Objectives:In the hospital setting,poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition.Understanding barriers to adequate dietary intake is an important strategy to g...Objectives:In the hospital setting,poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition.Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake.The aim of this study reported in this paper was to explore patient,family and health care professionals'perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients.Methods:An exploratory qualitative study design incorporating group and individual interviews of patients(n=14),their family members(n=4),and health care professionals(n=18)was undertaken.Participants were recruited pragmatically,using a mix of convenience and purposive sampling.A theoretically informed,semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework.Interviews were audio-recorded,transcribed verbatim and analysed inductively using a general inductive approach.Results:Three key themes emerged from analysing participant interviews.Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues.Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures.Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients'nutrition intakes.Conclusions:We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients.These predominantly reflect issues inherent in the hospital culture and environment.Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration,inclusive of patients and families,are needed to address these underlying barriers.展开更多
BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.S...BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.展开更多
Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregn...Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.展开更多
BACKGROUND Pancreatitis with infected necrosis is a severe complication of acute pancreatitis and carries with it high rates of morbidity and mortality. The management of infected pancreatic necrosis alongside concomi...BACKGROUND Pancreatitis with infected necrosis is a severe complication of acute pancreatitis and carries with it high rates of morbidity and mortality. The management of infected pancreatic necrosis alongside concomitant colorectal cancer has never been described in literature.CASE SUMMARY A 77 years old gentleman presented to the Emergency Department of our hospital complaining of ongoing abdominal pain for 8 h. The patient had clinical features of pancreatitis with a raised lipase of 3810 U/L, A computed tomography(CT) abdomen confirmed pancreatitis with extensive peri-pancreatic edema. During the course of his admission, the patient had persistent high fevers and delirium thought secondary to infected necrosis, prompting the commencement of broad-spectrum antibiotic therapy with Piperacillin/Tazobactam. Subsequent CT abdomen confirmed extensive pancreatic necrosis(over 70%). Patient was managed with supportive therapy,nutritional support and gut rest initially and improved over the course of his admission and was discharged 42 d post admission. He represented 24 d following his discharge with fever and chills and a repeat CT abdomen scan noted gas bubbles within the necrotic pancreatic tissue thereby confirming infected necrotic pancreatitis. This CT scan also revealed asymmetric thickening of the rectal wall suspicious for malignancy. A rectal cancer was confirmed on flexible sigmoidoscopy. The patient underwent two endoscopic necrosectomies and was treated with intravenous antibiotics and was discharged after 28 d.Within 1 wk post discharge, the patient commenced a course of neoadjuvant radiotherapy and subsequently underwent concomitant chemotherapy prior to undergoing a successful Hartmann's procedure for treatment of his colorectal cancer.CONCLUSION This case highlights the efficacy of endoscopic necrosectomy, early enteral feeding and targeted antibiotic therapy for timely management of infected necrotic pancreatitis. The prompt resolution of pancreatitis permitted the patient to undergo neoadjuvant treatment and resection for his concomitant colorectal cancer.展开更多
AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.METHODS Data on liver donors and recipients in Queensland between 2005...AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.METHODS Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system.In addition,intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures.RESULTS Of 296 liver transplants performed,285(96.3%) were from brain dead donors.Biliary strictures developed in 45(15.2%) recipients.Anastomotic stricture formation(n = 25,48.1%) was the commonest complication,with 14(58.3%) of these occurred within 6-mo of transplant.A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17(37.8%) patients with biliary strictures.Biliary reconstruction was initially or ultimately required in 22(48.9%) patients.In recipients developing biliary strictures,bilirubin was significantly increased within the first postoperative week(Day 7 total bilirubin 74 μmol/L vs 49 μmol/L,P = 0.012).In both univariate and multivariate regression analysis,Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation.In addition,hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors.CONCLUSION In addition to known risk factors,bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation.展开更多
AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy services.METHODS:The literature was searched for publications reporting nurs...AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy services.METHODS:The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms.Studies were screened against eligibility criteria and for relevance.Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of nonphysician endoscopists.These publications included a total of 28883 procedures performed by non-physician endoscopists.RESULTS:The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter.17/26 studies related to flexible sigmoidoscopies,5 to upper GI endoscopy and 6 to colonoscopy.All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists.Geographic distribution of publications showed the majority of research was conducted in the United States(43%),the United Kingdom(39%)and the Netherlands(7%).Most studies conclude that after appropriate training nurseendoscopists safely perform procedures.However,in relation to endoscopic competency,safety or patient satisfaction,all studies had major methodological limitations.Patients were often not randomized(21/26studies)and not appropriately controlled.In relation to cost-efficiency,nurse endoscopists were less costeffective per procedure at year 1 when compared to services provided by physicians,due largely to the increased need for subsequent endoscopies,specialist follow-up and primary care consultations.CONCLUSION:Contrary to general beliefs,endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite.Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.展开更多
