a non-random control population. Participants—Study municipality (population 41 000) and control municipality (population 26 000) in Sweden. Main outcome measures—Morbidity rate for sports related injuries treated in the health care system; severity classification according to the abbreviated injury scale (AIS). Results—The total morbidity rate for sports related injuries in the study area decreased by 14% from 21 to 18 injuries per 1000 population years (odds ratio 0.87; 95% confidence interval (CI) 0.79 to 0.96). No tendency towards a decrease was observed in people over 40. The rate of moderately severe injury (AIS 2) decreased to almost half (odds ratio 0.58; 95% CI 0.50 to 0.68), whereas the rate of minor injuries (AIS 1) increased (odds ratio 1.22; 95% CI 1.06 to 1.40). The risk of severe injuries (AIS 3–6) remained constant. The rate of total sports injury in the control area did not change (odds ratio 0.93; 95% CI 0.81 to 1.07), and the trends in the study and control areas were not statistically significantly different. Conclusion—An evidence based prevention programme based on local safety rules and educational programmes can reduce the burden of injuries related to physical exercise in a community. Future studies need to look at adjusting the programme to benefit all age groups. Key Words: injuries; prevention; evaluation; community; intervention; safety promotion PMID:11157457

  18. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects.

    PubMed

    Weersing, V Robin; Shamseddeen, Wael; Garber, Judy; Hollon, Steven D; Clarke, Gregory N; Beardslee, William R; Gladstone, Tracy R; Lynch, Frances L; Porta, Giovanna; Iyengar, Satish; Brent, David A

    2016-03-01

    To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92-0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38-17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9-417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00-1.08), higher anxiety (HR = 1.05, 95% CI = 1.01-1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01-1.20), or lower functioning (HR = 0.94, 95% CI = 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%-57%). Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/; NCT00073671. Copyright © 2016 American Academy of Child and Adolescent Psychiatry

  19. Airway Tissue Plasminogen Activator Prevents Acute Mortality Due to Lethal Sulfur Mustard Inhalation

    PubMed Central

    Veress, Livia A.; Anderson, Dana R.; Hendry-Hofer, Tara B.; Houin, Paul R.; Rioux, Jacqueline S.; Garlick, Rhonda B.; Loader, Joan E.; Paradiso, Danielle C.; Smith, Russell W.; Rancourt, Raymond C.; Holmes, Wesley W.; White, Carl W.

    2015-01-01

    Rationale: Sulfur mustard (SM) is a chemical weapon stockpiled today in volatile regions of the world. SM inhalation causes a life-threatening airway injury characterized by airway obstruction from fibrin casts, which can lead to respiratory failure and death. Mortality in those requiring intubation is more than 80%. No therapy exists to prevent mortality after SM exposure. Our previous work using the less toxic analog of SM, 2-chloroethyl ethyl sulfide, identified tissue plasminogen activator (tPA) an effective rescue therapy for airway cast obstruction (Veress, L. A., Hendry-Hofer, T. B., Loader, J. E., Rioux, J. S., Garlick, R. B., and White, C. W. (2013). Tissue plasminogen activator prevents mortality from sulfur mustard analog-induced airway obstruction. Am. J. Respir. Cell Mol. Biol. 48, 439–447). It is not known if exposure to neat SM vapor, the primary agent used in chemical warfare, will also cause death due to airway casts, and if tPA could be used to improve outcome. Methods: Adult rats were exposed to SM, and when oxygen saturation reached less than 85% (median: 6.5 h), intratracheal tPA or placebo was given under isoflurane anesthesia every 4 h for 48 h. Oxygen saturation, clinical distress, and arterial blood gases were assessed. Microdissection was done to assess airway obstruction by casts. Results: Intratracheal tPA treatment eliminated mortality (0% at 48 h) and greatly improved morbidity after lethal SM inhalation (100% death in controls). tPA normalized SM-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress. Moreover, tPA treatment resulted in greatly diminished airway casts, preventing respiratory failure from airway obstruction. Conclusions: tPA given via airway more than 6 h after exposure prevented death from lethal SM inhalation, and normalized oxygenation and ventilation defects, thereby rescuing from respiratory distress and failure. Intra-airway tPA should be considered as a life

  20. Strategy Training During Inpatient Rehabilitation May Prevent Apathy Symptoms After Acute Stroke.

    PubMed

    Skidmore, Elizabeth R; Whyte, Ellen M; Butters, Meryl A; Terhorst, Lauren; Reynolds, Charles F

    2015-06-01

    Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke. To examine the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke. Secondary analysis of randomized controlled trial. Acute inpatient rehabilitation. Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n = 15, 1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n = 15, same dose). Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding). Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models. Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, mean = 25.79, standard deviation = 7.62; reflective listening, mean = 25.18, standard deviation = 4.40). A significant group × time interaction (F2,28 = 3.61, P = .040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d = -0.99, t28 = -2.64, P = .013) at month 3 and moderate to large (d = -0.70, t28 = -1.86, P = .073) at month 6. Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels

  1. Caspase-3 inhibitor prevents the apoptosis of brain tissue in rats with acute cerebral infarction.

    PubMed

    Sun, Yuhua; Xu, Yuming; Geng, Lijiao

    2015-07-01

    The aim of the present study was to investigate the effect of the caspase-3 inhibitor z-DEVD-fmk on the apoptosis of the brain tissues of rats with acute cerebral infarction. Middle cerebral artery occlusion was used to establish a rat model of infarction, and the rats were randomly divided into a sham group (n=15), model group (n=15) and treatment group (n=15). z-DEVD-fmk (2.5 µg/kg) was injected into the intracranial artery of rats in the treatment group, while the same volume of phosphate-buffered saline solution was administered to the rats of the sham and model groups. After 48 h, all rats were sacrificed and their brain tissues were removed. The caspase-3 mRNA level, protein level and activity, brain cell apoptosis index and infarction scope of the three groups were analyzed. Neurological impairment was also assessed. At 48 h after model establishment, the caspase-3 mRNA and protein levels in the brain tissues of the model group were significantly higher than those of the sham group, and those in the treatment group were significantly lower than those in the model group (P<0.05); however, they remained significantly higher than those in the sham group. Caspase-3 activity in the model group was significantly higher than that in the sham group, and treatment with the caspase-3 inhibitor significantly reduced caspase-3 activity compared with that in the model group (P<0.05). The apoptosis index and infarction scope in the model and treatment groups were significantly increased compared with those in the sham group, and were significantly lower in the treatment group than in the model group (P<0.05). The neurological impairment of rats in the model and treatment groups was increased significantly compared with that in the sham group, and the treatment group exhibited a significantly lower level of neurological impairment than the model group (P<0.05). In conclusion, the caspase-3 inhibitor z-DEVD-fmk effectively inhibited apoptosis and delayed the necrosis of

  2. 15-hydroxyprostaglandin dehydrogenase (15-PGDH) prevents lipopolysaccharide (LPS)-induced acute liver injury

    PubMed Central

    Yao, Lu; Chen, Weina; Song, Kyoungsub; Han, Chang; Gandhi, Chandrashekhar R.; Lim, Kyu; Wu, Tong

    2017-01-01

    The NAD+-dependent 15-hydroxyprostaglandin dehydrogenase (15-PGDH) catalyzes the oxidation of the 15(S)-hydroxyl group of prostaglandin E2 (PGE2), converting the pro-inflammatory PGE2 to the anti-inflammatory 15-keto-PGE2 (an endogenous ligand for peroxisome proliferator-activated receptor-gamma [PPAR-γ]). To evaluate the significance of 15-PGDH/15-keto-PGE2 cascade in liver inflammation and tissue injury, we generated transgenic mice with targeted expression of 15-PGDH in the liver (15-PGDH Tg) and the animals were subjected to lipopolysaccharide (LPS)/Galactosamine (GalN)-induced acute liver inflammation and injury. Compared to the wild type mice, the 15-PGDH Tg mice showed lower levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), less liver tissue damage, less hepatic apoptosis/necrosis, less macrophage activation, and lower inflammatory cytokine production. In cultured Kupffer cells, treatment with 15-keto-PGE2 or the conditioned medium (CM) from 15-PGDH Tg hepatocyes inhibited LPS-induced cytokine production, in vitro. Both 15-keto-PGE2 and the CM from15-PGDH Tg hepatocyes also up-regulated the expression of PPAR-γ downstream genes in Kupffer cells. In cultured hepatocytes, 15-keto-PGE2 treatment or 15-PGDH overexpression did not influence TNF-α-induced hepatocyte apoptosis. These findings suggest that 15-PGDH protects against LPS/GalN-induced liver injury and the effect is mediated via 15-keto-PGE2, which activates PPAR-γ in Kupffer cells and thus inhibits their ability to produce inflammatory cytokines. Accordingly, we observed that the PPAR-γ antagonist, GW9662, reversed the effect of 15-keto-PGE2 in Kupffer cell in vitro and restored the susceptibility of 15-PGDH Tg mice to LPS/GalN-induced acute liver injury in vivo. Collectively, our findings suggest that 15-PGDH-derived 15-keto-PGE2 from hepatocytes is able to activate PPAR-γ and inhibit inflammatory cytokine production in Kupffer cells and that this paracrine mechanism

  3. Caspase-3 inhibitor prevents the apoptosis of brain tissue in rats with acute cerebral infarction

    PubMed Central

    SUN, YUHUA; XU, YUMING; GENG, LIJIAO

    2015-01-01

    The aim of the present study was to investigate the effect of the caspase-3 inhibitor z-DEVD-fmk on the apoptosis of the brain tissues of rats with acute cerebral infarction. Middle cerebral artery occlusion was used to establish a rat model of infarction, and the rats were randomly divided into a sham group (n=15), model group (n=15) and treatment group (n=15). z-DEVD-fmk (2.5 µg/kg) was injected into the intracranial artery of rats in the treatment group, while the same volume of phosphate-buffered saline solution was administered to the rats of the sham and model groups. After 48 h, all rats were sacrificed and their brain tissues were removed. The caspase-3 mRNA level, protein level and activity, brain cell apoptosis index and infarction scope of the three groups were analyzed. Neurological impairment was also assessed. At 48 h after model establishment, the caspase-3 mRNA and protein levels in the brain tissues of the model group were significantly higher than those of the sham group, and those in the treatment group were significantly lower than those in the model group (P<0.05); however, they remained significantly higher than those in the sham group. Caspase-3 activity in the model group was significantly higher than that in the sham group, and treatment with the caspase-3 inhibitor significantly reduced caspase-3 activity compared with that in the model group (P<0.05). The apoptosis index and infarction scope in the model and treatment groups were significantly increased compared with those in the sham group, and were significantly lower in the treatment group than in the model group (P<0.05). The neurological impairment of rats in the model and treatment groups was increased significantly compared with that in the sham group, and the treatment group exhibited a significantly lower level of neurological impairment than the model group (P<0.05). In conclusion, the caspase-3 inhibitor z-DEVD-fmk effectively inhibited apoptosis and delayed the necrosis of

  4. Peripheral blood monocyte-derived chemokine blockade prevents murine transfusion-related acute lung injury (TRALI).

    PubMed

    McKenzie, Christopher G J; Kim, Michael; Singh, Tarandeep K; Milev, Youli; Freedman, John; Semple, John W

    2014-05-29

    Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality and can occur with any type of transfusion. TRALI is thought to be primarily mediated by donor antibodies activating recipient neutrophils resulting in pulmonary endothelial damage. Nonetheless, details regarding the interactions between donor antibodies and recipient factors are unknown. A murine antibody-mediated TRALI model was used to elucidate the roles of the F(ab')2 and Fc regions of a TRALI-inducing immunoglobulin G anti-major histocompatibility complex (MHC) class I antibody (34.1.2s). Compared with intact antibody, F(ab')2 fragments significantly increased serum levels of the neutrophil chemoattractant macrophage inflammatory protein 2 (MIP-2); however, pulmonary neutrophil levels were only moderately increased, and no pulmonary edema or mortality occurred. Fc fragments did not modulate any of these parameters. TRALI induction by intact antibody was completely abrogated by in vivo peripheral blood monocyte depletion by gadolinium chloride (GdCl3) or chemokine blockade with a MIP-2 receptor antagonist but was restored upon repletion with purified monocytes. The results suggest a two-step process for antibody-mediated TRALI induction: the first step involves antibody binding its cognate antigen on blood monocytes, which generates MIP-2 chemokine production that is correlated with pulmonary neutrophil recruitment; the second step occurs when antibody-coated monocytes increase Fc-dependent lung damage.

  5. Bacterial lysate in the prevention of acute exacerbation of COPD and in respiratory recurrent infections

    PubMed Central

    Braido, F; Tarantini, F; Ghiglione, V; Melioli, G; Canonica, G W

    2007-01-01

    Respiratory tract infections (RTIs) represent a serious problem because they are one of the most common cause of human death by infection. The search for the treatment of those diseases has therefore a great importance. In this study we provide an overview of the currently available treatments for RTIs with particular attention to chronic obstructive pulmonary diseases exacerbations and recurrent respiratory infections therapy and a description of bacterial lysate action, in particular making reference to the medical literature dealing with its clinical efficacy. Those studies are based on a very large number of clinical trials aimed to evaluate the effects of this drug in maintaining the immune system in a state of alert, and in increasing the defences against microbial infections. From this analysis it comes out that bacterial lysates have a protective effect, which induce a significant reduction of the symptoms related to respiratory infections. Those results could be very interesting also from an economic point of view, because they envisage a reduction in the number of acute exacerbations and a shorter duration of hospitalization. The use of bacterial lysate could therefore represent an important means to achieve an extension of life duration in patients affected by respiratory diseases. PMID:18229572

  6. Isoflurane Prevents Acute Lung Injury Through ADP-Mediated Platelet Inhibition

    PubMed Central

    Harr, Jeffrey N.; Moore, Ernest E.; Stringham, John; Wohlauer, Max V.; Fragoso, Miguel; Jones, Wilbert L.; Gamboni, Fabia; Silliman, Christopher C.; Banerjee, Anirban

    2012-01-01

    Background Growing evidence suggests platelets are essential in post-traumatic acute lung injury (ALI). Halogenated ethers interfere with platelet-granulocyte aggregate formation. The potential benefit of halogenated ethers has not been investigated in trauma/hemorrhagic shock (T/HS) models. Therefore, we hypothesized that isoflurane decreases T/HS-mediated ALI through platelet inhibition. Methods Sprauge-Dawley rats (n=47) were anesthetized by either pentobarbital or inhaled isoflurane, and placed into groups: control, trauma (laparotomy) sham shock, T/HS (MAP of 30 mmHg × 45 min), pre-treatment with an ADP receptor antagonist, or T/HS with isoflurane initiated during resuscitation. ALI was determined by BALF protein and pulmonary immunofluorescence. PlateletMapping™ specifically evaluated thrombin-independent inhibition of the ADP and AA pathways of platelet activation. Results Pre-treatment with isoflurane abrogated ALI as measured by both BAL fluid protein and pulmonary immunofluorescence (p<0.001). PlateletMapping™, revealed specific platelet ADP-pathway inhibition with isoflurane (p<0.001). Pre-treatment with an ADP receptor antagonist decreased ALI to sham levels, confirming that specific platelet ADP inhibition decreases ALI. Isoflurane initiated during resuscitation also decreased ALI (p<0.001). Conclusion Isoflurane attenuates ALI through an anti-platelet mechanism, in part, through inhibition of the platelet ADP pathway. Isoflurane given post-injury also protects against ALI, and highlights the potential applications of this therapy in various ischemia/reperfusion clinical scenarios. PMID:22828148

  7. Maintenance therapy with unprocessed bran in the prevention of acute anal fissure recurrence.

    PubMed Central

    Jensen, S L

    1987-01-01

    The effect of unprocessed bran in a dose of 5 g three times daily and a dose of 2.5 g three times daily for one year on the recurrence rate of anal fissures was studied in a double-blind, placebo-controlled trial in 90 patients with recently healed acute posterior anal fissures. Fifteen patients (16.6%) were withdrawn before the code was broken due to failure to follow the trial protocol for various reasons. Significantly fewer recurrences occurred in patients receiving bran 5 g three times daily (recurrence rate 16%, 95% confidence limits, 4.54 to 36.08) when compared with patients receiving bran 2.5 g three times daily (60%; 38.67 to 78.87) (P less than 0.01) and with patients receiving placebo three times daily (68%; 46.50 to 85.05) (P less than 0.01). No significant difference in recurrences was found between patients on bran 2.5 g and those on placebo. PMID:3039130

  8. Glycyrrhizic Acid Prevents Sepsis-Induced Acute Lung Injury and Mortality in Rats

    PubMed Central

    Zhao, Hongyu; Zhao, Min; Wang, Yu; Li, Fengchun; Zhang, Zhigang

    2015-01-01

    Glycyrrhizic acid (GA), an active ingredient in licorice, has multiple pharmacological activities. However, the effects of GA on sepsis-induced acute lung injury (ALI) have not been determined. Tthe aim of this study was to investigate the molecular mechanism involved in the effects of GA against sepsis-induced ALI in rats. We found that GA alleviated sepsis-induced ALI through improvements in various pathological changes, as well as decreases in the lung wet/dry weight ratio and total protein content in bronchoalveolar lavage fluid, and a significant increase in the survival rate of treated rats. Additionally, GA markedly inhibited sepsis-induced pulmonary inflammatory responses. Moreover, we found that treatment with GA inhibited oxidative stress damage and apoptosis in lung tissue induced by ALI. Finally, GA treatment significantly inhibited NF-κ B, JNK and P38 MAPK activation. Our data indicate that GA has a protective effect against sepsis-induced ALI by inhibiting the inflammatory response, damage from oxidative stress, and apoptosis via inactivation of NF-κB and MAPK signaling pathways, providing a molecular basis for a new medical treatment for sepsis-induced ALI. PMID:26385569

  9. Isoflurane prevents acute lung injury through ADP-mediated platelet inhibition.

    PubMed

    Harr, Jeffrey N; Moore, Ernest E; Stringham, John; Wohlauer, Max V; Fragoso, Miguel; Jones, Wilbert L; Gamboni, Fabia; Silliman, Christopher C; Banerjee, Anirban

    2012-08-01

    Growing evidence suggests platelets are essential in posttraumatic, acute lung injury (ALI). Halogenated ethers interfere with the formation of platelet-granulocyte aggregates. The potential benefit of halogenated ethers has not been investigated in models of trauma/hemorrhagic shock (T/HS). Therefore, we hypothesized that isoflurane decreases T/HS-mediated ALI through platelet inhibition. Sprague-Dawley rats (n = 47) were anesthetized by either pentobarbital or inhaled isoflurane and placed into (1) control, (2) trauma (laparotomy) sham shock, (3) T/HS (mean arterial pressure, 30 mmHg × 45 min), (4) pretreatment with an ADP receptor antagonist, or (5) T/HS with isoflurane initiated during resuscitation groups. ALI was determined by protein and pulmonary immunofluorescence bronchoalveolar lavage (BAL) fluid. Platelet Mapping specifically evaluated thrombin-independent inhibition of the ADP and AA pathways of platelet activation. Pretreatment with isoflurane abrogated ALI as measured by both BAL fluid protein and pulmonary immunofluorescence (P < .001). Platelet Mapping revealed specific inhibition of the platelet ADP-pathway with isoflurane (P < .001). Pretreatment with an ADP receptor antagonist decreased ALI to sham levels, confirming that specific platelet ADP inhibition decreases ALI. Isoflurane initiated during resuscitation also decreased ALI (P < .001). Isoflurane attenuates ALI through an antiplatelet mechanism, in part, through inhibition of the platelet ADP pathway. Isoflurane given postinjury also protects against ALI, and highlights the potential applications of this therapy in various clinical scenarios of ischemia/reperfusion. Copyright © 2012 Mosby, Inc. All rights reserved.