Objective: To review the long-term outcomes for 155 women with a vulvar dystrophy (VD) who attended the Royal Brisbane Hospital Vulvar Clinic between 1976 and 1988. Methods: VD data from Vulvar Diseases Clinic were re...Objective: To review the long-term outcomes for 155 women with a vulvar dystrophy (VD) who attended the Royal Brisbane Hospital Vulvar Clinic between 1976 and 1988. Methods: VD data from Vulvar Diseases Clinic were reviewed and analysed using the computer software Statistical package for the Social Sciences (SPSS) 11.0. Results: Of 155 patients 94 had Lichen Sclerosus (LS), 41 Lichen Simplex Chronicus (LSC) and 20 Mixed Dystrophy (MD). Three patients developed squamous cell carcinomas of the vulva between 10 and 26 years after presentation with a VD. To date only one of these three patients remains alive following treatment. Conclusion: The need for long term follow up is stressed and any of the three types of VD may become malignant. Time from diagnosis to malignant change is not predictive. VD treatments seem to go through phases with the application of potent steroid creams having stood the test of time.展开更多
BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease.An optimal evaluation depends on adequate bowel cleansing.Patients with inflammatory bowel disease(IBD),require frequent endoscopic ass...BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease.An optimal evaluation depends on adequate bowel cleansing.Patients with inflammatory bowel disease(IBD),require frequent endoscopic assessment for both activity and dysplasia assessment.Two commonly used bowel preparations in Australia are Prep Kit-C(Pc)and Moviprep(Mp).Little is known about tolerability,efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.AIM To primary aim was to compare the tolerability,efficacy and safety of split protocols of Mp and Pc in patients having a colonoscopy.The secondary aim was to compare the efficacy,tolerability and safety of either preparation in patients with or without IBD.METHODS Patients were randomized to Pc or Mp bowel preparation.Patients completed a questionnaire to assess tolerability.Efficacy was assessed using the Ottawa Bowel Preparation Score.Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.RESULTS Of 338 patients met the inclusion criteria.Of 168 patients randomized to Mp and 170 to Pc.The efficacy of bowel preparation(mean Ottawa Bowel Preparation Score)was similar between Mp(5.4±2.4)and Pc(5.1±2.1)(P=0.3).Mean tolerability scores were similar in Mp(11.84±5.4)and Pc(10.99±5.2;P=0.17).125 patients had IBD(73 had Crohn’s Disease and 52 had Ulcerative colitis).Sixtyfour IBD patients were allocated to Mp and 61 to Pc.In non-IBD patients,104 were allocated to Mp and 109 to Pc.The mean tolerability score in the IBD group was lower than the non-IBD group(mean tolerability scores:IBD:10.3±5.1 and non-IBD:12.0±5.3;P=0.01).IBD patients described more abdominal pain with Mp when compared with Pc;(Mp:5.7±4.4 vs Pc:3.6±2.6,P=0.046).Serum magnesium level increased with Pc compared with Mp in all patients(mean increase in mmol/L:Mp:0.03±0.117 and Pc:0.11±0.106;P<0.0001).CONCLUSION In this study,the efficacy,tolerability and safety of Mp and Pc were similar in all patients.However,patients with IBD reported lower tolerability with both preparations.Specifically,IBD patients had more abdominal pain with Mp.These results should be considered when recommending bowel preparation especially to IBD patients.展开更多
Objectives: This study aimed to identify School and University support services available and accessed by nursing students transitioning into a university environment as many struggle to adjust to competing demands of...Objectives: This study aimed to identify School and University support services available and accessed by nursing students transitioning into a university environment as many struggle to adjust to competing demands of personal commitments and expectations at university.Methods: A mixed methods design was used,based on activity theory and Lizzio's Five Senses of Success frameworks as exploratory guides.This study was conducted amongst the first year cohort at one campus of the Bachelor of Nursing (BN) program in Queensland,Australia.An initial baseline assessment of what University and School-based support services were on offer for students,and how the students interacted with the support services was conducted.This was followed by a survey to identify awareness and access to support services.Focus groups were then conducted to clarify the previous results and to determine engagement with these support services.Results: A randomly selected number of students (n =150) in the first-year 2014 cohort of the BN program (n =300) were included in this study.The survey was completed by 54 students and three semistructured focus groups were conducted.The analysis indicated that the support services in place were successful in reaching the majority of students and contributed to their sense of success at university,Specifically students identified that a whole cohort approach to support enhanced their transition to university.Conclusion: Identifying lesser known services early in the first year will ensure that students are supported and encouraged to use all services,contributing to their sense of success at university.展开更多
Objective:This study aimed to explore the lived experiences of the disease journey and patients'care needs with idiopathic pulmonary fibrosis(IPF).Methods:Face-to-face semi-structured interviews were conducted wit...Objective:This study aimed to explore the lived experiences of the disease journey and patients'care needs with idiopathic pulmonary fibrosis(IPF).Methods:Face-to-face semi-structured interviews were conducted with a purposive sampling of IPF patients admitted to the department of respiratory medicine in a tertiary hospital in Beijing.Interview data were analyzed using the thematic analysis method.In the end,16 patients were interviewed.Results:Four themes emerged from the qualitative data included the long and confusing journey to reach a diagnosis,living with the disease,understanding the disease and treatment and desire for continuity of care.A series of subthemes were also identified,including uncertainty of diagnosis,delaying the process,living with physical symptoms,living with emotional distress,loss of independence,uncertainty with the prognosis,questioning the cause of the disease,concerning the side effects of treatments,lacking continuity of care,and wanting a better quality ofhealthcare in community hospitals.Conclusions:Based on the findings,there is an urgent need to improve the care delivery to this vulnerable population in China.To meet their health needs,it is of paramount importance to develop effective education programs for health professionals and IPF patients and improve care models of healthcare systems,especially in remote areas,to enhance care continuity in the communities.展开更多
Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared w...Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared with less-extensive resections.This study aimed to analyze the short-and long-term outcomes of LHT and identify factors associated with the postoperative morbidity of this technically demanding surgical procedure.Methods:The medical records of 53 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed.The independent prognostic factor of postoperative morbidity was analyzed using the logistic regression model.Results:Hepatocellular carcinoma was the most common indication for surgery(n=21),followed by hilar cholangiocarcinoma(n=14),intrahepatic cholangiocarcinoma(n=10),and other pathologies(including colorectal liver metastasis,hepatolithiasis,gallbladder cancer,living donor,hemangioma,and multilocular biliary cyst;n=8).The rates of postoperative morbidities of Clavien-Dindo grade 3 or higher and 90-day mortality were 39.6% and 1.9%,respectively.The 1-,3-,and 5-year overall survival rates were 81.1%,61.4%,and 44.6%,respectively.Multivariate analysis revealed that preoperative jaundice[hazard ratio(HR)=6.15,95%confidence interval(CI):1.57-24.17,P=0.009]and operative time>420 min(HR=4.66,95%CI:1.27–17.17,P=0.021)were independent predictors of postoperative morbidity.Conclusions:The in-hospital mortality of LHT surgery can be minimalized by a reliable preoperative evaluation of liver function and selection of the dominant anatomic features of right posterior sector,active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector,and the experience of the surgeon.展开更多
Traumatic brain injury (TBI) is a devastating and extraordinarily expensive entity. It is becoming increasingly burdensome in the military setting with societal costs of managing the sequelae of TBI running into the b...Traumatic brain injury (TBI) is a devastating and extraordinarily expensive entity. It is becoming increasingly burdensome in the military setting with societal costs of managing the sequelae of TBI running into the billions of dollars (US$) each year. Increasing awareness among non-neurosurgical medical personnel of the pathophysiology of TBI and rapid and appropriate assessment, triage and treatment will increase the likelihood of a better outcome in any given head injured patient. Careful attention to prevention of secondary injury is vital if further decline following the initial insult is to be achieved. Early and repeated neurological assessment, and aggressive management of intracranial hypertension and disorders affecting airway and cardiorespiratory systems are the mainstay of managing moderate to severe TBI. This management may involve medical and surgical options and often requires battlefield assessment prior to aeromedical evacuation. The unique profile and epidemiology of TBI in the military, necessitates ongoing research into primary prevention and appropriate, cost-effective means of assessing and treating these often debilitating injuries. Improvements in the prevention and care of these individuals will lead to enormous individual and societal gains.展开更多
Primary central nervous system lymphoma of T-cell lineage (PCNSTL) is an extremely rare entity, with relatively few cases reported in the literature. Presented here is a case of a 44-year-old, HIV negative woman found...Primary central nervous system lymphoma of T-cell lineage (PCNSTL) is an extremely rare entity, with relatively few cases reported in the literature. Presented here is a case of a 44-year-old, HIV negative woman found to have a solitary cerebellar lesion following presentation to the Emergency Department with a fall. The lesion responded to emergent dexamethasone and was followed with serial MRI imaging, which continued to show lesion regression. The lesion was shown to have recurred on MRI 14 months post-presentation and found to be T-cell lymphoma following immunophenotyping and TCR gene rearrangement studies of tissue specimen obtained via excisional biopsy.展开更多
Introduction: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is often associated with gastrointestinal disturbance and inflammatory markers;however, there have been no histological studies performed in th...Introduction: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is often associated with gastrointestinal disturbance and inflammatory markers;however, there have been no histological studies performed in the small intestine from CFS/ME patients. The aim of this investigation was to assess the expression of certain inflammatory markers and inflammatory receptors, namely transient receptor potential melastin 3 (TRPM3) ion channels and muscarinic acetylcholine M3 (mAChRM3) receptors, in small intestinal tissues in a case controlled study comprising a CFS/ME patient and a healthy non-fatigued control. Method: Immunohistochemistry was performed on a small intestinal biopsy from a CFS/ME patient (age = 50;female) with self-reported symptoms of gastrointestinal disturbance and a non-fatigued control (NFC), (age = 28;female). Semi-quantitative analysis of expression was undertaken for interferon-gamma (IFNy), interleukin-1 alpha (IL-1α), tumour necrosis factor-alpha (TNFα), TRPM3 ion channels and mAChRM3 acetylcholine receptors. Results: There was significantly decreased expression of TRPM3 in the CFS/ME patient (35% ±9%) and a significant decrease in mAChRM3 in the CFS/ME patient (54% ±9%). There was no difference in IL-1α between CFS/ME patient and NFC, however;there was an increase in IFNy (13% ±6%) in the CFS/ME patient compared to NFC. There was a difference observed in TNFα in CFS/ME compared to NFC. Conclusion: Differences were noted in the expression of specific TRP ion channels and cholinergic receptors in CFS/ME compared with NFC, with CFS/ME demonstrating decreased TRPM3 and mAChRM3. Further, IFNy was increased, and TNFα decreased, in the small intestine of the CFS/ME patient with reported gastrointestinal disturbance.展开更多