  10. Glycyrrhizic Acid Prevents Sepsis-Induced Acute Lung Injury and Mortality in Rats.

    PubMed

    Zhao, Hongyu; Zhao, Min; Wang, Yu; Li, Fengchun; Zhang, Zhigang

    2016-02-01

    Glycyrrhizic acid (GA), an active ingredient in licorice, has multiple pharmacological activities. However, the effects of GA on sepsis-induced acute lung injury (ALI) have not been determined. Tthe aim of this study was to investigate the molecular mechanism involved in the effects of GA against sepsis-induced ALI in rats. We found that GA alleviated sepsis-induced ALI through improvements in various pathological changes, as well as decreases in the lung wet/dry weight ratio and total protein content in bronchoalveolar lavage fluid, and a significant increase in the survival rate of treated rats. Additionally, GA markedly inhibited sepsis-induced pulmonary inflammatory responses. Moreover, we found that treatment with GA inhibited oxidative stress damage and apoptosis in lung tissue induced by ALI. Finally, GA treatment significantly inhibited NF-κ B, JNK and P38 MAPK activation. Our data indicate that GA has a protective effect against sepsis-induced ALI by inhibiting the inflammatory response, damage from oxidative stress, and apoptosis via inactivation of NF-κB and MAPK signaling pathways, providing a molecular basis for a new medical treatment for sepsis-induced ALI.

  11. Acute and fatal hyponatraemia after resection of a craniopharyngioma: a preventable tragedy.

    PubMed

    Bohn, D; Davids, M R; Friedman, O; Halperin, M L

    2005-09-01

    Central diabetes insipidus developed for the first time in a 14-year-old female during the resection of a craniopharyngioma. The water diuresis persisted until a vasopressin analogue (dDAVP) was given. Professor McCance was asked to explain why hypernatraemia developed, to anticipate dangers that might develop in the salt and water area with therapy, and to provide insights into why this patient died, due to the subsequent development of hyponatraemia that caused a lethal rise in intracranial pressure. The team specifically wanted Professor McCance's opinions as to why a PNa of 124 mmol/l was uniquely dangerous for this patient, and this was a particularly challenging conundrum. Nevertheless, with the aid of a mini-experiment, a careful chart review, and creative thinking, he was able to offer a novel solution, and to suggest ways to prevent its occurrence in other patients.

  12. MDM2 prevents spontaneous tubular epithelial cell death and acute kidney injury

    PubMed Central

    Thomasova, Dana; Ebrahim, Martrez; Fleckinger, Kristina; Li, Moying; Molnar, Jakob; Popper, Bastian; Liapis, Helen; Kotb, Ahmed M; Siegerist, Florian; Endlich, Nicole; Anders, Hans-Joachim

    2016-01-01

    Murine double minute-2 (MDM2) is an E3-ubiquitin ligase and the main negative regulator of tumor suppressor gene p53. MDM2 has also a non-redundant function as a modulator of NF-kB signaling. As such it promotes proliferation and inflammation. MDM2 is highly expressed in the unchallenged tubular epithelial cells and we hypothesized that MDM2 is necessary for their survival and homeostasis. MDM2 knockdown by siRNA or by genetic depletion resulted in demise of tubular cells in vitro. This phenotype was completely rescued by concomitant knockdown of p53, thus suggesting p53 dependency. In vivo experiments in the zebrafish model demonstrated that the tubulus cells of the larvae undergo cell death after the knockdown of mdm2. Doxycycline-induced deletion of MDM2 in tubular cell-specific MDM2-knockout mice Pax8rtTa-cre; MDM2f/f caused acute kidney injury with increased plasma creatinine and blood urea nitrogen and sharp decline of glomerular filtration rate. Histological analysis showed massive swelling of renal tubular cells and later their loss and extensive tubular dilation, markedly in proximal tubules. Ultrastructural changes of tubular epithelial cells included swelling of the cytoplasm and mitochondria with the loss of cristae and their transformation in the vacuoles. The pathological phenotype of the tubular cell-specific MDM2-knockout mouse model was completely rescued by co-deletion of p53. Tubular epithelium compensates only partially for the cell loss caused by MDM2 depletion by proliferation of surviving tubular cells, with incomplete MDM2 deletion, but rather mesenchymal healing occurs. We conclude that MDM2 is a non-redundant survival factor for proximal tubular cells by protecting them from spontaneous p53 overexpression-related cell death. PMID:27882940

  13. Acute alcohol exposure during mouse gastrulation alters lipid metabolism in placental and heart development: Folate prevention

    PubMed Central

    Han, Mingda

    2016-01-01

    Background Embryonic acute exposure to ethanol (EtOH), lithium, and homocysteine (HCy) induces cardiac defects at the time of exposure; folic acid (FA) supplementation protects normal cardiogenesis (Han et al., 2009, 2012; Serrano et al., 2010). Our hypothesis is that EtOH exposure and FA protection relate to lipid and FA metabolism during mouse cardiogenesis and placentation. Methods On the morning of conception, pregnant C57BL/6J mice were placed on either of two FA‐containing diets: a 3.3 mg health maintenance diet or a high FA diet of 10.5 mg/kg. Mice were injected a binge level of EtOH, HCy, or saline on embryonic day (E) 6.75, targeting gastrulation. On E15.5, cardiac and umbilical blood flow were examined by ultrasound. Embryonic cardiac tissues were processed for gene expression of lipid and FA metabolism; the placenta and heart tissues for neutral lipid droplets, or for medium chain acyl‐dehydrogenase (MCAD) protein. Results EtOH exposure altered lipid‐related gene expression on E7.5 in comparison to control or FA‐supplemented groups and remained altered on E15.5 similarly to changes with HCy, signifying FA deficiency. In comparison to control tissues, the lipid‐related acyl CoA dehydrogenase medium length chain gene and its protein MCAD were altered with EtOH exposure, as were neutral lipid droplet localization in the heart and placenta. Conclusion EtOH altered gene expression associated with lipid and folate metabolism, as well as neutral lipids, in the E15.5 abnormally functioning heart and placenta. In comparison to controls, the high FA diet protected the embryo and placenta from these effects allowing normal development. Birth Defects Research (Part A) 106:749–760, 2016. © 2016 The Authors Birth Defects Research Part A: Clinical and Molecular Teratology Published by Wiley Periodicals, Inc. PMID:27296863

  14. Acute and preventive management of anaphylaxis in German primary school and kindergarten children.

    PubMed

    Kilger, Magdalena; Range, Ursula; Vogelberg, Christian

    2015-10-15

    Anaphylaxis is a severe, life-threatening situation. However, little is known about real-life anaphylactic management in children, especially in kindergarten and school settings, where a large number of anaphylaxes take place. Parents, school teachers and child-care providers of 86 primary schools and kindergartens in the city of Dresden, Germany, received questionnaires to report their experience with anaphylaxis in children. The main foci of interest were symptoms, allergens, sites of occurrence, acute treatment and emergency sets. Out of 6352 returned questionnaires, 87 cases of anaphylaxis were identified. Prevalence was calculated at 1.5%. Average age of the patients was 7 years, 58% were boys. The majority of reactions occurred at home (67%/58 children). Fourty seven percent (41 children) had recurrent episodes of anaphylaxis. Eighty two percent (71 children) showed cutaneous symptoms, 40% (35 children) respiratory symptoms, 29% (25 children) gastrointestinal symptoms, and 3.4% (3 children) cardiovascular symptoms. Fourty seven percent were classified as mild reactions. Foods were the most common cause (60%/52 cases). Out of these 52, tree-nuts (23%/12 cases) and peanuts (16%/8 cases) were the most frequent triggers. Sixty percent (52 cases) of reactions were treated by a physician, 35% (30 cases) were treated by non-medical professionals only. Fifty one percent (44 children) received antihistamines, 37% (32 children) corticosteroids, 1% (1 child) intramuscular adrenaline. Sixty one percent of children (53 cases) received an emergency kit. Content were corticosteroids (70%/37 cases) and antihistamines (62%/33 cases). Adrenaline auto-injectors were prescribed to 26% (14 cases). Concerning school and kindergarten-staff, 13% of the child-care providers had no knowledge about the emergency kit's content, compared to 34% of teachers. This study might support the impression of severe under-treatment of anaphylactic children in the use of adrenaline and prescription

  15. Acute decompensated heart failure (ADHF): A comprehensive contemporary review on preventing early readmissions and postdischarge death.

    PubMed

    Rocha, Bruno M L; Menezes Falcão, Luiz

    2016-11-15

    Heart failure (HF) is an increasingly prevalent syndrome and a leading cause of both first hospitalization and readmissions. Strikingly, up to 25% of the patients are readmitted within 30 to 60-days, accounting for HF as the primary cause for readmission in the adult population. Given its poor prognosis, one could describe it as a "malignant condition". Acute decompensation is intrinsically related to increased right heart tele-diastolic pressures and often related to congestive symptoms. In-hospital strategies to adequately compensate and timely discharge patients are limited. Conversely, the fragile early postdischarge phase is a vulnerable period when one could potentially intervene cost-effectively to improve survival and to reduce morbidity. Promising transitional hospital-to-home programs may have a broader role in the near future, namely for selected higher risk patients. However, identifying patients at risk for hospital readmission has been challenging. Novel approaches, such as ferric carboxymaltose and valsartan/sacubitril, and reemerging drugs, particularly digoxin, may reduce hospitalizations. Despite this, optimizing the use of "older" therapies is still warranted. Right heart pressures monitoring may provide novel insights into promptly outpatient management. Unfortunately, randomized trials in the specific ADHF population are scarce. A novel paradigmatic approach is needed in order to suitably improve the currently poor prognosis of ADHF. Both improving survival and reducing hospitalizations are, therefore, primordial therapy goals. Lastly, no single drug has consistently proved to improve survival in HF with preserved ejection fraction (HFpEF); yet, some approaches may efficiently reduce hospitalizations. Awareness on HFpEF management beyond the failing heart is imperative.

  16. N-acetylcysteine versus Dopamine to Prevent Acute Kidney Injury after Cardiac Surgery in Patients with Preexisting Moderate Renal Insufficiency

    PubMed Central

    Savluk, Omer Faruk; Guzelmeric, Fusun; Yavuz, Yasemin; Cevirme, Deniz; Gurcu, Emre; Ogus, Halide; Orki, Tulay; Kocak, Tuncer

    2017-01-01

    Objective Acute kidney injury after cardiac surgery is associated with mortality and morbidity. Therefore, strategies to prevent acute kidney injury are very important. The aim of this placebo-controlled randomized double-blind study was to compare the prophylactic efficacy of N-Acetylcysteine and dopamine administration in patients with pre-existing moderate renal insufficiency who were undergoing cardiopulmonary bypass. Methods This study included 135 patients with pre-existing moderate renal insufficiency who were scheduled for coronary artery bypass grafting surgery. Serum creatinine and GFR were recorded preoperatively and on the first and second postoperative days. Results On the first and second postoperative days, the drugs used showed statistically significant differences among the creatinine groups (P<0.001). According to Tukey’s HSD, on the first and second PO, the creatinine of Group N, D and P were significantly different (P<0.001). On the first and second PO, the used drugs showed statistically significant differences among the effects of eGFR (P<0.001). According to Tukey’s HSD on the first postoperative day, the average eGFR score of Group N compared to D and P were significantly difference (P<0.001). On the second postoperative day, the eGFR of Group N and D showed no difference (P=0.37), but P showed a difference (P<0.001). Conclusion We found that the prophylactic use of intravenous N-Acetylcysteine had a protective effect on renal function, whereas the application of renal dose dopamine did not have a protective effect in patients with pre-existing moderate renal failure.

  17. Perioperative Antibiotics to Prevent Acute Endophthalmitis after Ophthalmic Surgery: A Systematic Review and Meta-Analysis

    PubMed Central

    Huang, Jinzhu; Wang, Xiaofang; Chen, Xiaohong; Song, Qiuyue; Liu, Wen; Lu, Laichun

    2016-01-01

    isolation rates (RR = 0.57, 95% CI (0.44, 0.74), p<0.0001). Conclusions This meta-analysis concluded intracameral antibiotics are effective at preventing endophthalmitis in ocular surgery. A randomized controlled trial confirms the efficacy of cefuroxime but recent large cohort studies support the efficacy of vancomycin/moxifloxacin intracamerally. Intracameral antibitoics are superior to subconjunctival injections but that irrigation antibitoic data are not of enough quality to make a comparison. Different results were found in two clinical outcomes between the use or lack of use of topical antibiotic therapy, we did not find sufficient evidence to conclude that its use prevents endophthalmitis. PMID:27824933

  18. Selective bowel decontamination for the prevention of infection in acute myelogenous leukemia: a prospective randomized trial.

    PubMed

    Lee, Dong Gun; Choi, Su Mi; Choi, Jung Hyun; Yoo, Jin Hong; Park, Yoon Hee; Kim, Yoo Jin; Lee, Seok; Min, Chang Ki; Kim, Hee Je; Kim, Dong Wook; Lee, Jong Wook; Min, Woo Sung; Shin, Wan Shik; Kim, Chun Choo

    2002-03-01

    Infection is still a frequent cause of morbidity and mortality in acute myelogenous leukemia (AML) patients receiving chemotherapy. Recently the main cause of infection has changed from gram-negative to gram-positive bacteria and the resistance to antibiotics has increased. This study aimed to access the effectiveness of antimicrobial prophylaxis (AP) with orally absorbable antibiotics. Ninety-five AML patients receiving chemotherapy at Catholic Hemopoietic Stem Cell Transplantation Center from March 1999 to July 1999 were randomly divided into the AP group (250 mg ciprofloxacin twice a day, 150 mg roxithromycin twice a day, 50 mg fluconazole once a day) and the control group for a prospective analysis. The incidence of fever was 82.6% in the AP group and 91.6% in the control group (p = 0.15). Though classification and sites of infections showed no difference between the two groups, the catheter associated infection occurred more frequently in the AP group in significance. The time interval between initiation of chemotherapy and onset of fever, white blood cell (WBC) count at the onset of fever, duration of leukopenia (WBC < 1,000/mm3), duration of systemic antibiotic therapy, mortality due to infection and hospitalization period from the data starting chemotherapy showed no differences between the two groups. Infections due to gram negative bacteria decreased to 33.3% in the AP group (vs. 92% in the control group), but infections due to gram positive bacteria increased to 66.7% (vs. 8% in the control group). Gram negative bacteria showed 100% resistance to ciprofloxacin in the AP group and gram-positive bacteria showed 90-100% resistance to erythromycin, regardless of the presence of AP. The AP could not reduce the occurrence of infection or infection associated death in AML patients receiving chemotherapy. On considering increased gram-positive infection and resistance to fluoroquinolone and macrolide, routine prescription of AP should be reconsidered. Further

  19. Intraportal mesenchymal stem cell transplantation prevents acute liver failure through promoting cell proliferation and inhibiting apoptosis.

    PubMed

    Sang, Jian-Feng; Shi, Xiao-Lei; Han, Bin; Huang, Tao; Huang, Xu; Ren, Hao-Zhen; Ding, Yi-Tao

    2016-12-01

    Transplantation of mesenchymal stem cells (MSCs) has been regarded as a potential treatment for acute liver failure (ALF), but the optimal route was unknown. The present study aimed to explore the most effective MSCs transplantation route in a swine ALF model. The swine ALF model induced by intravenous injection of D-Gal was treated by the transplantation of swine MSCs through four routes including intraportal injection (InP group), hepatic intra-arterial injection (AH group), peripheral intravenous injection (PV group) and intrahepatic injection (IH group). The living conditions and survival time were recorded. Blood samples before and after MSCs transplantation were collected for the analysis of hepatic function. The histology of liver injury was interpreted and scored in terminal samples. Hepatic apoptosis was detected by TUNEL assay. Apoptosis and proliferation related protein expressions including cleaved caspase-3, survivin, AKT, phospho-AKT (Ser473), ERK and phospho-ERK (Tyr204) were analyzed by Western blotting. The average survival time of each group was 10.7+/-1.6 days (InP), 6.0+/-0.9 days (AH), 4.7+/-1.4 days (PV), 4.3+/-0.8 days (IH), respectively, when compared with the average survival time of 3.8+/-0.8 days in the D-Gal group. The survival rates between the InP group and D-Gal group revealed a statistically significant difference (P<0.01). Pathological and biochemical analysis showed that liver damage was the worst in the D-Gal group, while less injury in the InP group. Histopathological scores revealed a significant decrease in the InP group (3.17+/-1.04, P<0.01) and AH group (8.17+/-0.76, P<0.05) as compared with that in the D-Gal group (11.50+/-1.32). The apoptosis rate in the InP group (25.0%+/-3.4%, P<0.01) and AH group (40.5%+/-1.0%, P<0.05) was lower than that in the D-Gal group (70.6%+/-8.5%). The expression of active caspase-3 was inhibited, while the expression of survivin, AKT, phospho-AKT (Ser473), ERK and phospho-ERK (Tyr204) was

  20. Sunburn and Sunscreens.

    ERIC Educational Resources Information Center

    Henriksen, Peter N.; Payerle, Paul

    Sunlight (solar radiation) provides many beneficial contributions to mankind, including warmth and energy, vision and photoresponses, photosynthesis, and vitamin D synthesis. Along with these positive benefits attributed to solar radiation, there are also adverse effects. A particular adverse effect of current interest and concern which is…

  1. Sunburn and Sunscreens.

    ERIC Educational Resources Information Center

    Henriksen, Peter N.; Payerle, Paul

    Sunlight (solar radiation) provides many beneficial contributions to mankind, including warmth and energy, vision and photoresponses, photosynthesis, and vitamin D synthesis. Along with these positive benefits attributed to solar radiation, there are also adverse effects. A particular adverse effect of current interest and concern which is…

  2. Travelers' Health: Sunburn

    MedlinePlus

    ... Compartir Chapter 2 - Protection against Mosquitoes, Ticks, & Other Arthropods Chapter 2 - Problems with Heat & Cold Sun Exposure ... 3. Chapter 2 - Protection against Mosquitoes, Ticks, & Other Arthropods Chapter 2 - Problems with Heat & Cold File Formats ...

  3. Travelers' Health: Sunburn

    MedlinePlus

    ... UVA and UVB radiation. With the advent of nanotechnology, these products no longer cause an opaque white ... SQ, Tooley IR. Photoprotection in the era of nanotechnology. Semin Cutan Med Surg. 2011 Dec;30(4): ...

  4. An acute post-sexual assault intervention to prevent drug abuse: Updated Findings

    PubMed Central

    Resnick, Heidi S.; Acierno, Ron; Amstadter, Ananda B.; Self-Brown, Shannon

    2007-01-01

    Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape in efforts to ameliorate post assault distress. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address this problem, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1) < 3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault. PMID:17275198

  5. An acute post-sexual assault intervention to prevent drug abuse: updated findings.

    PubMed

    Resnick, Heidi S; Acierno, Ron; Amstadter, Ananda B; Self-Brown, Shannon; Kilpatrick, Dean G

    2007-10-01

    Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)<3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.

  6. Lack of analgesia by oral standardized cannabis extract on acute inflammatory pain and hyperalgesia in volunteers.

    PubMed

    Kraft, Birgit; Frickey, Nathalie A; Kaufmann, Rainer M; Reif, Marcus; Frey, Richard; Gustorff, Burkhard; Kress, Hans G

    2008-07-01

    Cannabinoid-induced analgesia was shown in animal studies of acute inflammatory and neuropathic pain. In humans, controlled clinical trials with Delta-tetrahydrocannabinol or other cannabinoids demonstrated analgesic efficacy in chronic pain syndromes, whereas the data in acute pain were less conclusive. Therefore, the aim of this study was to investigate the effects of oral cannabis extract in two different human models of acute inflammatory pain and hyperalgesia. The authors conducted a double-blind, crossover study in 18 healthy female volunteers. Capsules containing Delta-tetrahydrocannabinol-standardized cannabis extract or active placebo were orally administered. A circular sunburn spot was induced at one upper leg. Heat and electrical pain thresholds were determined at the erythema, the area of secondary hyperalgesia, and the contralateral leg. Intradermal capsaicin-evoked pain and areas of flare and secondary hyperalgesia were measured. Primary outcome parameters were heat pain thresholds in the sunburn erythema and the capsaicin-evoked area of secondary hyperalgesia. Secondary measures were electrical pain thresholds, sunburn-induced secondary hyperalgesia, and capsaicin-induced pain. Cannabis extract did not affect heat pain thresholds in the sunburn model. Electrical thresholds (250 Hz) were significantly lower compared with baseline and placebo. In the capsaicin model, the area of secondary hyperalgesia, flare, and spontaneous pain were not altered. To conclude, no analgesic or antihyperalgesic activity of cannabis extract was found in the experiments. Moreover, the results even point to the development of a hyperalgesic state under cannabinoids. Together with previous data, the current results suggest that cannabinoids are not effective analgesics for the treatment of acute nociceptive pain in humans.

  7. Lessons Learned From Root Cause Analyses of Transfers of Skilled Nursing Facility (SNF) Patients to Acute Hospitals: Transfers Rated as Preventable Versus Nonpreventable by SNF Staff.

    PubMed

    Ouslander, Joseph G; Naharci, Ilkin; Engstrom, Gabriella; Shutes, Jill; Wolf, David G; Alpert, Graig; Rojido, Carolina; Tappen, Ruth; Newman, David

    2016-07-01

    Determining if a transfer of a skilled nursing facility (SNF) patient/resident to an acute hospital is potentially avoidable or preventable is challenging. Most previous research on potentially avoidable or preventable hospitalizations is based on diagnoses without in-depth root cause analysis (RCA), and few studies have examined SNF staff perspective on preventability of transfers. To examine factors associated with hospital transfers rated as potentially preventable versus nonpreventable by SNF staff. Trained staff from SNFs enrolled in a randomized controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period. SNFs from across the United States. Sixty-four of 88 SNFs randomized to the intervention group submitted RCAs with a rating of whether the transfer was determined to be potentially preventable or nonpreventable. SNFs were implementing the INTERACT Quality Improvement (QI) program. Data were abstracted from the INTERACT QI tool, a structured, retrospective RCA on hospital transfers. A total of 4527 RCAs with a rating of preventability were submitted during the 12-month implementation period, of which 1044 (23%) were rated as potentially preventable by SNF staff. In unadjusted univariate analyses, factors associated with ratings of potentially preventable included acute changes in condition of fever, decreased food or fluid intake, functional decline, shortness of breath, and new urinary incontinence; other factors included the clinician, resident, and/or family insisting on the transfer, transfers that occurred fewer than 30 days from SNF admission and that occurred on weekends, transfers ordered by a covering physician (as opposed to the primary physician), and transfers that resulted in an emergency department (ED) visit with return to the SNF. Factors associated with ratings of nonpreventable included on

  8. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer.

    PubMed

    Pommier, P; Gomez, F; Sunyach, M P; D'Hombres, A; Carrie, C; Montbarbon, X

    2004-04-15

    The effectiveness of nonsteroid topical agents for the prevention of acute dermatitis during adjuvant radiotherapy for breast carcinoma has not been demonstrated. The goal of this study was to compare the effectiveness of calendula (Pommade au Calendula par Digestion; Boiron Ltd, Levallois-Perret, France) with that of trolamine (Biafine; Genmedix Ltd, France), which is considered in many institutions to be the reference topical agent. Between July 1999 and June 2001, 254 patients who had been operated on for breast cancer and who were to receive postoperative radiation therapy were randomly allocated to application of either trolamine (128 patients) or calendula (126 patients) on the irradiated fields after each session. The primary end point was the occurrence of acute dermatitis of grade 2 or higher. Prognostic factors, including treatment modalities and patient characteristics, were also investigated. Secondary end points were the occurrence of pain, the quantity of topical agent used, and patient satisfaction. The occurrence of acute dermatitis of grade 2 or higher was significantly lower (41% v 63%; P <.001) with the use of calendula than with trolamine. Moreover, patients receiving calendula had less frequent interruption of radiotherapy and significantly reduced radiation-induced pain. Calendula was considered to be more difficult to apply, but self-assessed satisfaction was greater. Body mass index and adjuvant chemotherapy before radiotherapy after lumpectomy were significant prognostic factors for acute dermatitis. Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer.

  9. Oral allopurinol to prevent hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography

    PubMed Central

    Martinez-Torres, Hector; Rodriguez-Lomeli, Xochilt; Davalos-Cobian, Carlos; Garcia-Correa, Jesus; Maldonado-Martinez, Juan Manuel; Medrano-Muñoz, Fabiola; Fuentes-Orozco, Clotilde; Gonzalez-Ojeda, Alejandro

    2009-01-01

    AIM: To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). METHODS: One hundred and seventy patients were enrolled and randomized to two groups: a study group (n = 85) who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography (ERCP) and a control group (n = 85) receiving an oral placebo at the same times. Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis. Serum amylase levels were classified as normal (< 150 IU/L) or hyperamylasemia (> 151 IU/L). Episodes of PEP were classified following Ranson’s criteria and CT severity index. RESULTS: Gender distribution was similar between groups. Mean age was 53.5 ± 18.9 years for study group and 52.8 ± 19.8 years for controls. Also, the distribution of benign pathology was similar between groups. Hyperamylasemia was more common in the control group (P = 0.003). Mild PEP developed in two patients from the study group (2.3%) and eight (9.4%) from control group (P = 0.04), seven episodes were observed in high-risk patients of the control group (25%) and one in the allopurinol group (3.3%, P = 0.02). Risk factors for PEP were precut sphincterotomy (P = 0.02), pancreatic duct manipulation (P = 0.002) and multiple procedures (P = 0.000). There were no deaths or side effects. CONCLUSION: Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures. PMID:19340902

  10. An Alpha-1A Adrenergic Receptor Agonist Prevents Acute Doxorubicin Cardiomyopathy in Male Mice

    PubMed Central

    Montgomery, Megan D.; Chan, Trevor; Swigart, Philip M.; Myagmar, Bat-erdene; Dash, Rajesh; Simpson, Paul C.

    2017-01-01

    Alpha-1 adrenergic receptors mediate adaptive effects in the heart and cardiac myocytes, and a myocyte survival pathway involving the alpha-1A receptor subtype and ERK activation exists in vitro. However, data in vivo are limited. Here we tested A61603 (N-[5-(4,5-dihydro-1H-imidazol-2-yl)-2-hydroxy-5,6,7,8-tetrahydronaphthalen-1-yl]methanesulfonamide), a selective imidazoline agonist for the alpha-1A. A61603 was the most potent alpha-1-agonist in activating ERK in neonatal rat ventricular myocytes. A61603 activated ERK in adult mouse ventricular myocytes and protected the cells from death caused by the anthracycline doxorubicin. A low dose of A61603 (10 ng/kg/d) activated ERK in the mouse heart in vivo, but did not change blood pressure. In male mice, concurrent subcutaneous A61603 infusion at 10 ng/kg/d for 7 days after a single intraperitoneal dose of doxorubicin (25 mg/kg) increased survival, improved cardiac function, heart rate, and cardiac output by echocardiography, and reduced cardiac cell necrosis and apoptosis and myocardial fibrosis. All protective effects were lost in alpha-1A-knockout mice. In female mice, doxorubicin at doses higher than in males (35–40 mg/kg) caused less cardiac toxicity than in males. We conclude that the alpha-1A-selective agonist A61603, via the alpha-1A adrenergic receptor, prevents doxorubicin cardiomyopathy in male mice, supporting the theory that alpha-1A adrenergic receptor agonists have potential as novel heart failure therapies. PMID:28081170

  11. Pulsed focused ultrasound pretreatment improves mesenchymal stem cell efficacy in preventing and rescuing established acute kidney injury in mice

    PubMed Central

    Burks, Scott R.; Nguyen, Ben A.; Tebebi, Pamela A.; Kim, Saejeong J.; Bresler, Michele N.; Ziadloo, Ali; Street, Jonathan M.; Yuen, Peter S. T.; Star, Robert A.; Frank, Joseph A.

    2014-01-01

    Animal studies have shown that mesenchymal stem cell (MSC) infusions improve acute kidney injury (AKI) outcomes when administered early after ischemic/reperfusion injury or within 24hr after cisplatin administration. These findings have spurred several human clinical trials to prevent AKI. However, no specific therapy effectively treats clinically obvious AKI or rescues renal function once advanced injury is established. We investigated if noninvasive image-guided pulsed focused ultrasound (pFUS) could alter the kidney microenvironment to enhance homing of subsequently infused MSC. To examine the efficacy of pFUS-enhanced cell homing in disease, we targeted pFUS to kidneys to enhance MSC homing after cisplatin-induced AKI. We found that pFUS enhanced MSC homing at 1 day post-cisplatin, prior to renal functional deficits, and that enhanced homing improved outcomes of renal function, tubular cell death, and regeneration at 5 days post-cisplatin compared to MSC alone. We then investigated whether pFUS+MSC therapy could rescue established AKI. MSC alone at 3 days post-cisplatin, after renal functional deficits were obvious, significantly improved 7-day survival of animals. Survival was further improved using pFUS+MSC. MSC, alone or with pFUS, changed kidney macrophage phenotypes from M1 to M2. This study shows pFUS is a neoadjuvant approach to improve MSC homing to diseased organs. pFUS with MSC better prevents AKI than MSC alone and allows rescue therapy in established AKI, which currently has no meaningful therapeutic options. PMID:25640064

  12. Inhibition of leukotriene B4 synthesis does not prevent development of acute renal failure following storage and transplantation.

    PubMed

    Lane, N J; Thorniley, M S; Manek, S; Fuller, B J; Green, C J

    1994-12-27

    Compound BW B70C, a selective 5-lipoxygenase inhibitor was tested for its ability to reduce inflammatory damage in an in vivo rabbit model of renal storage and transplantation. Kidneys were stored at 0-2 degrees C for 48 hr prior to autografting. In controls, renal vein LTB4 levels rose significantly after 30 min reperfusion but fell after 2 hr to baseline. TxB2 levels remained at baseline for the 6 hr measured. 6-k-PGF1 alpha levels rose significantly after 1 hr of reperfusion and remained elevated thereafter. Histology after 6 hr reperfusion showed moderate-to-severe cortical edema and mild congestion. Infused colloidal carbon was retained in the perivascular area in a narrow band at the corticomedullary junction, indicating a zone of vascular permeability. At 3 days after transplant, kidneys exhibited widespread tubular necrosis and calcification but little inflammation. Serum creatinine and urea peaked between days 3 and 5. 3/6 rabbits showed no symptoms of renal failure after 3 weeks. Pretreatment with BW B70C prevented the increase in LTB4 but had little effect on TxB2 and 6-k-PGF1 alpha levels. Histology showed no amelioration of cortical edema at 6 hr and congestion and hemorrhage were exacerbated. BW B70C had no effect on either colloidal carbon retention or distribution but did significantly reduce tubular necrosis and calcification at day 3. There was very little inflammatory infiltrate. BW B70C treatment did not improve the long-term viability of transplanted kidneys: 2/6 rabbits showed no symptoms of renal failure after 3 weeks. These data indicate that inhibition of LTB4 synthesis by BW B70C does not prevent the development of acute renal failure following 48 hr hypothermic storage and transplantation.

  13. Ticagrelor versus genotype-driven antiplatelet therapy for secondary prevention after acute coronary syndrome: a cost-effectiveness analysis.

    PubMed

    Crespin, Daniel J; Federspiel, Jerome J; Biddle, Andrea K; Jonas, Daniel E; Rossi, Joseph S

    2011-06-01

    Clopidogrel's effectiveness is likely reduced significantly for prevention of thrombotic events after acute coronary syndrome (ACS) in patients exhibiting a decreased ability to metabolize clopidogrel into its active form. A genetic mutation responsible for this reduced effectiveness is detectable by genotyping. Ticagrelor is not dependent on gene-based metabolic activation and demonstrated greater clinical efficacy than clopidogrel in a recent secondary prevention trial. In 2011, clopidogrel will lose its patent protection and likely will be substantially less expensive than ticagrelor. To determine the cost-effectiveness of ticagrelor compared with a genotype-driven selection of antiplatelet agents. A hybrid decision tree/Markov model was used to estimate the 5-year medical costs (in 2009 US$) and outcomes for a cohort of ACS patients enrolled in Medicare receiving either genotype-driven or ticagrelor-only treatment. Outcomes included life years and quality-adjusted life years (QALYs) gained. Data comparing the clinical performance of ticagrelor and clopidogrel were derived from the Platelet Inhibition and Patient Outcomes trial. The incremental cost-effectiveness ratio (ICER) for universal ticagrelor was $10,059 per QALY compared to genotype-driven treatment, and was most sensitive to the price of ticagrelor and the hazard ratio for death for ticagrelor compared with clopidogrel. The ICER remained below $50,000 per QALY until a monthly ticagrelor price of $693 or a 0.93 hazard ratio for death for ticagrelor relative to clopidogrel. In probabilistic analyses, universal ticagrelor was below $50,000 per QALY in 97.7% of simulations. Prescribing ticagrelor universally increases quality-adjusted life years for ACS patients at a cost below a typically accepted threshold. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. The Ignored Role of Intraoperative Hypotension in Producing Postoperative Acute Kidney Injury-An Obligatory Appeal for More Preventative Nephrology.