Background: Natural killer (NK) cell phenotypes have reported to be implicated in the pathomechanism of Multiple Sclerosis (MS). Several investigators have observed reduced peripheral numbers, reduced cytotoxic activi...Background: Natural killer (NK) cell phenotypes have reported to be implicated in the pathomechanism of Multiple Sclerosis (MS). Several investigators have observed reduced peripheral numbers, reduced cytotoxic activity, and altered CD56Dim and CD56Bright NK cell phenotypes. This current project, for the first time, investigates the NK cell cytotoxicity, calcium mobilisation and transient receptor potential melastatin 3 (TRPM3) surface expression. Methods: NK cell cytotoxic activity and calcium signaling were examined in CD56Dim and CD56Bright NK cells before and after stimulation using Ionomycin, Pregnenolone sulphate, 2-Aminoethoxydiphenyl borate and Thapsigargin. Purified NK cells were labelled with antibodies to determine TRPM3, CD69 and CD107a surface expression using flow cytometry. Results: Twenty-two MS patients and 22 healthy controls were recruited for this project. Twelve of the 22 previously received Alemtuzumab (Lemtrada®) and the remaining ten reported nil medication. We report TRPM3 was significantly increased in untreated MS patients compared with healthy controls and treated MS patients (p-value 0.034). There was a significant decrease in CD69 surface expression on CD56Dim NK cell phenotype for untreated MS patients (p-value 0.031) and treated MS patients (p-value 0.036). We report altered calcium mobilisation in CD56Bright NK cells and to a lesser extent CD56Dim NK cells between healthy controls, treated and untreated MS patients. Conclusion: This investigation suggests variations in TRPM3 expression and calcium mobilisation of NK cells may be implicated in the pathogenesis of MS. Further investigation is required to determine the mechanism by which alemtuzumab alters calcium signaling in NK cells.展开更多
Background: Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (CFS/ME), is a debilitating condition that presents with a range of symptoms, including fatigue, cognitive dysfunction, muscular and joint ...Background: Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (CFS/ME), is a debilitating condition that presents with a range of symptoms, including fatigue, cognitive dysfunction, muscular and joint pain, and may be immune-mediated. In particular, patients exhibit abnormal cytokine expression. Similarly, in Multiple Sclerosis (MS), patients display neuroimmunological symptoms, and abnormal cytokine expression, with some overlap in symptomology with CFS/ME. The purpose of this study was to compare Th1, Th2, Th17 cytokines, inflammatory cytokines and chemokines, in healthy controls, CFS/ME and MS patients. Methods: Serum samples were collected from healthy controls (n = 16, mean age = 50 ± 11.85 years), CFS/ME patients (n = 16, mean age = 49.88 ± 9.54 years) and MS patients (n = 11, mean age = 52.75 ± 12.81 years). The concentrations of 27 cytokines (IFN-γ, TNF-α, IL-12, IL-2, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-5, IL-17, IL-1ra, IL-7, IL-8, IL-9, eotaxin, IP-10, MCP-1, MIP1α, MIP1β, PDGF-bb, RANTES, basic FGF, GCSF, GMCSF, VEGF and IL-15) were measured using a Bio-Plex Pro™ kit. Results: IFN-γ, IL-10 and IL-5 were significantly higher in the serum of both CFS/ME and MS patients compared to the healthy controls (p ≤ 0.041). However, only the MS patients had significantly elevated levels of IL-12, IL-1β, IL-4, IL-13, IL-6, IL-17, IL-1ra, IL-7, IL-9, eotaxin, IL-10, MIP1α, basic FGF, GCSF and VEGF compared to the CFS/ME patients and controls (p ≤ 0.04). There were no significant differences between groups for IL-8, MCP-1, MIP1β, RANTES, GMCSF, TNF-α, and IL-2. Conclusion: CFS/ME and MS patients both displayed abnormal cytokine levels, with dual expression of Th1 and Th2 cytokines. Further research into cytokines such as IFN-γ, IL-10 and IL-5, with the use of a specific CFS/ME case definition and sensitive cytokine assays, is required to improve the understanding of the pathophysiology of CFS/ME.展开更多
Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limita...Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic lesions.We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(<4days)vs late(≥4days)anticoagulation.We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.Methods A prospective multicentre,observational cohort study was performed at 11 Australian stroke centres.Clinical and MRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two authors.Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.Results We recruited 276 patients of whom 208 met the eligibility criteria.The average age was 74.2 years(SD±10.63),and 79(38%)patients were female.Median National Institute of Health Stroke Scale score was 5(IQR 1–12).Median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation timing.Conclusion Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF patients.There is no increased rate of haemorrhage with early anticoagulation.These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe,but randomised controlled studies are needed to inform clinical practice.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Early anticoagulation after ischaemic stroke associ-ated with atrial fibrillation(AF)may reduce the rate of recurrent diffusion-weighted imaging ischaemic lesions and increase the rate of new haemorrhage.⇒It is unknown whether early anticoagulation also re-duces the rate of new silent ischaemic lesions.WHAT THIS STUDY ADDS⇒Early anticoagulation(<4days)after ischaemic stroke due to AF reduces the rate of new silent isch-aemic lesions at 1month without increasing the rate of new haemorrhage.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒Early anticoagulation after mild-to-moderate acute ischaemic stroke due to AF might be safe,howev-er,the results require further validation with ran-domised trials.展开更多
Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease(GORD),including treatment costs,safety profile and effectiveness.Methods A literature review was performed...Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease(GORD),including treatment costs,safety profile and effectiveness.Methods A literature review was performed of randomized-controlled trials,systematic reviews,Cochrane reports and National/Societal guidelines of themedical,endoscopic and surgicalmanagement of GORD.Proton pump inhibitor(PPI)prescribing patterns and expenditure were reviewed in different countries,including Australia,Canada,New Zealand,UK and USA.Results Proton pump inhibitors(PPIs)are primarily indicated for control of GORD,Helicobacter pylori eradication(combined with antibiotics),preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease.There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration,with substantial expense for national health providers.Despite a favourable short-term safety profile,there are observational associations of adverse effects with long-term PPIs.These include nutrient malabsorption,enteric infections and cardiovascular events.The prevalence of PPI use makes their long-termsafety profile clinically relevant.Cost-benefit,symptom control and quality-oflife outcomes favour laparoscopic fundoplication rather than chronic PPI treatment.Laparoscopic fundoplication in long-termmanagement of PPI-responsive GORD is supported by SAGES,NICE and ACG,and PPI-refractory GORD by AGA and SAGES guidelines.The importance of establishing a definitive diagnosis prior to invasive management is emphasized,especially in PPI-refractory heartburn.Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals.This narrative review presents the advantages and disadvantages of surgical,endoscopic and medical management of GORD,which may assist in shared decision making and treatment choice in individual patients.展开更多