    PubMed

    Onuigbo, Macaulay Amechi Chukwukadibia; Agbasi, Nneoma

    2017-01-01

    Intraoperative hypotension (IOH) invariably follows the induction of general anesthesia during surgical operations. The current prevailing and predominant consensus is that IOH has immense clinical benefits such as reduced bleeding, less need for blood transfusions, and shorter surgery times. Simultaneously, it is assumed that IOH is devoid of adverse renal, hepatic and neurological consequences. Emerging new evidence and our experiences suggest a strong link between IOH and postoperative acute kidney injury (AKI). Method/Case Reports: We report on three case presentations to illustrate the impact of IOH on postoperative AKI. Our recent experiences suggest and show a link between IOH and postoperative AKI. Sun et al. (2015) recently demonstrated that postoperative AKI was associated with sustained intraoperative hypotensive periods of MAP <55 and <60 mm Hg, respectively, in a graded pattern. Our experiences and new emerging Surgery-AKI literature provide an impetus for clinical trials to be set up and completed to determine whether interventions that promptly treat IOH, or better still that prevent IOH, and that are tailored to suit individual patient physiology, would reduce the risk of AKI. We posit that IOH is a neglected cause of postoperative AKI. We call for a preventative nephrology paradigm shift and the targeting of MAP ≥ 60 mm Hg and/or SBP ≥ 90 mm Hg during surgical procedures. Particularly in sub-Saharan Africa with its paucity of renal replacement therapy options to manage kidney failure, every effort to limit AKI, SORO-ESRD and exacerbation of kidney dysfunction in general, must be vigorously applied. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury.

    PubMed

    Mita, Naoji; Kawahito, Shinji; Soga, Tomohiro; Takaishi, Kazumi; Kitahata, Hiroshi; Matsuhisa, Munehide; Shimada, Mitsuo; Kinoshita, Hiroyuki; Tsutsumi, Yasuo M; Tanaka, Katsuya

    2017-03-01

    The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.

  16. Donor Atorvastatin Treatment in Preventing Severe Acute GVHD After Nonmyeloablative Peripheral Blood Stem Cell Transplant in Patients With Hematological Malignancies

    ClinicalTrials.gov

    2017-01-13

    Aggressive Non-Hodgkin Lymphoma; Myelodysplastic/Myeloproliferative Neoplasm; Non-Hodgkin Lymphoma; Prolymphocytic Leukemia; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Aggressive Adult Non-Hodgkin Lymphoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Chronic Lymphocytic Leukemia; Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Recurrent Diffuse Large B-Cell Lymphoma; Recurrent Hodgkin Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Plasma Cell Myeloma; Recurrent Small Lymphocytic Lymphoma; Waldenstrom Macroglobulinemia

  17. Early traditional Chinese medicine bundle therapy for the prevention of sepsis acute gastrointestinal injury in elderly patients with severe sepsis

    PubMed Central

    Wang, Yifei; Zhang, Yunhua; Jiang, Ronglin

    2017-01-01

    This study aimed to study the effect of early traditional Chinese medicine bundle therapy on the prevention of sepsis-associated acute gastrointestinal injury (AGI). This was a multicenter, prospective, observational, non-randomized cohort study of 296 consecutive patients with severe sepsis during 2013/3 and 2014/11; 150 patients received standard treatments (controls) and 146 received traditional Chinese medicine bundle therapy (intervention group) (herbal decoction gavage based on syndrome differentiation, Chinese acupuncture, application of mirabilite, and defecation mixture). D-lactic acid, diamine oxidase, endotoxin, gastrin, motilin, and intra-abdominal pressure were measured. AGI was categorized into four levels. Compared with controls, D-lactic acid, diamine oxidase, endotoxin, gastrin, and intra-abdominal pressure in the intervention group were decreased, and motilin was increased on day 7. AGI incidence in the intervention group was lower than in controls. GIF scores of the intervention AGI II and III groups were lower than in controls. The APACHE II scores of the intervention AGI II, III, and IV groups were lower than in controls. Compared with controls, mechanical ventilation time and ICU stay in the intervention group were shorter, and 28-day overall and AGI-attributed mortality were lower. For elderly patients with severe sepsis, early traditional Chinese medicine bundle therapy could decrease AGI incidence and improve prognosis. PMID:28382954

  18. Does a home treatment acute relapse prevention strategy reduce admissions for people with mania in bipolar affective disorder?

    PubMed Central

    Murton, Claudia; Cooper, Michael; Dinniss, Stephen; Roberts, Shon; Booth, Nicola; Newell, Paul

    2014-01-01

    Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this. Results We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P<0.0001. Clinical implications A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy. PMID:25505627

  19. The effect of a sweet potato, footbath, and acupressure intervention in preventing constipation in hospitalized patients with acute coronary syndromes.

    PubMed

    Ren, Kai; Qiu, Jingbo; Wang, Xiaohua; Niu, Fenglin; Jiang, Tingbo

    2012-01-01

    Constipation is a common health problem that adversely affects quality of life and the prognosis of hospitalized patients with acute coronary syndromes (ACS). The purpose of this study was to develop and test the sweet potato/footbath/acupressure massage (SFA) intervention as a safe treatment for prevention of constipation and to increase satisfaction with bowel emptying in hospitalized patients with ACS. The study was a prospective, randomized controlled trial with a sample of 93 patients (SFA group, n = 44; usual care group, n = 49). Patients in the SFA group received SFA intervention combined with usual care. The results showed that there were statistical differences between the two groups in terms of (1) the incidence of constipation; (2) the use of laxatives and enemas; (3) patients' subjective satisfaction with their bowel emptying during hospitalization; and (4) sensation of incomplete evacuation and anorectal obstruction/blockade. The SFA intervention was more effective, economical, and practical than usual care alone in managing constipation and satisfaction with defecation in patients hospitalized with ACS.

  20. Prevention of non-immune mediated transfusion-related acute lung injury; from blood bank to patient.

    PubMed

    van Bruggen, Robin; de Korte, Dirk

    2012-01-01

    Transfusion-related acute lung injury (TRALI) is a severe form of pulmonary insufficiency induced by transfusion. TRALI is the leading cause of transfusion-related death, and is caused by the infusion of either anti-leukocyte antibodies in plasma containing blood products or neutrophil priming substances that accumulate during storage of cellular blood products. Among these neutrophil priming substances are bioactive lipids, such as lyso-phosphatidylcholines (lysoPCs) and arachidonic acid, soluble CD40L (sCD40L) and possibly other, as yet unidentified substances. The accumulation of these substances during cellular blood product storage and their role in the induction of "non-immune mediated" TRALI pathogenesis are highly relevant for the current debate of the use of longer vs. shorter stored blood products. In this review, the accumulation of these different substances during storage, as well as their mode of action in inducing TRALI are discussed. In addition, different improvements in current blood banking procedures to prevent TRALI due to these non-immune mediators will be proposed.

  1. Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies.

    PubMed

    Cheng, Kevin; Ingram, Nicola; Keenan, Jan; Choudhury, Robin P

    2015-01-01

    Adherence to secondary prevention medications following acute coronary syndrome (ACS) is disappointingly low, standing around 40-75% by various estimates. This is an inefficient use of the resources devoted to their development and implementation, and also puts patients at higher risk of poor outcomes post-ACS. Numerous factors contribute to low adherence including poor motivation, forgetfulness, lack of education about medications, complicated polypharmacy of ACS regimens, (fear of) adverse side effects and limited practical support. Using technology to improve adherence in ACS is an emerging strategy and has the potential to address many of the above factors-computer-based education and mobile phone reminders are among the interventions trialled and appear to improve adherence in patients with ACS. As we move into an increasingly technological future, there is potential to use devices such as smartphones and tablets to encourage patient responsibility for medications. These handheld technologies have great scope for allowing patients to view online medical records, education modules and reminder systems, and although research specific to ACS is limited, they have shown initial promise in terms of uptake and improved adherence among similar patient populations. Given the overwhelming enthusiasm for handheld technologies, it would seem timely to further investigate their role in improving ACS medication adherence.

  2. A polyamine analogue prevents acute pancreatitis and restores early liver regeneration in transgenic rats with activated polyamine catabolism.

    PubMed

    Rasanen, Tiina-Liisa; Alhonen, Leena; Sinervirta, Riitta; Keinanen, Tuomo; Herzig, Karl-Heinz; Suppola, Suvikki; Khomutov, Alex R; Vepsalainen, Jouko; Janne, Juhani

    2002-10-18

    We recently generated a transgenic rat model for acute pancreatitis, which was apparently caused by a massive depletion of pancreatic polyamines spermidine and spermine due to inducible activation of their catabolism (Alhonen, L., Parkkinen, J. J., Keinänen, T., Sinervirta, R., Herzig, K. H., and Jänne, J. (2000) Proc. Natl. Acad. Sci. U. S. A. 97, 8290-8295). When subjected to partial hepatectomy, these animals showed striking activation of polyamine catabolism at 24 h postoperatively with a profound decrease in hepatic spermidine and spermine pools and failure to initiate liver regeneration. Here we show that pancreatitis in this model could be totally prevented, as judged by histopathology and plasma alpha-amylase activity, by administration of 1-methylspermidine, a metabolically stable analogue of spermidine. Similarly, the analogue, given prior to partial hepatectomy, restored early liver regeneration in the transgenic rats, as indicated by a dramatic increase in the number of proliferating cell nuclear antigen-positive hepatocytes from about 1% to more than 40% in response to the drug. The present results suggest that the extremely high concentration of spermidine in the pancreas, in fact the highest in the mammalian body, may have a critical role in maintaining organ integrity. The failure to initiate liver regeneration in the absence of sufficient hepatic polyamine pools similarly indicates that polyamines are required for proper commencement of the regenerative process.

  3. A phase III randomized, placebo-controlled, double-blind study of misoprostol rectal suppositories to prevent acute radiation proctitis in patients with prostate cancer

    SciTech Connect

    Hille, Andrea . E-mail: ahille@med.uni-goettingen.de; Schmidberger, Heinz; Hermann, Robert M.; Christiansen, Hans; Saile, Bernhard; Pradier, Olivier; Hess, Clemens F.

    2005-12-01

    Purpose: Acute radiation proctitis is the most relevant complication of pelvic radiation and is still mainly treated supportively. Considering the negative impact of acute proctitis symptoms on patients' daily activities and the potential relationship between the severity of acute radiation injury and late damage, misoprostol was tested in the prevention of acute radiation-induced proctitis. Methods and Materials: A total of 100 patients who underwent radiotherapy for prostate cancer were entered into this phase III randomized, placebo-controlled, double-blind study with misoprostol or placebo suppositories. Radiation-induced toxicity was evaluated weekly during radiotherapy using the Common Toxicity Criteria. Results: Between the placebo and the misoprostol groups, no significant differences in proctitis symptoms occurred: 76% of patients in each group had Grade 1 toxicity, and 26% in the placebo group and 36% in the misoprostol group had Grade 2 toxicity. No differences were found in onset or symptom duration. Comparing the peak incidence of patients' toxicity symptoms, significantly more patients experienced rectal bleeding in the misoprostol group (p = 0.03). Conclusion: Misoprostol given as a once-daily suppository did not decrease the incidence and severity of radiation-induced acute proctitis and may increase the incidence of acute bleeding.

  4. Travel health: sun protection and skin cancer prevention for travellers.

    PubMed

    Wood, Cate

    The UK population likes to travel to sunny parts of the world, where the risk of sunburn is greater than it is at home. Sunburn and the cultural desire for a tan is one of the risk factors for the increase in skin cancer. The rise in foreign travel has resulted in an increased demand for pre-travel health services, with nurses in primary care acting as the main providers.Within these consultations, the traveller and their travel plans are risk assessed.Travel health consultations give an ideal opportunity to discuss and advise the public regarding sun burn and skin cancer protection. However, there are also other ways to impart safety in the sun message to travellers. Skin protection is a health promoting activity provided as a part of public health provision and all nurses can play a role in prevention.

  5. Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project.

    PubMed

    Sykes, Pamela Kathleen; Walsh, Kenneth; Darcey, Chenqu Mimi; Hawkins, Heather Lee; McKenzie, Duncan Scott; Prasad, Ritam; Thomas, Anita

    2016-06-01

    Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE. A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital. A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days

  6. Preventive pancreatic stents in the management of acute biliary pancreatitis (PREPAST trial): pre-study protocol for a multicenter, prospective, randomized, interventional, controlled trial.

    PubMed

    Dubravcsik, Zsolt; Madácsy, László; Gyökeres, Tibor; Vincze, Áron; Szepes, Zoltán; Hegyi, Péter; Hritz, István; Szepes, Attila

    2015-01-01

    The outcome of the most common biliary form of acute pancreatitis has not changed even with the better described indications for early endoscopic intervention. It may be due to the fact that this intrevention theoretically can cause further pancreatic injury or cannot always relieve the pancreatic duct obstruction. We hypothesize that maintaining the outflow of the pancreatic duct with preventive pancreatic stents at the early ERCP improves the outcome of acute biliary pancreatitis. PREPAST is a prospective, randomized, controlled, multicenter trial. Patients with acute biliary pancreatitis with coexisting cholangitis are randomized to undergo urgent endoscopic intervention with or without pancreatic stenting within 48 h from the onset of pain, and in addition patients without signs of cholangitis but cholestasis are randomly allocated to recieve conservative treatment or early endoscopic intervention with or without pancreatic stenting within 48 h from the onset of pain. Patients without acute cholangitis and signs of cholestasis recieve conservative treatment. 230 patients are planned to be enrolled during a 48 months period from different centers. The primary endpoint is the outcome of acute biliary pancreatitis as described by the latest guidelines. Secondary endpoints include mortality data, and other variables not analyzed as a primary endpoint but related to the pancreatitis or the pancreatic stenting. The PREPAST trial is designed to show whether early endoscopic intervention with the usage of preventive pancreatic stenting improves the outcome of acute biliary pancreatitis. The study has been registered at the International Standard Randomised Controlled Trial Number (ISRCTN) Register (trial ID: ISRCTN13517695). Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  7. A FimH Inhibitor Prevents Acute Bladder Infection and Treats Chronic Cystitis Caused by Multidrug-Resistant Uropathogenic Escherichia coli ST131

    PubMed Central

    Totsika, Makrina; Kostakioti, Maria; Hannan, Thomas J.; Upton, Mathew; Beatson, Scott A.; Janetka, James W.; Hultgren, Scott J.; Schembri, Mark A.

    2013-01-01

    Background. Escherichia coli O25b:H4-ST131 represents a predominant clone of multidrug-resistant uropathogens currently circulating worldwide in hospitals and the community. Urinary tract infections (UTIs) caused by E. coli ST131 are typically associated with limited treatment options and are often recurrent. Methods. Using established mouse models of acute and chronic UTI, we mapped the pathogenic trajectory of the reference E. coli ST131 UTI isolate, strain EC958. Results. We demonstrated that E. coli EC958 can invade bladder epithelial cells and form intracellular bacterial communities early during acute UTI. Moreover, E. coli EC958 persisted in the bladder and established chronic UTI. Prophylactic antibiotic administration failed to prevent E. coli EC958–mediated UTI. However, 1 oral dose of a small-molecular-weight compound that inhibits FimH, the type 1 fimbriae adhesin, significantly reduced bacterial colonization of the bladder and prevented acute UTI. Treatment of chronically infected mice with the same FimH inhibitor lowered their bladder bacterial burden by >1000-fold. Conclusions. In this study, we provide novel insight into the pathogenic mechanisms used by the globally disseminated E. coli ST131 clone during acute and chronic UTI and establish the potential of FimH inhibitors as an alternative treatment against multidrug-resistant E. coli. PMID:23737602

  8. Preventive rather than therapeutic treatment with high fiber diet attenuates clinical and inflammatory markers of acute and chronic DSS-induced colitis in mice.

    PubMed

    Silveira, Ana Letícia Malheiros; Ferreira, Adaliene Versiani Matos; de Oliveira, Marina Chaves; Rachid, Milene Alvarenga; da Cunha Sousa, Larissa Fonseca; Dos Santos Martins, Flaviano; Gomes-Santos, Ana Cristina; Vieira, Angelica Thomaz; Teixeira, Mauro Martins

    2017-02-01

    Inflammatory bowel diseases (IBDs) are chronic inflammatory disorders with important impact on global health. Prebiotic and probiotic strategies are thought to be useful in the context of experimental IBD. Here, we compared the effects of preventive versus therapeutic treatment with a high fiber diet (prebiotic) in combination or not with Bifidobacterium longum (probiotic) in a murine model of chronic colitis. Colitis was induced by adding dextran sulfate sodium (DSS) to drinking water for 6 days (acute colitis) or for 5 cycles of DSS (chronic colitis). Administration of the high fiber diet protected from acute colitis. Protection was optimal when diet was started 20 days prior to DSS. A 5-day pretreatment with acetate, a short-chain fatty acid, provided partial protection against acute colitis. In chronic colitis, pretreatment with the high fiber diet attenuated clinical and inflammatory parameters of disease. However, when the treatment with the high fiber diet started after disease had been established, overall protection was minimal. Similarly, delayed treatment with acetate or B. longum did not provide any protection even when the probiotic was associated with the high fiber diet. Preventive use of a high fiber diet or acetate clearly protects mice against acute and chronic damage induced by DSS in mice. However, protection is lost when therapies are initiated after disease has been established. These results suggest that any therapy aimed at modifying the gut environment (e.g., prebiotic or probiotic strategies) should be given early in the course of disease.

  9. Role of probiotic in preventing acute diarrhoea in children: a community-based, randomized, double-blind placebo-controlled field trial in an urban slum.

    PubMed

    Sur, D; Manna, B; Niyogi, S K; Ramamurthy, T; Palit, A; Nomoto, K; Takahashi, T; Shima, T; Tsuji, H; Kurakawa, T; Takeda, Y; Nair, G B; Bhattacharya, S K

    2011-06-01

    Acute diarrhoea remains a major public health challenge in developing countries. We examined the role of a probiotic in the prevention of acute diarrhoea to discover if there was an effect directed towards a specific aetiology. A double-blind, randomized, controlled field trial involving 3758 children aged 1-5 years was conducted in an urban slum community in Kolkata, India. Participants were given either a probiotic drink containing Lactobacillus casei strain Shirota or a nutrient drink daily for 12 weeks. They were followed up for another 12 weeks. The primary outcome of this study was the occurrence of first episodes of diarrhoea. We assessed this during 12 weeks of intake of study agent and also for 12 weeks of follow-up. There were 608 subjects with diarrhoea in the probiotic group and 674 subjects in the nutrient group during the study period of 24 weeks. The level of protective efficacy for the probiotic was 14% (95% confidence interval 4-23, P<0·01 in adjusted model). The reduced occurrence of acute diarrhoea in the probiotic group compared to nutrient group was not associated with any specific aetiology. No adverse event was observed in children of either probiotic or nutrient groups. The study suggests that daily intake of a probiotic drink can play a role in prevention of acute diarrhoea in young children in a community setting of a developing country.

  10. Effect of preventive (beta blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial.

    PubMed

    Holroyd, Kenneth A; Cottrell, Constance K; O'Donnell, Francis J; Cordingley, Gary E; Drew, Jana B; Carlson, Bruce W; Himawan, Lina

    2010-09-29

    To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine. Randomised placebo controlled trial over 16 months from July 2001 to November 2005. Two outpatient sites in Ohio, USA. 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment. Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69). The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores. Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (-3.3 migraines/30 days, 95% confidence interval -3.2 to -3.5), but not the addition of β blocker alone (-2.1 migraines/30 days, -1.9 to -2.2) or behavioural migraine management alone (-2.2 migraines migraines/30 days, -2.0 to -2.4), improved outcomes compared with optimised acute treatment alone (-2.1 migraines/30 days, -1.9 to -2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute

  11. Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial

    PubMed Central

    Cottrell, Constance K; O’Donnell, Francis J; Cordingley, Gary E; Drew, Jana B; Carlson, Bruce W; Himawan, Lina

    2010-01-01

    Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine. Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005. Setting Two outpatient sites in Ohio, USA. Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment. Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69). Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores. Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment

  12. Local Tacrolimus (FK506) Delivery for Prevention of Acute Rejection in the Nonhuman Primate Delayed Mixed Chimerism Vascularized Composite Allograft Tolerance Induction Protocol

    DTIC Science & Technology

    2016-10-01

    optimizing a fabrication method, and developing characterization methods to test the pharmacokinetics after drug loading. To this end, the team...planned for testing the PLDS in a small animal model as well as a non-human primate model. 15. SUBJECT TERMS Drug delivery, immunosuppression...delivery of tacrolimus (a potent immunosuppressive drug ) to prevent acute rejection episodes of vascularized composite allografts (VCAs) in non-human

  13. Insufficient Evidence Supports the Use of Low-Level Laser Therapy to Accelerate Tooth Movement, Prevent Orthodontic Relapse, and Modulate Acute Pain During Orthodontic Treatment.

    PubMed

    Farsaii, Adrian; Al-Jewair, Thikriat

    2017-09-01

    Efficacy of low-level laser therapy in accelerating tooth movement, preventing relapse and managing acute pain during orthodontic treatment in humans: A systematic review. Sonesson M, De Geer E, Subraian J, Petrén S. BMC Oral Health 2017;17:11. No funding was obtained for this study TYPE OF STUDY/DESIGN: Systematic review. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Meta-Analysis of Sodium Bicarbonate Therapy for Prevention of Cardiac Surgery-Associated Acute Kidney Injury.

    PubMed

    Kim, Jun Hyun; Kim, Hyun Jung; Kim, Ji Yeon; Ahn, Hyeong sik; Ahn, Il Min; Choe, Won Joo; Lim, Choon-Hak

    2015-10-01

    The aim of this study was to determine whether or not perioperative administration of sodium bicarbonate had a preventive effect on cardiac surgery-associated acute kidney injury (CSA-AKI) as shown in randomized controlled trials. The authors conducted a systematic review and meta-analysis using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. The authors searched MEDLINE, EMBASE, CENTRAL, and KoreaMed without language and date restrictions. They used both MeSH and free-text terms to identify relevant studies. Electronic searches were undertaken on July 31, 2014. Five randomized controlled studies included in this review. There were no differences in the development of CSA-AKI among patients in the sodium bicarbonate group compared with those in the control group (5 trials, 1,092 patients; n = 233 of 547 in sodium bicarbonate (SB) group versus 225 of 545 in control group (SC); risk ratio (RR), 0.95; 95% confidence interval (CI), 0.74-1.22. Also, there were no statistical differences in in-hospital mortality (3 trials, 573 patients; n = 21 of 288 in SB versus 14 of 285 in SC; RR, 1.44; 95% CI, 0.76-2.72), need for renal replacement therapy (4 trials, 1,000 patients; n = 21 of 503 in SB versus 23 of 497 in SC; RR, 0.90; 95% CI, 0.50-1.60), length of stay in the intensive care unit (ICU) (hours) (4 trials, n = 969 patients, weighted men difference (WMD), 2.17; 95% CI, -1.15-5.49), and length of ventilation (hours) (4 trials, 969 patients; WMD, 0.34; 95% CI,-0.80-1.48). Perioperative administration of sodium bicarbonate did not reduce the rate of CSA-AKI in randomized controlled trials. Therefore, use of perioperative administration of sodium bicarbonate for the prevention of CSA-AKI is questionable. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention.

    PubMed

    Balbir Singh, Gillian; Ann, Soe Hee; Park, Jongha; Chung, Hyun Chul; Lee, Jong Soo; Kim, Eun-Sook; Choi, Jung Il; Lee, Jiho; Kim, Shin-Jae; Shin, Eun-Seok

    2016-01-01

    Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI. This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR ≤60 ml/min/1.73 m2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. One hundred and two patients (68.9 ± 8.2 years old, 47.1% men) were included. Baseline eGFR, creatinine and serum NGAL was similar between RIPC and control groups (48.5 ± 12 ml/min vs. 46.6 ± 10 ml/min, p = 0.391; 1.42 ± 0.58 mg/dl vs. 1.41 ± 0.34 mg/dl, p = 0.924; and 136.0 ± 45.0 ng/ml vs. 137.6 ± 43.3 ng/ml, p = 0.961, respectively). CI-AKI occurred in 13.7% (14/102) of the total subjects, with both RIPC and control groups having an equal incidence of 13.7% (7/51). No significant differences were seen in creatinine, NGAL, cardiac enzymes (troponin T, CKMB) and hs-CRP between the groups post-procedure. In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. ClinicalTrials.gov NCT02329444.

  16. Remote Ischemic Preconditioning for the Prevention of Contrast-Induced Acute Kidney Injury in Diabetics Receiving Elective Percutaneous Coronary Intervention

    PubMed Central

    Balbir Singh, Gillian; Ann, Soe Hee; Park, Jongha; Chung, Hyun Chul; Lee, Jong Soo; Kim, Eun-Sook; Choi, Jung Il; Lee, Jiho; Kim, Shin-Jae; Shin, Eun-Seok

    2016-01-01

    Objective Remote ischemic preconditioning (RIPC) induces transient episodes of ischemia by the occlusion of blood flow in non-target tissue, before a subsequent ischemia-reperfusion injury. When RIPC is applied before percutaneous coronary intervention (PCI), the kidneys may be protected against ischemia-reperfusion injury and subsequently contrast-induced acute kidney injury (CI-AKI). The aim of this study was to evaluate the efficacy of RIPC for the prevention of CI-AKI in patients with diabetes with pre-existing chronic kidney disease (CKD) undergoing elective PCI. Methods This randomized, double-blind, sham-controlled study enrolled patients with diabetes scheduled for elective PCI with eGFR ≤60 ml/min/1.73 m2 or urinary albumin creatinine ratio of >300 mg/g to receive either RIPC or the sham ischemic preconditioning. Results One hundred and two patients (68.9 ± 8.2 years old, 47.1% men) were included. Baseline eGFR, creatinine and serum NGAL was similar between RIPC and control groups (48.5 ± 12 ml/min vs. 46.6 ± 10 ml/min, p = 0.391; 1.42 ± 0.58 mg/dl vs. 1.41 ± 0.34 mg/dl, p = 0.924; and 136.0 ± 45.0 ng/ml vs. 137.6 ± 43.3 ng/ml, p = 0.961, respectively). CI-AKI occurred in 13.7% (14/102) of the total subjects, with both RIPC and control groups having an equal incidence of 13.7% (7/51). No significant differences were seen in creatinine, NGAL, cardiac enzymes (troponin T, CKMB) and hs-CRP between the groups post-procedure. Conclusions In this study, RIPC applied prior to elective PCI was not effective in preventing CI-AKI in patients with diabetes with pre-existing CKD. Trial Registration ClinicalTrials.gov NCT02329444 PMID:27723839

  17. Secondary prevention after acute myocardial infarction: drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry.

    PubMed

    Urbinati, Stefano; Olivari, Zoran; Gonzini, Lucio; Savonitto, Stefano; Farina, Rosario; Del Pinto, Maurizio; Valbusa, Alberto; Fantini, Giuseppe; Mazzoni, Alessandra; Maggioni, Aldo P

    2015-12-01

    To describe drug adherence and treatment goals, and to identify the independent predictors of smoking persistence and unsatisfactory lifestyle habits six months after an acute myocardial infarction (AMI). 11,706 patients with AMI (30% female, mean age 68 years) were enrolled in 163 large-volume coronary care units (CCUs). At six months, drug adherence was ≥90%, while blood pressure (BP) <140/90 mmHg, low density lipoprotein (LDL) <100 mg/dl (in patients on statins), HbA1c <7% (in treated diabetics), and smoking persistence were observed in 74%, 76%, 45%, and 27% of patients, respectively. Inadequate fish intake decreased from 73% to 55%, inadequate intake of fruit and vegetables from 32% to 23%, and insufficient exercise in eligible patients from 74% to 59% (p < 0.0001). At multivariable analysis, a post-discharge cardiac visit and referral to cardiac rehabilitation at follow-up were independently associated with a lower risk of insufficient physical exercise (odds ratio (OR) 0.71 and 0.70, respectively) and persistent smoking (OR 0.68 and 0.60), whereas only referral to cardiac rehabilitation was associated with a lower risk of inadequate fish and fruit/vegetable intake (OR 0.70 and 0.65). Six months after an AMI, despite a high adherence to drug treatments, BP, LDL, and diabetic goals are inadequately achieved. Subjects with healthy lifestyles improved after discharge, but the rate of those with regular exercise habits and adequate fish intake could be further improved. Access to post-discharge cardiac visit and referral to cardiac rehabilitation were associated with better adherence to healthy lifestyles. Knowledge of the variables associated with specific lifestyle changes may help in tailoring secondary prevention programmes. © The European Society of Cardiology 2014.

  18. Acute administration of Δ⁹ tetrahydrocannabinol does not prevent enhancement of sensory gating by clozapine in DBA/2 mice.

    PubMed

    Smucny, Jason; Stevens, Karen E; Tregellas, Jason R

    2014-03-01

    Despite high rates of marijuana abuse in schizophrenia, the physiological interactions between tetrahydrocannabinol (THC) and antipsychotic medications are poorly understood. A well-characterized feature of schizophrenia is poor gating of the P50 auditory-evoked potential. This feature has been translationally modeled by the DBA/2 mouse, which exhibits poor suppression of the P20-N40 AEP, the rodent analog of the human P50. Previous work has demonstrated that this deficit is reversed by the antipsychotic clozapine. It is unknown, however, if this effect is altered by THC administration. Using a conditioning-testing paradigm with paired auditory stimuli, the effects of clozapine and dronabinol (a pharmaceutical THC formulation) on inhibitory P20-N40 AEP processing were assessed from in vivo hippocampal CA3 recordings in anesthetized DBA/2 mice. The effects of clozapine (0.33 mg/kg) and dronabinol (10 mg/kg) were assessed alone and in combination (0.33, 1 or 1.83 mg/kg clozapine with 10mg/kg dronabinol). Improved P20-N40 AEP gating was observed after acute administration of 0.33 mg/kg clozapine. Co-injection of 0.33 mg/kg clozapine and 10 mg/kg THC, however, did not improve gating relative to baseline. This effect was overcome by higher doses of clozapine (1 and 1.83 mg/kg), as these doses improved gating relative to baseline in the presence of 10 mg/kg THC. 10 mg/kg THC alone did not affect gating. In conclusion, THC does not prevent improvement of P20-N40 gating by clozapine.

  19. Could Vitamin E Prevent Contrast-Induced Acute Kidney Injury? A Systematic Review and Meta-Analysis.

    PubMed

    Cho, Myung Hyun; Kim, Soo Nyung; Park, Hye Won; Chung, Sochung; Kim, Kyo Sun

    2017-09-01

    Several clinical studies have proposed a protective role for vitamin E (α-tocopherol) against contrast-induced acute kidney injury (CIAKI). The aim of study was to assess the effects of vitamin E for the prevention of CIAKI. A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) reporting the effects of vitamin E on CIAKI development and measurements of renal function were included. Four trials including 623 participants were analyzed in the meta-analysis. All participants received intravenous hydration in addition to vitamin E or placebo. The incidence of the vitamin E group (5.8%) was lower than that of the control group (15.4%). Compared with the control, vitamin E significantly reduced the risk ratio (RR) of CIAKI by 62% (0.38; 95% confidence interval [CI], 0.22, 0.63; P < 0.010). In addition, vitamin E reduced serum creatinine (SCr) increase after contrast administration (standardized mean difference [SMD], -0.27; 95% CI, -0.49, -0.06; P = 0.010). However, changes in glomerular filtration rate (GFR) after contrast administration were not significantly different between vitamin E and the control group (SMD, 0.21; 95% CI, -0.01, 0.43; P = 0.060). Heterogeneity within the available trials was not observed. Our meta-analysis provides evidence that vitamin E plus hydration significantly reduced the risk of CIAKI in patients with renal impairment compared with hydration alone. © 2017 The Korean Academy of Medical Sciences.

  20. Aerosolised liposomal amphotericin B to prevent aspergillosis in acute myeloid leukaemia: Efficacy and cost effectiveness in real-life.

    PubMed

    Chong, Ga-Lai M; Broekman, Fleur; Polinder, Suzanne; Doorduijn, Jeanette K; Lugtenburg, Pieternella J; Verbon, Annelies; Cornelissen, Jan J; Rijnders, Bart J A

    2015-07-01

    Chemotherapy-induced neutropenia can be complicated by invasive pulmonary aspergillosis (IPA). In 2008, liposomal amphotericin B (L-AmB) inhalation was shown to prevent IPA in a placebo-controlled trial. Patients with acute myeloid leukaemia (AML) are the subset of haematology patients at high risk for IPA. In 2008, L-AmB inhalation prophylaxis became the standard of care for all AML patients in Erasmus MC. In this study, the efficacy and cost effectiveness of L-AmB inhalation were evaluated in a prospective cohort of AML patients. In total, 127 consecutive AML patients received chemotherapy and prophylactically inhaled L-AmB during their first and second chemotherapy cycles; 108 patients treated for AML at the same sites from 2005-2008 served as controls. A standardised diagnostic protocol was used and probable/proven IPA served as the primary endpoint. Diagnostic and therapeutic costs were also comprehensively analysed and compared. A significant decrease in probable/proven IPA in the L-AmB inhalation group was observed (L-AmB 9.5% vs. controls 23.4%; P=0.0064). Systemic antifungal therapy given at any time during the entire AML therapy decreased from 52.8% to 29.9%. Per-patient equipment and drug costs for L-AmB inhalation (1292 €/patient) were more than compensated for by a decrease in costs for diagnostics and therapeutic voriconazole use (-1816 €/patient). No serious adverse events related to L-AmB inhalation were observed. In an unselected AML patient group, L-AmB inhalation resulted in a significant and substantial decrease in IPA and was cost saving. Now that azole resistance is more frequent, non-azole-based prophylaxis may become an attractive strategy.

  1. An Audit of the Use of Gonadorelin Analogues to Prevent Recurrent Acute Symptoms in Patients with Acute Porphyria in the United Kingdom.

    PubMed

    Schulenburg-Brand, Danja; Gardiner, Tricia; Guppy, Simon; Rees, David C; Stein, Penelope; Barth, Julian; Felicity Stewart, M; Badminton, Michael

    2017-02-21

    Severe recurrent acute attacks of porphyria have traditionally been treated with either prophylactic human haemin or gonadorelin analogues (GnA) in females. Evidence on the most effective treatment for this patient subgroup is lacking. This audit surveyed the use of prophylactic GnA in the UK.Twenty female patients (who experienced between 2 and 45 acute attacks of porphyria requiring hospitalisation and treatment with human haemin prior to GnA prophylaxis) were included in the audit. Data was retrospectively collected based on patient history and case review.Twenty three treatment courses were given lasting a median period of 12 months. Monthly subcutaneous Goserelin was most commonly used. In three patients in whom timing with the menstrual cycle was not considered, an acute attack occurred after initiation of the first dose. The majority of patients experienced oestrogen deficiency symptoms during treatment. Fifty percent of the prescribed courses of GnA resulted in a degree of clinical benefit. This successfully treated group experienced between 3 and 20 acute attacks prior to and between 0 and 6 acute attacks during GnA treatment.The audit revealed large variation in practice in the United Kingdom regarding indication, duration of treatment, specific drug used and management of side effects. In view of the limited treatment options available for this cohort and the mixed outcome successes reported, we believe it is reasonable for porphyria specialists to continue offering GnA treatment to women with severe recurrent debilitating acute attacks of porphyria associated with the menstrual cycle, and we propose best practice guidelines to standardise management.