background Rectal biopsy for the diagnosis for Hirschsprung's disease(HD)can be performed in several ways.Suction rectal biopsy(SRB)is the most widely used method for neonates and younger infants while open strip ...background Rectal biopsy for the diagnosis for Hirschsprung's disease(HD)can be performed in several ways.Suction rectal biopsy(SRB)is the most widely used method for neonates and younger infants while open strip biopsy(OSB)is reserved for older children.Current notions suggest that SRB should not be used in older infants due to perceived thicker fibrous tissue in their rectal walls leading to higher rates of inconclusive results.This study aims to compare the inconclusive rates of both methods in children of different age groups.Methods A retrospective study were carried out with patients aged 13 years who underwent SRB or OSB during a 4-year period in a single center.Rectal biopsies were performed on patients with HD with previous endorectal pull-through surgeries excluded.Primary outcomes were rates of inconclusive results for SRB and OSB overall and when divided into different age groups.results 79 biopsies(57 SRB and 22 OSB)were included in the study.12 biopsies(9 SRB and 3 OSB)were deemed inconclusive.There was no significant difference in the rate of inconclusive results between patients underwent SRB and OSB overall(15.8%vs 13.6%,p=1.000).The same results were obtained when patients were divided into under one year and over one year groups or other different age groups(30.0%vs 33.3%,p=1.000).Conclusions Despite low biopsy numbers,our study suggests that SRB provides comparable rates of inconclusive results with OSB in children of all age groups.展开更多
基金This work was generously funded through the Private Practice Trust Fund at Gold Coast Hospital and Health Service
文摘Objectives:In the hospital setting,poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition.Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake.The aim of this study reported in this paper was to explore patient,family and health care professionals'perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients.Methods:An exploratory qualitative study design incorporating group and individual interviews of patients(n=14),their family members(n=4),and health care professionals(n=18)was undertaken.Participants were recruited pragmatically,using a mix of convenience and purposive sampling.A theoretically informed,semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework.Interviews were audio-recorded,transcribed verbatim and analysed inductively using a general inductive approach.Results:Three key themes emerged from analysing participant interviews.Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues.Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures.Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients'nutrition intakes.Conclusions:We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients.These predominantly reflect issues inherent in the hospital culture and environment.Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration,inclusive of patients and families,are needed to address these underlying barriers.
文摘BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.
基金Supported in part by funds from Australia's James Cook University research infrastructure block grant(Grant No.RIBG 09-2009)
文摘Objective:To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.Methods:From 2006 to 2009 all non-gestational diabetes mellitus(non-CDM)pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record.Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.Results:Ninety-one non-CDM mothers with macrosomia were studied and compared with 41normoglycemic subjects without macrosomia.Of the subjects with non-GDM macrosomia,45(49.4%)had normal SO g glucose challenge test(GCT)without further testing,another 8(8.8%)had abnormal GCT but normal 75 g oral glucose tolerance test(OGTT).A total of 4(4.4%)subjects had normal GCT and OGTT.Interestingly.14 out of 16(87.5%)subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies.Only 12 subjects had both GCT and OGTT,the rest of the cohort had either of the two tests.Subjects with non-CDM macrosomia had higher frequency of neonatal hypoglycaemia 34%as compared to 10%in nonmacrosomic babies(P=0.003).Other feto-maternal complications were similar in both groups.Conclussions:No significant pattern of glucose tolerance characteristics was identified in nonGDM mothers with macrosomic babies.In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies.Further prospective studies on a larger population are needed to verify our findings.
文摘BACKGROUND Pancreatitis with infected necrosis is a severe complication of acute pancreatitis and carries with it high rates of morbidity and mortality. The management of infected pancreatic necrosis alongside concomitant colorectal cancer has never been described in literature.CASE SUMMARY A 77 years old gentleman presented to the Emergency Department of our hospital complaining of ongoing abdominal pain for 8 h. The patient had clinical features of pancreatitis with a raised lipase of 3810 U/L, A computed tomography(CT) abdomen confirmed pancreatitis with extensive peri-pancreatic edema. During the course of his admission, the patient had persistent high fevers and delirium thought secondary to infected necrosis, prompting the commencement of broad-spectrum antibiotic therapy with Piperacillin/Tazobactam. Subsequent CT abdomen confirmed extensive pancreatic necrosis(over 70%). Patient was managed with supportive therapy,nutritional support and gut rest initially and improved over the course of his admission and was discharged 42 d post admission. He represented 24 d following his discharge with fever and chills and a repeat CT abdomen scan noted gas bubbles within the necrotic pancreatic tissue thereby confirming infected necrotic pancreatitis. This CT scan also revealed asymmetric thickening of the rectal wall suspicious for malignancy. A rectal cancer was confirmed on flexible sigmoidoscopy. The patient underwent two endoscopic necrosectomies and was treated with intravenous antibiotics and was discharged after 28 d.Within 1 wk post discharge, the patient commenced a course of neoadjuvant radiotherapy and subsequently underwent concomitant chemotherapy prior to undergoing a successful Hartmann's procedure for treatment of his colorectal cancer.CONCLUSION This case highlights the efficacy of endoscopic necrosectomy, early enteral feeding and targeted antibiotic therapy for timely management of infected necrotic pancreatitis. The prompt resolution of pancreatitis permitted the patient to undergo neoadjuvant treatment and resection for his concomitant colorectal cancer.