  2. Ultraviolet radiation-induced histopathologic changes in the skin of the marsupial Monodelphis domestica. II. Quantitative studies of the photoreactivation of induced hyperplasia and sunburn cell formation

    SciTech Connect

    Ley, R.D.; Applegate, L.A.

    1985-10-01

    Induction of sunburn cells (SBCs) and hyperplasia of the epidermis of the marsupial Monodelphis domestica by ultraviolet radiation (UVR) has been studied. A dose of 500 J/m2 (approximately 1 minimal erythemal dose) from an FS-40 sunlamp induced measurable numbers of SBCs with a peak number at 32-48 h post-UVR exposure of skin to photoreactivating light suppressed the induction of SBCs by approximately 75%. Pre-UVR exposure to photoreactivating light had no effect on the induction of SBCs. Induction of hyperplasia also was suppressed to a similar extent by post-UVR photoreactivation treatment. These studies identify pyrimidine dimers in DNA as the major photoproduct involved in the induction of SBCs and hyperplasia in M. domestica by UVR.

  3. Assessing Compliance With Mercaptopurine Treatment in Younger Patients With Acute Lymphoblastic Leukemia in First Remission | Division of Cancer Prevention

    Cancer.gov

    This randomized phase III trial studies compliance to a mercaptopurine treatment intervention compared to standard of care in younger patients with acute lymphoblastic leukemia in remission. Assessing ways to help patients who have acute lymphoblastic leukemia to take their medications as prescribed may help them in taking their medications more consistently and may improve treatment outcomes. |

  4. Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study.

    PubMed

    Parkkari, Jari; Taanila, Henri; Suni, Jaana; Mattila, Ville M; Ohrankämmen, Olli; Vuorinen, Petteri; Kannus, Pekka; Pihlajamäki, Harri

    2011-04-11

    The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). A neuromuscular training and injury

  5. Neuromuscular training with injury prevention counselling to decrease the risk of acute musculoskeletal injury in young men during military service: a population-based, randomised study

    PubMed Central

    2011-01-01

    Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. Methods The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. Results In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). Conclusions A

  6. The effects of a mid-winter 8-week course of sub-sunburn sunbed exposures on tanning, vitamin D status and colds.

    PubMed

    de Gruijl, Frank R; Pavel, Stan

    2012-12-01

    Like UV irradiation, which generates vitamin D(3) in the skin, the hormonally active metabolite, 1,25-dihydroxyvitamin D(3), boosts innate immunity against viruses and bacteria. Epidemiologic studies have found high vitamin D levels to be associated with lower risk of infections of the upper respiratory tract (colds). We have therefore performed an intervention study in 105 young adults (ages 18-30 years; 91% female) over a mid-winter 8-week period (January-March 2010). The participants were randomised to 3 groups: (A) subjected to 3 times a week sub-sunburn sunbed exposure (n = 35), (B) daily vitamin D supplementation, @ 1000 IU (n = 37), and (C) a control group without any intervention (n = 33). The mean serum level of 25-hydroxyvitamin D (25(OH)D) dropped from 62 to 55 nmol l(-1) in group C, while these levels rose from 62 to 109 and from 58 to 93 nmol l(-1) in groups A and B, respectively (p < 0.001). The skin on the chest darkened significantly in group A (mean difference in lightness, L*, equalled -5.7, p < 0.001), correlating significantly, but weakly, with increases in 25(OH)D (3.3 nmol l(-1) per unit drop in L*, R(2) = 0.17, p = 0.014). The percentage of self-reported colds with proper signs and symptoms was only slightly and not significantly reduced in groups A and B in comparison to group C: 57 and 51 versus 67%, respectively. Hence, the sub-sunburn sunbed treatment was effective in tanning and increasing the 25(OH)D serum level, more so than 1000 IU per day, but had no appreciable effect on colds.

  7. The Effects of Topically Applied Glycolic Acid and Salicylic Acid on Ultraviolet Radiation-Induced Erythema, DNA Damage and Sunburn Cell Formation in Human Skin

    PubMed Central

    Kornhauser, Andrija; Wei, Rong-Rong; Yamaguchi, Yuji; Coelho, Sergio G.; Kaidbey, Kays; Barton, Curtis; Takahashi, Kaoruko; Beer, Janusz Z.; Miller, Sharon A.; Hearing, Vincent J.

    2009-01-01

    Background α-Hydroxy acids (αHA) are reported to reduce signs of aging in the skin and are widely used cosmetic ingredients. Several studies suggest that αHA can increase the sensitivity of skin to ultraviolet radiation. More recently, β-hydroxy acids (βHA), or combinations of αHA and βHA have also been incorporated into antiaging skin care products. Concerns have also arisen about increased sensitivity to ultraviolet radiation following use of skin care products containing β-HA. Objective To determine whether topical treatment with glycolic acid, a representative αHA, or with salicylic acid, a βHA, modifies the short-term effects of solar simulated radiation (SSR) in human skin. Methods Fourteen subjects participated in this study. Three of the four test sites on the mid-back of each subject were treated daily Monday - Friday, for a total of 3.5 weeks, with glycolic acid (10%), salicylic acid (2%), or vehicle (control). The fourth site received no treatment. After the last treatment, each site was exposed to SSR, and shave biopsies from all 4 sites were obtained. The endpoints evaluated in this study were erythema (assessed visually and instrumentally), DNA damage and sunburn cell formation. Results Treatment with glycolic acid resulted in increased sensitivity of human skin to SSR, measured as an increase in erythema, DNA damage and sunburn cell formation. Salicylic acid did not produce significant changes in any of these biomarkers. Conclusions Short-term topical application of glycolic acid in a cosmetic formulation increased the sensitivity of human skin to SSR, while a comparable treatment with salicylic acid did not. PMID:19411163

  8. HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.

    PubMed

    Lewicki, Michelle; Ng, Irene; Schneider, Antoine G

    2015-03-11

    Acute kidney injury (AKI) is common in patients undergoing cardiac surgery among whom it is associated with poor outcomes, prolonged hospital stays and increased mortality. Statin drugs can produce more than one effect independent of their lipid lowering effect, and may improve kidney injury through inhibition of postoperative inflammatory responses. This review aimed to look at the evidence supporting the benefits of perioperative statins for AKI prevention in hospitalised adults after surgery who require cardiac bypass. The main objectives were to 1) determine whether use of statins was associated with preventing AKI development; 2) determine whether use of statins was associated with reductions in in-hospital mortality; 3) determine whether use of statins was associated with reduced need for RRT; and 4) determine any adverse effects associated with the use of statins. We searched the Cochrane Renal Group's Specialised Register to 13 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) that compared administration of statin therapy with placebo or standard clinical care in adult patients undergoing surgery requiring cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need for renal replacement therapy (RRT) as an outcome were eligible for inclusion. All forms and dosages of statins in conjunction with any duration of pre-operative therapy were considered for inclusion in this review. All authors extracted data independently and assessments were cross-checked by a second author. Likewise, assessment of study risk of bias was initially conducted by one author and then by a second author to ensure accuracy. Disagreements were arbitrated among authors until consensus was reached. Authors from two of the included studies provided additional data surrounding post-operative SCr as well as need for RRT. Meta-analyses were used to assess the outcomes of AKI, SCr

  9. Melatonin Restores White Blood Cell Count, Diminishes Glycated Haemoglobin Level and Prevents Liver, Kidney and Muscle Oxidative Stress in Mice Exposed to Acute Ethanol Intoxication.

    PubMed

    Kurhaluk, Natalia; Sliuta, Alina; Kyriienko, Svitlana; Winklewski, Pawel J

    2017-09-01

    The aim of the study was to examine the effects of melatonin impact on changes in haematological profile, biomarkers of oxidative stress (dienes conjugates, malondialdehyde (MDA), oxidatively modified protein levels, total antioxidant capacity and antioxidant enzyme activity) in liver, muscle, kidney and erythrocytes, and glycated haemoglobin (HBA1c) in mice during acute ethanol stress. Assays were carried out in quadruplicate: control, melatonin (10 mg/kg, 10 days), acute ethanol stress (0.75 g/kg/day, 10 days) and acute ethanol stress plus melatonin groups. Acute ethanol stress caused a significant increase in the total number of white blood cells (WBC), especially neutrophils in the blood, and HBA1c levels vs. control mice. The correlation between lipid peroxidation and the glycated haemoglobin level was shown (r = 0.93, P = 0.007). Ethanol reduced the antioxidant capacity by increasing reactive oxygen species (ROS) production and the level of oxidatively modified protein content, diene conjugates and MDA. Melatonin administration in animals during acute ethanol stress reduced antioxidant stress biomarkers, WBC, HBA1c levels and ROS production. Melatonin had protective effects on liver, kidney and muscle tissues by preventing the intensive lipid peroxidation processes in initial (diene conjugation production) and late stages (MDA level), and significantly reduced the level of aldehyde and ketone protein derivatives. Furthermore, melatonin restored elevated WBC count and HBA1c level and diminished ROS production. Ethanol reduces antioxidant capacity and leads to exaggerated reactive oxygen species production and consequent increases in oxidatively modified proteins. Melatonin exerts protective effects by preventing the intensive lipid peroxidation processes. Melatonin significantly reduces the level of aldehyde and ketone protein derivatives, restores glycated haemoglobin level and white blood cell count.

  10. Interventions to prevent hemodynamic instability during renal replacement therapy for acute kidney injury: a systematic review protocol.

    PubMed

    Douvris, Adrianna; Hiremath, Swapnil; McIntyre, Lauralyn; Sikora, Lindsey; Weber, Catherine; Clark, Edward G

    2017-06-15

    Hemodynamic instability during renal replacement therapy (HIRRT) in the form of intradialytic hypotension (IDH) is a frequent complication of hemodialysis in end-stage kidney disease (ESKD), and most studies have focused on this chronic population. However, HIRRT is also an important concern for critically ill ICU patients with acute kidney injury (AKI), complicating an estimated 30% of dialysis treatments in this population. HIRRT can exacerbate organ hypoperfusion in the setting of critical illness and may negatively impact renal recovery in the AKI population. This is a protocol for a systematic review to synthesize the evidence surrounding dialysis-related interventions used to minimize HIRRT in critically ill patients with RRT-requiring AKI. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) database. We will search MEDLINE, EMBASE, and CENTRAL databases in collaboration with a health information specialist using a comprehensive search strategy. We will also supplement our search with a scan of the "gray literature" to identify relevant ongoing trials or conference abstracts. Observational studies and clinical trials will be included in our analysis. Our outcomes will include the incidence of HIRRT, dialysis-related complications, in-hospital mortality, and renal recovery. Prior to our search, we performed an initial search of these databases and PROSPERO, which yielded no prior or ongoing systematic reviews on this topic. Two reviewers will independently screen the list of identified abstracts using pre-defined inclusion and exclusion criteria. Two reviewers will then independently extract data from selected studies and undertake an assessment of their quality using validated tools. HIRRT is a common complication of renal replacement therapy not only in ESKD but also in the critically ill AKI population. It can result in early discontinuation of dialysis, further organ injury from hypoperfusion, and

  11. Ivabradine treatment prevents dobutamine-induced increase in heart rate in patients with acute decompensated heart failure.

    PubMed

    Cavusoglu, Yuksel; Mert, Ugur; Nadir, Aydin; Mutlu, Fezan; Morrad, Bektas; Ulus, Taner

    2015-09-01

    Ivabradine is a heart rate (HR)-lowering agent acting by inhibiting the If-channel. Dobutamine does increase the HR and has some deleterious effects on myocardium. So, we aimed to evaluate whether ivabradine treatment blunts a dobutamine-induced increase in HR. The main study population consisted of 58 acute decompensated heart failure patients requiring inotropic support with left-ventricular ejection fraction below 35%, who were randomized to ivabradine (n = 29) or control (n = 29). All patients underwent Holter recording for 6 h and then dobutamine was administered at incremental doses of 5, 10 and 15 μg/kg/min, with 6-h steps. Holter recording was continued during dobutamine infusion. Ivabradine 7.5 mg was given at the initiation of dobutamine and readministered at 12 h of infusion. Also, a nonrandomized beta-blocker group with 15 patients receiving beta-blocker was included in the analysis. Control and beta-blocker groups did not receive ivabradine. In the control group, mean HR gradually and significantly increased at each step of dobutamine infusion (81 ± 11, 90 ± 16, 97 ± 14 and 101 ± 16 b.p.m., respectively; P = 0.001), whereas no significant increase in HR was observed in the ivabradine group (82 ± 17, 82 ± 15, 85 ± 14 and 83 ± 12 b.p.m., respectively; P = 0.439). Mean HR was also found to significantly increase during dobutamine infusion in the beta-blocker group (75 ± 13, 82 ± 13, 86 ± 14 and 88 ± 13 b.p.m., respectively; P = 0.001). The median increase in HR from baseline was significantly higher in the control group compared to those in the ivabradine group (5 vs. 2 b.p.m.; P = 0.007 at first step, 13 vs. 5 b.p.m.; P = 0.001 at second step and 18 vs. 6 b.p.m.; P = 0.0001 at third step of dobutamine, respectively). Ivabradine treatment prevents dobutamine-induced increase in HR and may be useful in reducing HR-related adverse effects of

  12. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial.

    PubMed

    Ha, Lisa; Hauge, Truls; Spenning, Anne Bente; Iversen, Per Ole

    2010-10-01

    Undernutrition after an acute stroke increases the risk of poor outcome. We wanted to examine the effect of individualized, nutritional support on weight loss and functional outcomes in stroke patients. Acute stroke patients at nutritional risk were randomized to either individualized, nutritional care or routine care while in hospital. Patients in the intervention group received an individualized treatment plan aiming to prevent weight loss. In accordance with routine care, the controls did not have such a treatment plan. Patients were reviewed at follow-up after three months. Primary outcome measure was the percentage of patients with weight loss ≥5%. Secondary outcomes measures were quality of life (QoL), handgrip strength and length of hospital stay. This trial is registered with ClinicalTrials.gov, number NCT00163007. At follow-up, 20.7% of the intervention group (n = 58) lost ≥5% weight compared with 36.4% in the control group (n = 66) (P = 0.055). The intervention group had a significantly higher increase in QoL score (P = 0.009) and in handgrip strength (P = 0.002). There was no difference in length of hospital stay. Individualized, nutritional treatment strategy can prevent clinically significant weight loss and improve QoL in elderly acute stroke patients at nutritional risk. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  13. Yoghurt consumption regulates the immune cells implicated in acute intestinal inflammation and prevents the recurrence of the inflammatory process in a mouse model.

    PubMed

    Chaves, Silvina; Perdigon, Gabriela; de Moreno de LeBlanc, Alejandra

    2011-05-01

    Crohn's disease and ulcerative colitis, two forms of inflammatory bowel disease, are important problems in industrialized countries. The complete etiology of these two diseases is still unknown but likely involves genetic, environmental, and immunological factors. The aim of the present work was to determine whether the anti-inflammatory effects reported for yoghurt in acute trinitrobenzene sulfonic acid-induced intestinal inflammation in mice also could prevent or attenuate the recurrent intestinal inflammation, thus maintaining remission. The innate response also was evaluated through participation of Toll-like receptors (TLRs) and the analysis of T-cell populations to determine the effects of yoghurt in an acute inflammatory bowel disease model. Yoghurt exerted a beneficial effect on acute intestinal inflammation by regulating T-cell expansion and modulating the expression of TLRs, with decrease of TLR4(+) and increase of TLR9(+) cells. The anti-inflammatory effect of yoghurt also was demonstrated in a recurrent inflammation model. Yoghurt administration during the remission phase prevented the recurrence of inflammation without producing undesirable side effects. The yoghurt effect may be mediated by increased interleukin 10 production and changes in intestinal microbiota.

  14. Increased taurine in pre-weaned juvenile mdx mice greatly reduces the acute onset of myofibre necrosis and dystropathology and prevents inflammation

    PubMed Central

    Terrill, Jessica R.; Grounds, Miranda D; Arthur, Peter G.