文摘AIM To identify risk factors associated with the formation of biliary strictures post liver transplantation over a period of 10-year in Queensland.METHODS Data on liver donors and recipients in Queensland between 2005 and 2014 was obtained from an electronic patient data system.In addition,intra-operative and post-operative characteristics were collected and a logistical regression analysis was performed to evaluate their association with the development of biliary strictures.RESULTS Of 296 liver transplants performed,285(96.3%) were from brain dead donors.Biliary strictures developed in 45(15.2%) recipients.Anastomotic stricture formation(n = 25,48.1%) was the commonest complication,with 14(58.3%) of these occurred within 6-mo of transplant.A percutaneous approach or endoscopic retrograde cholangiography was used to treat 17(37.8%) patients with biliary strictures.Biliary reconstruction was initially or ultimately required in 22(48.9%) patients.In recipients developing biliary strictures,bilirubin was significantly increased within the first postoperative week(Day 7 total bilirubin 74 μmol/L vs 49 μmol/L,P = 0.012).In both univariate and multivariate regression analysis,Day 7 total bilirubin > 55 μmol/L was associated with the development of biliary stricture formation.In addition,hepatic artery thrombosis and primary sclerosing cholangitis were identified as independent risk factors.CONCLUSION In addition to known risk factors,bilirubin levels in the early post-operative period could be used as a clinical indicator for biliary stricture formation.
文摘AIM:To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal(GI) endoscopy services.METHODS:The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms.Studies were screened against eligibility criteria and for relevance.Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of nonphysician endoscopists.These publications included a total of 28883 procedures performed by non-physician endoscopists.RESULTS:The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter.17/26 studies related to flexible sigmoidoscopies,5 to upper GI endoscopy and 6 to colonoscopy.All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists.Geographic distribution of publications showed the majority of research was conducted in the United States(43%),the United Kingdom(39%)and the Netherlands(7%).Most studies conclude that after appropriate training nurseendoscopists safely perform procedures.However,in relation to endoscopic competency,safety or patient satisfaction,all studies had major methodological limitations.Patients were often not randomized(21/26studies)and not appropriately controlled.In relation to cost-efficiency,nurse endoscopists were less costeffective per procedure at year 1 when compared to services provided by physicians,due largely to the increased need for subsequent endoscopies,specialist follow-up and primary care consultations.CONCLUSION:Contrary to general beliefs,endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite.Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.
文摘Objective: To review the long-term outcomes for 155 women with a vulvar dystrophy (VD) who attended the Royal Brisbane Hospital Vulvar Clinic between 1976 and 1988. Methods: VD data from Vulvar Diseases Clinic were reviewed and analysed using the computer software Statistical package for the Social Sciences (SPSS) 11.0. Results: Of 155 patients 94 had Lichen Sclerosus (LS), 41 Lichen Simplex Chronicus (LSC) and 20 Mixed Dystrophy (MD). Three patients developed squamous cell carcinomas of the vulva between 10 and 26 years after presentation with a VD. To date only one of these three patients remains alive following treatment. Conclusion: The need for long term follow up is stressed and any of the three types of VD may become malignant. Time from diagnosis to malignant change is not predictive. VD treatments seem to go through phases with the application of potent steroid creams having stood the test of time.
文摘BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease.An optimal evaluation depends on adequate bowel cleansing.Patients with inflammatory bowel disease(IBD),require frequent endoscopic assessment for both activity and dysplasia assessment.Two commonly used bowel preparations in Australia are Prep Kit-C(Pc)and Moviprep(Mp).Little is known about tolerability,efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.AIM To primary aim was to compare the tolerability,efficacy and safety of split protocols of Mp and Pc in patients having a colonoscopy.The secondary aim was to compare the efficacy,tolerability and safety of either preparation in patients with or without IBD.METHODS Patients were randomized to Pc or Mp bowel preparation.Patients completed a questionnaire to assess tolerability.Efficacy was assessed using the Ottawa Bowel Preparation Score.Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.RESULTS Of 338 patients met the inclusion criteria.Of 168 patients randomized to Mp and 170 to Pc.The efficacy of bowel preparation(mean Ottawa Bowel Preparation Score)was similar between Mp(5.4±2.4)and Pc(5.1±2.1)(P=0.3).Mean tolerability scores were similar in Mp(11.84±5.4)and Pc(10.99±5.2;P=0.17).125 patients had IBD(73 had Crohn’s Disease and 52 had Ulcerative colitis).Sixtyfour IBD patients were allocated to Mp and 61 to Pc.In non-IBD patients,104 were allocated to Mp and 109 to Pc.The mean tolerability score in the IBD group was lower than the non-IBD group(mean tolerability scores:IBD:10.3±5.1 and non-IBD:12.0±5.3;P=0.01).IBD patients described more abdominal pain with Mp when compared with Pc;(Mp:5.7±4.4 vs Pc:3.6±2.6,P=0.046).Serum magnesium level increased with Pc compared with Mp in all patients(mean increase in mmol/L:Mp:0.03±0.117 and Pc:0.11±0.106;P<0.0001).CONCLUSION In this study,the efficacy,tolerability and safety of Mp and Pc were similar in all patients.However,patients with IBD reported lower tolerability with both preparations.Specifically,IBD patients had more abdominal pain with Mp.These results should be considered when recommending bowel preparation especially to IBD patients.
基金This work was supported by the Griffith University Grants for Teaching and Learning for the project,"Building Academic Capacity in the Bachelor of Nursing: Developing a Scholarship of Learning and Teaching in a Nursing Education Community of Practice."
文摘Objectives: This study aimed to identify School and University support services available and accessed by nursing students transitioning into a university environment as many struggle to adjust to competing demands of personal commitments and expectations at university.Methods: A mixed methods design was used,based on activity theory and Lizzio's Five Senses of Success frameworks as exploratory guides.This study was conducted amongst the first year cohort at one campus of the Bachelor of Nursing (BN) program in Queensland,Australia.An initial baseline assessment of what University and School-based support services were on offer for students,and how the students interacted with the support services was conducted.This was followed by a survey to identify awareness and access to support services.Focus groups were then conducted to clarify the previous results and to determine engagement with these support services.Results: A randomly selected number of students (n =150) in the first-year 2014 cohort of the BN program (n =300) were included in this study.The survey was completed by 54 students and three semistructured focus groups were conducted.The analysis indicated that the support services in place were successful in reaching the majority of students and contributed to their sense of success at university,Specifically students identified that a whole cohort approach to support enhanced their transition to university.Conclusion: Identifying lesser known services early in the first year will ensure that students are supported and encouraged to use all services,contributing to their sense of success at university.