    2016-01-01

    Background: The mdx mouse model for the fatal muscle wasting disease Duchenne Muscular Dystrophy (DMD) shows a very mild pathology once growth has ceased, with low levels of myofibre necrosis in adults. However, from about 3 weeks of post-natal age, muscles of juvenile mdx mice undergo an acute bout of severe necrosis and inflammation: this subsequently decreases and stabilises to lower adult levels by about 6 weeks of age. Prior to the onset of this severe dystropathology, we have shown that mdx mice are deficient in the amino acid taurine (potentially due to weaning), and we propose that this exacerbates myofibre necrosis and inflammation in juvenile mdx mice. Objectives: The purpose of this study was to increase taurine availability to pre-weaned juvenile mdx mice (from 14 days of age), to evaluate the impact on levels of myofibre necrosis and inflammation (at 22 days) during the acute period of severe dystropathology. Results: Untreated 22 day old mdx muscle was not deficient in taurine, with similar levels to normal C57 control muscle. However taurine treatment, which increased the taurine content of young dystrophic muscle (by 40%), greatly reduced myofibre necrosis (by 75%) and prevented significant increases in 3 markers of inflammation. Conclusion: Taurine was very effective at preventing the acute phase of muscle damage that normally results in myofibre necrosis and inflammation in juvenile mdx mice, supporting continued research into the use of taurine as a therapeutic intervention for protecting growing muscles of young DMD boys PMID:27679740

  15. U-Bang-Haequi Tang: A Herbal Prescription that Prevents Acute Inflammation through Inhibition of NF-κB-Mediated Inducible Nitric Oxide Synthase

    PubMed Central

    Hwangbo, Min; Jung, Ji Yun; Ki, Sung Hwan; Park, Sang Mi; Jegal, Kyung Hwan; Lee, Ju-Hee; Kang, Seung Ho; Park, Sun-Dong; Ku, Sae Kwang; Zhao, Rong Jie; Jee, Seon Young

    2014-01-01

    Since antiquity, medical herbs have been prescribed for both treatment and preventative purposes. Herbal formulas are used to reduce toxicity as well as increase efficacy in traditional Korean medicine. U-bang-haequi tang (UBT) is a herbal prescription containing Arctii fructus and Forsythia suspensa as its main components and has treated many human diseases in traditional Korean medicine. This research investigated the effects of UBT against an acute phase of inflammation. For this, we measured induction of nitric oxide (NO) and related proteins in macrophage cell line stimulated by lipopolysaccharide (LPS). Further, paw swelling was measured in carrageenan-treated rats. Carrageenan significantly induced activation of inflammatory cells and increases in paw volume, whereas oral administration of 0.3 or 1 g/kg/day of UBT inhibited the acute inflammatory response. In RAW264.7 cells, UBT inhibited mRNA and protein expression levels of iNOS. UBT treatment also blocked elevation of NO production, nuclear translocation of NF-κB, phosphorylation of Iκ-Bα induced by LPS. Moreover, UBT treatment significantly blocked the phosphorylation of p38 and c-Jun NH2-terminal kinases by LPS. In conclusion, UBT prevented both acute inflammation in rats as well as LPS-induced NO and iNOS gene expression through inhibition of NF-κB in RAW264.7 cells. PMID:24959187

  16. Efficacy of low-level laser therapy in accelerating tooth movement, preventing relapse and managing acute pain during orthodontic treatment in humans: a systematic review.

    PubMed

    Sonesson, Mikael; De Geer, Emelie; Subraian, Jaqueline; Petrén, Sofia

    2016-07-07

    Recently low-level laser therapy (LLLT) has been proposed to improve orthodontic treatment. The aims of this systematic review were to investigate the scientific evidence to support applications of LLLT: (a) to accelerate tooth movement, (b) to prevent orthodontic relapse and (c) to modulate acute pain, during treatment with fixed appliances in children and young adults. To ensure a systematic literature approach, this systematic review was conducted to Goodman's four step model. Three databases were searched (Medline, Cochrane Controlled Clinical Trials Register and Scitation), using predetermined search terms. The quality of evidence was rated according to the GRADE system. The search identified 244 articles, 16 of which fulfilled the inclusion criteria: three on acceleration of tooth movement by LLLT and 13 on LLLT modulation of acute pain. No study on LLLT for prevention of relapse was identified. The selected studies reported promising results for LLLT; elevated acceleration of tooth movement and lower pain scores, than controls. With respect to method, there were wide variations in type of laser techniques. The quality of evidence supporting LLLT to accelerate orthodontic tooth movement is very low and low with respect to modulate acute pain. No studies met the inclusion criteria for evaluating LLLT to limit relapse. The results highlight the need for high quality research, with consistency in study design, to determine whether LLLT can enhance fixed appliance treatment in children and young adults.

  17. Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity

    PubMed Central

    Aziz, Hassan A.; Kim, Jonathan W.; Munier, Francis L.; Berry, Jesse L.

    2017-01-01

    Aims To report the occurrence of acute hemorrhagic retinopathy following intravitreal melphalan injection for retinoblastoma. Methods This is a retrospective case series of 2 patients with retinoblastoma treated with intravitreal melphalan for vitreous seeding who developed acute hemorrhagic retinopathy. Results Patient 1 is a 6-month-old female with bilateral retinoblastoma (Group D right eye and Group B left eye) treated with 4 cycles of systemic chemotherapy and 2 intravitreal melphalan injections in each eye. Patient 2 is a 10-month-old male with unilateral Group D retinoblastoma treated with 6 cycles of systemic chemotherapy and 2 injections of intravitreal melphalan. At the 1-week follow-up after the second injection, both patients had an acute hemorrhagic retinopathy that resulted in chorioretinal toxicity with a sharp demarcation line between the normal and abnormal retina. At the last follow-up (22 and 12 months, respectively), there was total tumor control and resolution of vitreous seeding in both patients. Conclusions Although intravitreal melphalan injection is effective for vitreous seeding in eyes with retinoblastoma, acute hemorrhagic retinopathy and diffuse chorioretinal atrophy is a possible complication of this treatment modality. Given the clinical findings observed in these patients, the development of this retinal toxicity most likely results from a retrohyaloid overdose. Consequently we suggest preventive measures aimed at limiting the risk of retrohyaloid injection.

  18. Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP

    PubMed Central

    Mukherjee, Rajarshi; Mareninova, Olga A; Odinokova, Irina V; Huang, Wei; Murphy, John; Chvanov, Michael; Javed, Muhammad A; Wen, Li; Booth, David M; Cane, Matthew C; Awais, Muhammad; Gavillet, Bruno; Pruss, Rebecca M; Schaller, Sophie; Molkentin, Jeffery D; Tepikin, Alexei V; Petersen, Ole H; Pandol, Stephen J; Gukovsky, Ilya; Criddle, David N; Gukovskaya, Anna S

    2016-01-01

    Objective Acute pancreatitis is caused by toxins that induce acinar cell calcium overload, zymogen activation, cytokine release and cell death, yet is without specific drug therapy. Mitochondrial dysfunction has been implicated but the mechanism not established. Design We investigated the mechanism of induction and consequences of the mitochondrial permeability transition pore (MPTP) in the pancreas using cell biological methods including confocal microscopy, patch clamp technology and multiple clinically representative disease models. Effects of genetic and pharmacological inhibition of the MPTP were examined in isolated murine and human pancreatic acinar cells, and in hyperstimulation, bile acid, alcoholic and choline-deficient, ethionine-supplemented acute pancreatitis. Results MPTP opening was mediated by toxin-induced inositol trisphosphate and ryanodine receptor calcium channel release, and resulted in diminished ATP production, leading to impaired calcium clearance, defective autophagy, zymogen activation, cytokine production, phosphoglycerate mutase 5 activation and necrosis, which was prevented by intracellular ATP supplementation. When MPTP opening was inhibited genetically or pharmacologically, all biochemical, immunological and histopathological responses of acute pancreatitis in all four models were reduced or abolished. Conclusions This work demonstrates the mechanism and consequences of MPTP opening to be fundamental to multiple forms of acute pancreatitis and validates the MPTP as a drug target for this disease. PMID:26071131

  19. Mechanism of mitochondrial permeability transition pore induction and damage in the pancreas: inhibition prevents acute pancreatitis by protecting production of ATP.

    PubMed

    Mukherjee, Rajarshi; Mareninova, Olga A; Odinokova, Irina V; Huang, Wei; Murphy, John; Chvanov, Michael; Javed, Muhammad A; Wen, Li; Booth, David M; Cane, Matthew C; Awais, Muhammad; Gavillet, Bruno; Pruss, Rebecca M; Schaller, Sophie; Molkentin, Jeffery D; Tepikin, Alexei V; Petersen, Ole H; Pandol, Stephen J; Gukovsky, Ilya; Criddle, David N; Gukovskaya, Anna S; Sutton, Robert

    2016-08-01

    Acute pancreatitis is caused by toxins that induce acinar cell calcium overload, zymogen activation, cytokine release and cell death, yet is without specific drug therapy. Mitochondrial dysfunction has been implicated but the mechanism not established. We investigated the mechanism of induction and consequences of the mitochondrial permeability transition pore (MPTP) in the pancreas using cell biological methods including confocal microscopy, patch clamp technology and multiple clinically representative disease models. Effects of genetic and pharmacological inhibition of the MPTP were examined in isolated murine and human pancreatic acinar cells, and in hyperstimulation, bile acid, alcoholic and choline-deficient, ethionine-supplemented acute pancreatitis. MPTP opening was mediated by toxin-induced inositol trisphosphate and ryanodine receptor calcium channel release, and resulted in diminished ATP production, leading to impaired calcium clearance, defective autophagy, zymogen activation, cytokine production, phosphoglycerate mutase 5 activation and necrosis, which was prevented by intracellular ATP supplementation. When MPTP opening was inhibited genetically or pharmacologically, all biochemical, immunological and histopathological responses of acute pancreatitis in all four models were reduced or abolished. This work demonstrates the mechanism and consequences of MPTP opening to be fundamental to multiple forms of acute pancreatitis and validates the MPTP as a drug target for this disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Goshajinkigan, a traditional Japanese medicine, prevents oxaliplatin-induced acute peripheral neuropathy by suppressing functional alteration of TRP channels in rat.

    PubMed

    Mizuno, Keita; Kono, Toru; Suzuki, Yasuyuki; Miyagi, Chika; Omiya, Yuji; Miyano, Kanako; Kase, Yoshio; Uezono, Yasuhito

    2014-01-01

    The acute peripheral neuropathy induced by oxaliplatin treatment occurs very frequently and is aggravated by exposure to cold. Goshajinkigan (GJG), a traditional Japanese (kampo) medicine, was recently shown to be effective against oxaliplatin-induced acute neuropathy. However, because the effects of GJG and its mechanism in relation to those of its ingredients and its mechanism are not well understood, we examined the effects of GJG on acute neuropathy. Further, we investigated whether GJG affects the functions and gene expressions of transient receptor potential (TRP) channels using a rat model of oxaliplatin-induced neuropathy. Administration of oxaliplatin increased withdrawal responses from cold stimulation, and GJG or calcium gluconate/magnesium sulfate significantly inhibited the oxaliplatin-induced cold hypersensitivity. Application of menthol, a TRPA1/TRPM8 agonist, or allyl isothiocyanate (AITC), a selective TRPA1 agonist, to the hind paw of oxaliplatin-treated rats enhanced the nocifensive behaviors evoked by each agonist, whereas oxaliplatin had no significant effect on nocifensive behaviors evoked by capsaicin, a TRPV1 agonist. GJG treatment reduced menthol- or AITC-evoked withdrawal responses potentiated by oxaliplatin. Furthermore, GJG suppressed the increase of TRPA1 and TRPM8 mRNA expression induced by oxaliplatin in dorsal root ganglia. These findings suggest that GJG prevented oxaliplatin-induced acute peripheral neuropathy by suppressing functional alteration of TRP channels, especially TRPA1 and TRPM8.

  1. Efficacy of intraoperative, single-bolus corticosteroid administration to prevent postoperative acute respiratory failure after oesophageal cancer surgery.

    PubMed

    Park, Seong Yong; Lee, Hyun-Sung; Jang, Hee-Jin; Joo, Jungnam; Zo, Jae Ill

    2012-10-01

    Respiratory failure from acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and pneumonia are the major cause of morbidity and mortality following an oesophagectomy for oesophageal cancer. This study was performed to investigate whether an intraoperative corticosteroid can attenuate postoperative respiratory failure. Between November 2005 and December 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were reviewed. A 125-mg dose of methylprednisolone was administered after performing the anastomosis. ALI, ARDS and pneumonia occurring before postoperative day (POD) 7 were regarded as acute respiratory failure. The mean age was 64.2 ± 8.7 years. One hundred and fifty-one patients were in the control group and 83 patients in the steroid group. Patients' characteristics were comparable. The incidence of acute respiratory failure was lower in the steroid group (P = 0.037). The incidences of anastomotic leakage and wound dehiscence were not different (P = 0.57 and P = 1.0). The C-reactive protein level on POD 2 was lower in the steroid group (P < 0.005). Multivariate analysis indicates that the intraoperative steroid was a protective factor against acute respiratory failure (P = 0.046, OR = 0.206). Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that corticosteroids may attenuate the stress-induced inflammatory responses after surgery.

  2. Acute effects of UVR on human eyes and skin.

    PubMed

    Young, Antony R

    2006-09-01

    Solar UVR ( approximately 295-400 nm) has acute clinical effects on the eyes and the skin. The only effect on the eye is inflammation of the cornea (photokeratitis), which is caused by UVB (and non-solar UVC) and resolves without long-term consequences within 48 h. The effects on the skin are more extensive and include sunburn (inflammation), tanning and immunosuppression for which UVB is mainly responsible. Tanning is modestly photoprotective against further acute UVR damage. Skin colour is also transiently changed by UVA-dependent immediate pigment darkening, the function of which is unknown. Skin type determines sensitivity to the acute and chronic effects of UVR on the skin. Some of the photochemical events that initiate acute effects are also related to skin cancer. Solar UVB is also responsible for the synthesis of vitamin D.

  3. Phase III trials of new oral anticoagulants in the acute treatment and secondary prevention of VTE: comparison and critique of study methodology and results.

    PubMed

    Cohen, Alexander T; Imfeld, Stephan; Rider, Thomas

    2014-05-01

    The traditional treatment of venous thromboembolism (VTE) has been use of heparin and vitamin K antagonists (VKA), and although shown to be effective, they have numerous limitations. New oral anticoagulants (NOACs) including direct thrombin (factor IIa) inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) have emerged as promising alternatives with the potential to overcome the limitations of traditional treatments. Clinical trials have been performed with a view to making significant changes to the acute, long-term and extended treatment of VTE. Data are now available on the efficacy and safety, including bleeding rates, of the NOACs in comparison with VKA in the acute treatment and secondary prevention of VTE as well as in comparison with placebo extended VTE treatment. This review compares and contrasts the design and results of the Phase III trials of NOACs in VTE and discusses the implications of the NOACs in terms of treatment strategies in VTE patients.

  4. Potential of the angiotensin receptor blockers (ARBs) telmisartan, irbesartan, and candesartan for inhibiting the HMGB1/RAGE axis in prevention and acute treatment of stroke.

    PubMed

    Kikuchi, Kiyoshi; Tancharoen, Salunya; Ito, Takashi; Morimoto-Yamashita, Yoko; Miura, Naoki; Kawahara, Ko-ichi; Maruyama, Ikuro; Murai, Yoshinaka; Tanaka, Eiichiro

    2013-09-13

    Stroke is a major cause of mortality and disability worldwide. The main cause of stroke is atherosclerosis, and the most common risk factor for atherosclerosis is hypertension. Therefore, antihypertensive treatments are recommended for the prevention of stroke. Three angiotensin receptor blockers (ARBs), telmisartan, irbesartan and candesartan, inhibit the expression of the receptor for advanced glycation end-products (RAGE), which is one of the pleiotropic effects of these drugs. High mobility group box 1 (HMGB1) is the ligand of RAGE, and has been recently identified as a lethal mediator of severe sepsis. HMGB1 is an intracellular protein, which acts as an inflammatory cytokine when released into the extracellular milieu. Extracellular HMGB1 causes multiple organ failure and contributes to the pathogenesis of hypertension, hyperlipidemia, diabetes mellitus, atherosclerosis, thrombosis, and stroke. This is the first review of the literature evaluating the potential of three ARBs for the HMGB1-RAGE axis on stroke therapy, including prevention and acute treatment. This review covers clinical and experimental studies conducted between 1976 and 2013. We propose that ARBs, which inhibit the HMGB1/RAGE axis, may offer a novel option for prevention and acute treatment of stroke. However, additional clinical studies are necessary to verify the efficacy of ARBs.

  5. Single intrathecal administration of the transcription factor decoy AYX1 prevents acute and chronic pain after incisional, inflammatory, or neuropathic injury.

    PubMed

    Mamet, Julien; Klukinov, Michael; Yaksh, Tony L; Malkmus, Shelle A; Williams, Samantha; Harris, Scott; Manning, Donald C; Taylor, Bradley K; Donahue, Renee R; Porreca, Frank; Xie, Jennifer Y; Oyarzo, Janice; Brennan, Timothy J; Subieta, Alberto; Schmidt, William K; Yeomans, David C

    2014-02-01

    The persistence of pain after surgery increases the recovery interval from surgery to a normal quality of life. AYX1 is a DNA-decoy drug candidate designed to prevent post-surgical pain following a single intrathecal injection. Tissue injury causes a transient activation of the transcription factor EGR1 in the dorsal root ganglia-dorsal horn network, which then triggers changes in gene expression that induce neuronal hypersensitivity. AYX1 is a potent, specific inhibitor of EGR1 activity that mimics the genomic EGR1-binding sequence. Administered in the peri-operative period, AYX1 dose dependently prevents mechanical hypersensitivity in models of acute incisional (plantar), inflammatory (CFA), and chronic neuropathic pain (SNI) in rats. Furthermore, in a knee surgery model evaluating functional measures of postoperative pain, AYX1 improved weight-bearing incapacitance and spontaneous rearing compared to control. These data illustrate the potential clinical therapeutic benefits of AYX1 for preventing the transition of acute to chronic post-surgical pain.