基金The study was supported by grants from Beijing Excellent Talents Training Programme(2018000021469G220)Beijing Hospitals Authority Youth Programme(QML20200309),Beijing,China.
文摘Objective:This study aimed to explore the lived experiences of the disease journey and patients'care needs with idiopathic pulmonary fibrosis(IPF).Methods:Face-to-face semi-structured interviews were conducted with a purposive sampling of IPF patients admitted to the department of respiratory medicine in a tertiary hospital in Beijing.Interview data were analyzed using the thematic analysis method.In the end,16 patients were interviewed.Results:Four themes emerged from the qualitative data included the long and confusing journey to reach a diagnosis,living with the disease,understanding the disease and treatment and desire for continuity of care.A series of subthemes were also identified,including uncertainty of diagnosis,delaying the process,living with physical symptoms,living with emotional distress,loss of independence,uncertainty with the prognosis,questioning the cause of the disease,concerning the side effects of treatments,lacking continuity of care,and wanting a better quality ofhealthcare in community hospitals.Conclusions:Based on the findings,there is an urgent need to improve the care delivery to this vulnerable population in China.To meet their health needs,it is of paramount importance to develop effective education programs for health professionals and IPF patients and improve care models of healthcare systems,especially in remote areas,to enhance care continuity in the communities.
文摘Background:Despite remarkable advances in surgical techniques and perioperative management,left hepatic trisectionectomy(LHT)remains a challenging procedure with a somewhat high postoperative morbidity rate compared with less-extensive resections.This study aimed to analyze the short-and long-term outcomes of LHT and identify factors associated with the postoperative morbidity of this technically demanding surgical procedure.Methods:The medical records of 53 patients who underwent LHT between June 2005 and October 2019 at a single institution were retrospectively reviewed.The independent prognostic factor of postoperative morbidity was analyzed using the logistic regression model.Results:Hepatocellular carcinoma was the most common indication for surgery(n=21),followed by hilar cholangiocarcinoma(n=14),intrahepatic cholangiocarcinoma(n=10),and other pathologies(including colorectal liver metastasis,hepatolithiasis,gallbladder cancer,living donor,hemangioma,and multilocular biliary cyst;n=8).The rates of postoperative morbidities of Clavien-Dindo grade 3 or higher and 90-day mortality were 39.6% and 1.9%,respectively.The 1-,3-,and 5-year overall survival rates were 81.1%,61.4%,and 44.6%,respectively.Multivariate analysis revealed that preoperative jaundice[hazard ratio(HR)=6.15,95%confidence interval(CI):1.57-24.17,P=0.009]and operative time>420 min(HR=4.66,95%CI:1.27–17.17,P=0.021)were independent predictors of postoperative morbidity.Conclusions:The in-hospital mortality of LHT surgery can be minimalized by a reliable preoperative evaluation of liver function and selection of the dominant anatomic features of right posterior sector,active and appropriate preoperative management for obstructive cholangitis and compensatory hypertrophy of the future remnant posterior sector,and the experience of the surgeon.
文摘Traumatic brain injury (TBI) is a devastating and extraordinarily expensive entity. It is becoming increasingly burdensome in the military setting with societal costs of managing the sequelae of TBI running into the billions of dollars (US$) each year. Increasing awareness among non-neurosurgical medical personnel of the pathophysiology of TBI and rapid and appropriate assessment, triage and treatment will increase the likelihood of a better outcome in any given head injured patient. Careful attention to prevention of secondary injury is vital if further decline following the initial insult is to be achieved. Early and repeated neurological assessment, and aggressive management of intracranial hypertension and disorders affecting airway and cardiorespiratory systems are the mainstay of managing moderate to severe TBI. This management may involve medical and surgical options and often requires battlefield assessment prior to aeromedical evacuation. The unique profile and epidemiology of TBI in the military, necessitates ongoing research into primary prevention and appropriate, cost-effective means of assessing and treating these often debilitating injuries. Improvements in the prevention and care of these individuals will lead to enormous individual and societal gains.
文摘Primary central nervous system lymphoma of T-cell lineage (PCNSTL) is an extremely rare entity, with relatively few cases reported in the literature. Presented here is a case of a 44-year-old, HIV negative woman found to have a solitary cerebellar lesion following presentation to the Emergency Department with a fall. The lesion responded to emergent dexamethasone and was followed with serial MRI imaging, which continued to show lesion regression. The lesion was shown to have recurred on MRI 14 months post-presentation and found to be T-cell lymphoma following immunophenotyping and TCR gene rearrangement studies of tissue specimen obtained via excisional biopsy.