  6. Potential of the Angiotensin Receptor Blockers (ARBs) Telmisartan, Irbesartan, and Candesartan for Inhibiting the HMGB1/RAGE Axis in Prevention and Acute Treatment of Stroke

    PubMed Central

    Kikuchi, Kiyoshi; Tancharoen, Salunya; Ito, Takashi; Morimoto-Yamashita, Yoko; Miura, Naoki; Kawahara, Ko-ichi; Maruyama, Ikuro; Murai, Yoshinaka; Tanaka, Eiichiro

    2013-01-01

    Stroke is a major cause of mortality and disability worldwide. The main cause of stroke is atherosclerosis, and the most common risk factor for atherosclerosis is hypertension. Therefore, antihypertensive treatments are recommended for the prevention of stroke. Three angiotensin receptor blockers (ARBs), telmisartan, irbesartan and candesartan, inhibit the expression of the receptor for advanced glycation end-products (RAGE), which is one of the pleiotropic effects of these drugs. High mobility group box 1 (HMGB1) is the ligand of RAGE, and has been recently identified as a lethal mediator of severe sepsis. HMGB1 is an intracellular protein, which acts as an inflammatory cytokine when released into the extracellular milieu. Extracellular HMGB1 causes multiple organ failure and contributes to the pathogenesis of hypertension, hyperlipidemia, diabetes mellitus, atherosclerosis, thrombosis, and stroke. This is the first review of the literature evaluating the potential of three ARBs for the HMGB1-RAGE axis on stroke therapy, including prevention and acute treatment. This review covers clinical and experimental studies conducted between 1976 and 2013. We propose that ARBs, which inhibit the HMGB1/RAGE axis, may offer a novel option for prevention and acute treatment of stroke. However, additional clinical studies are necessary to verify the efficacy of ARBs. PMID:24065095

  7. Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.

    PubMed

    Boockvar, Kenneth S; Teresi, Jeanne A; Inouye, Sharon K

    2016-05-01

    Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs. © 2016, Copyright the Authors Journal compilation

  8. Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

    PubMed Central

    Kim, Hyun Jung; Ahn, Hyeong Sik; Lee, Jae Young; Choi, Seong Soo; Cheong, Yu Seon; Kwon, Koo; Yoon, Syn Hae

    2017-01-01

    Background Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed. PMID:28119767

  9. Skin tear prevention and management among patients in the acute aged care and rehabilitation units in the Australian Capital Territory: a best practice implementation project.

    PubMed

    Lopez, Violeta; Dunk, Ann Marie; Cubit, Katrina; Parke, Jill; Larkin, David; Trudinger, Maria; Stuart, Margaret

    2011-12-01

    A skin tear is a traumatic wound that results from the separation of the skin layers due to shearing forces, friction or blunt trauma that affects all people. Numerous preventative measures aim to reduce the skin tears and minimise conditions that predispose the epidermis to injury. With the increasing elderly population in acute aged care, implementation of an evidence-based guideline is critical as changes to ageing skin integrity make this population more susceptible to skin tear. The aim of this project was to ensure the practice of skin tear assessment, prevention and management among acute aged care causes and rehabilitation patients was performed according to best available evidence. This project utilised a pre- and post-implementation audit design using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The project was conducted from June to November 2010 with the audits conducted in the acute aged care and rehabilitation units of two public hospitals in the Australian Capital Territory involving a sample size of 96 patients at pre-audit and 95 patient at post-audit admitted during the audit period. A convenience sample of 20 nurses also consented to be observed. The audits were conducted after obtaining ethics approval and consent from patients and nurses. The results showed a significant change in compliance to the skin tear guidelines at post-implementation audit. Staff education in particular had a dramatic increase from 20% to 98% and the point prevalence rate of hospital-acquired skin tear decreased from 10% to 0.15%. This project emphasised the importance of education of all personnel involved in patient care and that a simple assessment of skin integrity is critical in preventing and managing skin tear especially among the susceptible elderly population. 2011 The Authors. International Journal of Evidence-Based Healthcare. 2011 The Joanna Briggs Institute.

  10. Possible role of the microbiome in the development of acute malnutrition and implications for food-based strategies to prevent and treat acute malnutrition

    USDA-ARS?s Scientific Manuscript database

    A pattern of changes in the microbiome composition have been observed in the normal maturation of the human gut. Perturbations from this pattern have been described in malnourished humans and reproduced in animal models of severe malnutrition. Treatment and prevention of malnutrition in the future m...

  11. Prevention of hepatitis B in Italy: lessons from surveillance of type-specific acute viral hepatitis. SEIEVA Collaborating Group.

    PubMed Central

    Mele, A.; Stazi, M. A.; Gill, O. N.; Pasquini, P.

    1990-01-01

    The relative contribution of various risk factors to the incidence of acute hepatitis B in Italy was estimated using a special surveillance system (SEIEVA) for type-specific acute viral hepatitis. At present 146 health departments (USLs) which contain 21% of the Italian population participate in SEIEVA out of the total of 650. Data on 2460 hepatitis B cases and 708 hepatitis A cases were compared. Hospitalization, surgical intervention, dental therapy, other percutaneous exposures, barber shop shaving, i.v. drug abuse and household contact with HBsAg carriers were associated with acute hepatitis B and a large number of cases were attributable to these risk factors. Because the control programme based on vaccination will not be effective in the short term at reducing hepatitis B incidence, other additional interventions are recommended. PMID:2307181

  12. Programmed Ventricular Stimulation to Risk Stratify for Early Cardioverter-Defibrillator Implantation to Prevent Tachyarrhythmias following Acute Myocardial Infarction (PROTECT-ICD): Trial Protocol, Background and Significance.

    PubMed

    Zaman, Sarah; Taylor, Andrew J; Stiles, Martin; Chow, Clara; Kovoor, Pramesh

    2016-11-01

    The 'Programmed Ventricular Stimulation to Risk Stratify for Early Cardioverter-Defibrillator Implantation to Prevent Tachyarrhythmias following Acute Myocardial Infarction' (PROTECT-ICD) trial is an Australian-led multicentre randomised controlled trial targeting prevention of sudden cardiac death in patients who have at least moderately reduced cardiac function following a myocardial infarct (MI). The primary objective of the trial is to assess whether electrophysiological study to guide prophylactic implantation of an implantable cardioverter-defibrillator (ICD) early following MI (first 40 days) will lead to a significant reduction in sudden cardiac death and non-fatal arrhythmia. The secondary objective is to assess the utility of cardiac MRI (CMR) in assessing early myocardial characteristics, and its predictive value for both inducible ventricular tachycardia (VT) at EPS and SCD/ non-fatal arrhythmia at follow-up.

  13. Safety evaluation of sunscreen formulations containing titanium dioxide and zinc oxide nanoparticles in UVB sunburned skin: an in vitro and in vivo study.

    PubMed

    Monteiro-Riviere, N A; Wiench, K; Landsiedel, R; Schulte, S; Inman, A O; Riviere, J E

    2011-09-01

    Sunscreens containing titanium dioxide (TiO(2)) and zinc oxide (ZnO) nanoparticles (NP) are effective barriers against ultraviolet B (UVB) damage to skin, although little is known about their disposition in UVB-damaged skin. Pigs were exposed to UVB that resulted in moderate sunburn. For in vitro studies, skin in flow-through diffusion cells were treated 24 h with four sunscreen formulations as follows: 10% coated TiO(2) in oil/water (o/w), 10% coated TiO(2) in water/oil (w/o), 5% coated ZnO in o/w, and 5% uncoated ZnO in o/w. TiO(2) (rutile, crystallite) primary particle size was 10 × 50 nm with mean agglomerates of 200 nm (range ca. 90 nm--460 nm); mean for ZnO was 140 nm (range ca. 60--200 nm). Skin was processed for light microscopy, scanning (SEM) and transmission electron microscopy (TEM), and time-of-flight secondary ion mass spectrometry (TOF-SIMS). UVB-exposed skin had typical sunburn histology. TEM showed TiO(2) NP 17 layers into stratum corneum (SC), whereas ZnO remained on the surface. TOF-SIMS showed TiO(2) and ZnO epidermal penetration in both treatments. Perfusate analyzed by TEM/energy dispersive x-ray spectroscopy or inductively coupled plasma mass spectrometry detected no Ti or Zn, indicating minimal transdermal absorption. In vivo, skin was dosed at 24 h occluded with formulations and at 48 h. TiO(2) NP in o/w formulation penetrated 13 layers into UVB-damaged SC, whereas only 7 layers in normal skin; TiO(2) in w/o penetrated deeper in UVB-damaged SC. Coated and uncoated Zn NP in o/w were localized to the upper one to two SC layers in all skin. By SEM, NP were localized as agglomerates in formulation on the skin surface and base of hair. TOF-SIMS showed Ti within epidermis and superficial dermis, whereas Zn was limited to SC and upper epidermis in both treatments. In summary, UVB-damaged skin slightly enhanced TiO(2) NP or ZnO NP penetration in sunscreen formulations but no transdermal absorption was detected.

  14. Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand

    PubMed Central

    Redfern, Julie; Hyun, Karice; Chew, Derek P; Astley, Carolyn; Chow, Clara; Aliprandi-Costa, Bernadette; Howell, Tegwen; Carr, Bridie; Lintern, Karen; Ranasinghe, Isuru; Nallaiah, Kellie; Turnbull, Fiona; Ferry, Cate; Hammett, Chris; Ellis, Chris J; French, John; Brieger, David; Briffa, Tom

    2014-01-01

    Objective To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. Methods All patients hospitalised bi-nationally with ACS were identified between 14–27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. Results For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88–3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52–2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67–6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21–3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06–1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35–0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42–0.84]; p=0.003) were associated with lower exposure to preventive care. Conclusions Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care. PMID:24914060

  15. Human Bone Marrow Mesenchymal Stem Cell-Derived Hepatocytes Improve the Mouse Liver after Acute Acetaminophen Intoxication by Preventing Progress of Injury

    PubMed Central

    Stock, Peggy; Brückner, Sandra; Winkler, Sandra; Dollinger, Matthias M.; Christ, Bruno

    2014-01-01

    Mesenchymal stem cells from human bone marrow (hMSC) have the potential to differentiate into hepatocyte-like cells in vitro and continue to maintain important hepatocyte functions in vivo after transplantation into host mouse livers. Here, hMSC were differentiated into hepatocyte-like cells in vitro (hMSC-HC) and transplanted into livers of immunodeficient Pfp/Rag2−/− mice treated with a sublethal dose of acetaminophen (APAP) to induce acute liver injury. APAP induced a time- and dose-dependent damage of perivenous areas of the liver lobule. Serum levels of aspartate aminotransferase (AST) increased to similar levels irrespective of hMSC-HC transplantation. Yet, hMSC-HC resided in the damaged perivenous areas of the liver lobules short-term preventing apoptosis and thus progress of organ destruction. Disturbance of metabolic protein expression was lower in the livers receiving hMSC-HC. Seven weeks after APAP treatment, hepatic injury had completely recovered in groups both with and without hMSC-HC. Clusters of transplanted cells appeared predominantly in the periportal portion of the liver lobule and secreted human albumin featuring a prominent quality of differentiated hepatocytes. Thus, hMSC-HC attenuated the inflammatory response and supported liver regeneration after acute injury induced by acetaminophen. They hence may serve as a novel source of hepatocyte-like cells suitable for cell therapy of acute liver diseases. PMID:24758938

  16. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

    PubMed

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

    2017-07-18

    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience.

    PubMed

    La Mantia, Ignazio; Varricchio, Attilio; Ciprandi, Giorgio

    2017-01-01

    Recurrence of acute otitis media (RAOM) is a relevant issue in the clinical practice. "Bacteriotherapy" has been proposed as an option in children with RAOM. Streptococcus salivarius 24SMB nasal spray has been previously demonstrated to reduce the risk of acute otitis media (AOM) in otitis-prone children. The current retrospective and observational study aimed to confirm this outcome in a real-life setting, such as the common pediatric practice. Group A (108 children) served as control; group B (159 children) was treated with S. salivarius 24SMB and Streptococcus oralis 89a nasal spray after the first AOM episode. Active treatment consisted of 3 monthly courses: 2 puffs per nostril twice/day for a week. Group B showed a significant reduction of AOM episodes in comparison with group A (p<0.0001). Notably, all actively treated children with the highest AOM recurrence had a reduction of recurrence, whereas only 50% of the control group children had reduced RAOM (p<0.0001). Also, severity grade of AOM significantly diminished after the preventive bacteriotherapy (p<0.0001). In conclusion, the current retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of RAOM in a real-life setting.

  18. Joint bleeding in factor VIII deficient mice causes an acute loss of trabecular bone and calcification of joint soft tissues which is prevented with aggressive factor replacement

    PubMed Central

    Lau, Anthony G.; Sun, Junjiang; Hannah, William B.; Livingston, Eric W.; Heymann, Dominique; Bateman, Ted A.; Monahan, Paul E.

    2015-01-01

    Introduction While chronic degenerative arthropathy is the main morbidity of hemophilia, a very high prevalance of low bone density is also seen in men and boys with hemophilia. The current study investigates bone degradation in the knee joint of hemophilic mice resulting from hemarthrosis and the efficacy of aggressive treatment with factor VIII in the period surrounding injury to prevent bone pathology. Methods Skeletally mature factor VIII knock-out mice were subjected to knee joint hemorrhage induced by puncture of the left knee joint capsule. Mice received either intravenous Factor VIII treatment or placebo immediately prior to injury and at hours 4, 24, 48, 72 and 96 after hemorrhage. Mice were euthanized two-weeks after injury and the joint morphology and loss of bone in the proximal tibia was assessed using microCT imaging. Results Quantitative microCT imaging of the knee joint found acute bone loss at the proximal tibia following injury including loss of trabecular bone volumetric density and bone mineral density, as well as trabecular connectivity density, number, and thickness. Unexpectedly, joint injury also resulted in calcification of the joint soft tissues including the tendons, ligaments, menisci, and cartilage. Treatment with factor VIII prevented this bone and soft tissue degeneration. Conclusion Knee joint hemorrhage resulted in acute changes of adjacent bone including loss of bone density and mineralization of joint soft tissues. The rapid calcification and loss of bone has implications for the initiation and progression of osteoarthritic degradation following joint bleeding. PMID:24712867

  19. NAP prevents acute cerebral oxidative stress and protects against long-term brain injury and cognitive impairment in a model of neonatal hypoxia-ischemia.

    PubMed

    Greggio, Samuel; de Paula, Simone; de Oliveira, Iuri M; Trindade, Cristiano; Rosa, Renato M; Henriques, João A P; DaCosta, Jaderson C

    2011-10-01

    Hypoxia-ischemia (HI) is a common cause of neonatal brain damage with lifelong morbidities in which current therapies are limited. In this study, we investigated the effect of neuropeptide NAP (NAPVSIPQ) on early cerebral oxidative stress, long-term neurological function and brain injury after neonatal HI. Seven-day-old rat pups were subjected to an HI model by applying a unilateral carotid artery occlusion and systemic hypoxia. The animals were randomly assigned to groups receiving an intraperitoneal injection of NAP (3 μg/g) or vehicle immediately (0 h) and 24 h after HI. Brain DNA damage, lipid peroxidation and reduced glutathione (GSH) content were determined 24 h after the last NAP injection. Cognitive impairment was assessed on postnatal day 60 using the spatial version of the Morris water maze learning task. Next, the animals were euthanized to assess the cerebral hemispheric volume using the Cavalieri principle associated with the counting point method. We observed that NAP prevented the acute HI-induced DNA and lipid membrane damage and also recovered the GSH levels in the injured hemisphere of the HI rat pups. Further, NAP was able to prevent impairments in learning and long-term spatial memory and to significantly reduce brain damage up to 7 weeks following the neonatal HI injury. Our findings demonstrate that NAP confers potent neuroprotection from acute brain oxidative stress, long-term cognitive impairment and brain lesions induced by neonatal HI through, at least in part, the modulation of the glutathione-mediated antioxidant system.

  20. Skin cancer prevention in Australia.

    PubMed

    Sinclair, C; Foley, P

    2009-11-01

    Australia has one of the highest skin cancer incidence and mortality rates in the world. The reason for these high rates is due in part to the high ambient UV radiation levels, combined with a predominantly susceptible fair-skinned population. To address this problem, since 1980 Australians have been exposed to social marketing campaigns to raise awareness of skin cancer prevention. These campaigns have used mass media alongside interventions in schools, workplaces, and in community and leisure settings to motivate sun protective behaviour. As a result of these interventions it can be demonstrated that social marketing campaigns can be a very effective method to not only motivate behaviour change, reduce sunburn, and increase awareness but more importantly, reduce melanoma rates and bring positive economic returns to government. However long term investment in this area is required otherwise any population gains in behaviour are very likely to be quickly eroded.

  1. Effectiveness of the influenza vaccine at preventing hospitalization due to acute exacerbation of cardiopulmonary disease in Korea from 2011 to 2012.

    PubMed

    Seo, Yu Bin; Choi, Won Suk; Baek, Ji Hyeon; Lee, Jacob; Song, Joon Young; Lee, Jin Soo; Cheong, Hee Jin; Kim, Woo Joo

    2014-01-01

    There is a lack of targeted studies to validate the effectiveness of influenza vaccination on the reduction in influenza-related hospitalizations among patients with co-morbidities. In this study, we estimate the effectiveness of influenza vaccination on preventing hospitalizations in persons with cardiopulmonary disease and establish an evidence base for recommendations on influenza vaccination in this population. During the influenza epidemic in 2011-2012, we performed a multicenter, retrospective case-control study. Cases were patients hospitalized due to acute exacerbation of asthma, COPD, ischemic heart disease (IHD), and congestive heart failure (CHF). Controls were selected from outpatients who visited study hospitals but who were not hospitalized. Cases and controls were matched 1:1 based on age, gender, and date of hospital visit. Conditional logistic regression analyses were used to determine the effectiveness of vaccination. Between 25 December 2011 and 5 May 2012, 828 of each hospitalized and control subjects were identified. The influenza vaccination rate of the hospitalized and non-hospitalized patients was 54.2% and 60.4%, respectively (P = 0.006). The overall vaccine effectiveness for preventing hospitalization was 33.7% (95% confidence interval [CI] 14.0-49.0%; P = 0.002). Conditional logistic regression analysis showed that influenza vaccination significantly reduced the risk