文摘Introduction: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is often associated with gastrointestinal disturbance and inflammatory markers;however, there have been no histological studies performed in the small intestine from CFS/ME patients. The aim of this investigation was to assess the expression of certain inflammatory markers and inflammatory receptors, namely transient receptor potential melastin 3 (TRPM3) ion channels and muscarinic acetylcholine M3 (mAChRM3) receptors, in small intestinal tissues in a case controlled study comprising a CFS/ME patient and a healthy non-fatigued control. Method: Immunohistochemistry was performed on a small intestinal biopsy from a CFS/ME patient (age = 50;female) with self-reported symptoms of gastrointestinal disturbance and a non-fatigued control (NFC), (age = 28;female). Semi-quantitative analysis of expression was undertaken for interferon-gamma (IFNy), interleukin-1 alpha (IL-1α), tumour necrosis factor-alpha (TNFα), TRPM3 ion channels and mAChRM3 acetylcholine receptors. Results: There was significantly decreased expression of TRPM3 in the CFS/ME patient (35% ±9%) and a significant decrease in mAChRM3 in the CFS/ME patient (54% ±9%). There was no difference in IL-1α between CFS/ME patient and NFC, however;there was an increase in IFNy (13% ±6%) in the CFS/ME patient compared to NFC. There was a difference observed in TNFα in CFS/ME compared to NFC. Conclusion: Differences were noted in the expression of specific TRP ion channels and cholinergic receptors in CFS/ME compared with NFC, with CFS/ME demonstrating decreased TRPM3 and mAChRM3. Further, IFNy was increased, and TNFα decreased, in the small intestine of the CFS/ME patient with reported gastrointestinal disturbance.
文摘Background: Natural killer (NK) cell phenotypes have reported to be implicated in the pathomechanism of Multiple Sclerosis (MS). Several investigators have observed reduced peripheral numbers, reduced cytotoxic activity, and altered CD56Dim and CD56Bright NK cell phenotypes. This current project, for the first time, investigates the NK cell cytotoxicity, calcium mobilisation and transient receptor potential melastatin 3 (TRPM3) surface expression. Methods: NK cell cytotoxic activity and calcium signaling were examined in CD56Dim and CD56Bright NK cells before and after stimulation using Ionomycin, Pregnenolone sulphate, 2-Aminoethoxydiphenyl borate and Thapsigargin. Purified NK cells were labelled with antibodies to determine TRPM3, CD69 and CD107a surface expression using flow cytometry. Results: Twenty-two MS patients and 22 healthy controls were recruited for this project. Twelve of the 22 previously received Alemtuzumab (Lemtrada®) and the remaining ten reported nil medication. We report TRPM3 was significantly increased in untreated MS patients compared with healthy controls and treated MS patients (p-value 0.034). There was a significant decrease in CD69 surface expression on CD56Dim NK cell phenotype for untreated MS patients (p-value 0.031) and treated MS patients (p-value 0.036). We report altered calcium mobilisation in CD56Bright NK cells and to a lesser extent CD56Dim NK cells between healthy controls, treated and untreated MS patients. Conclusion: This investigation suggests variations in TRPM3 expression and calcium mobilisation of NK cells may be implicated in the pathogenesis of MS. Further investigation is required to determine the mechanism by which alemtuzumab alters calcium signaling in NK cells.
文摘Background: Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (CFS/ME), is a debilitating condition that presents with a range of symptoms, including fatigue, cognitive dysfunction, muscular and joint pain, and may be immune-mediated. In particular, patients exhibit abnormal cytokine expression. Similarly, in Multiple Sclerosis (MS), patients display neuroimmunological symptoms, and abnormal cytokine expression, with some overlap in symptomology with CFS/ME. The purpose of this study was to compare Th1, Th2, Th17 cytokines, inflammatory cytokines and chemokines, in healthy controls, CFS/ME and MS patients. Methods: Serum samples were collected from healthy controls (n = 16, mean age = 50 ± 11.85 years), CFS/ME patients (n = 16, mean age = 49.88 ± 9.54 years) and MS patients (n = 11, mean age = 52.75 ± 12.81 years). The concentrations of 27 cytokines (IFN-γ, TNF-α, IL-12, IL-2, IL-1β, IL-4, IL-6, IL-10, IL-13, IL-5, IL-17, IL-1ra, IL-7, IL-8, IL-9, eotaxin, IP-10, MCP-1, MIP1α, MIP1β, PDGF-bb, RANTES, basic FGF, GCSF, GMCSF, VEGF and IL-15) were measured using a Bio-Plex Pro™ kit. Results: IFN-γ, IL-10 and IL-5 were significantly higher in the serum of both CFS/ME and MS patients compared to the healthy controls (p ≤ 0.041). However, only the MS patients had significantly elevated levels of IL-12, IL-1β, IL-4, IL-13, IL-6, IL-17, IL-1ra, IL-7, IL-9, eotaxin, IL-10, MIP1α, basic FGF, GCSF and VEGF compared to the CFS/ME patients and controls (p ≤ 0.04). There were no significant differences between groups for IL-8, MCP-1, MIP1β, RANTES, GMCSF, TNF-α, and IL-2. Conclusion: CFS/ME and MS patients both displayed abnormal cytokine levels, with dual expression of Th1 and Th2 cytokines. Further research into cytokines such as IFN-γ, IL-10 and IL-5, with the use of a specific CFS/ME case definition and sensitive cytokine assays, is required to improve the understanding of the pathophysiology of CFS/ME.
文摘Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic lesions.We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(<4days)vs late(≥4days)anticoagulation.We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.Methods A prospective multicentre,observational cohort study was performed at 11 Australian stroke centres.Clinical and MRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two authors.Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.Results We recruited 276 patients of whom 208 met the eligibility criteria.The average age was 74.2 years(SD±10.63),and 79(38%)patients were female.Median National Institute of Health Stroke Scale score was 5(IQR 1–12).Median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation timing.Conclusion Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF patients.There is no increased rate of haemorrhage with early anticoagulation.These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe,but randomised controlled studies are needed to inform clinical practice.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Early anticoagulation after ischaemic stroke associ-ated with atrial fibrillation(AF)may reduce the rate of recurrent diffusion-weighted imaging ischaemic lesions and increase the rate of new haemorrhage.⇒It is unknown whether early anticoagulation also re-duces the rate of new silent ischaemic lesions.WHAT THIS STUDY ADDS⇒Early anticoagulation(<4days)after ischaemic stroke due to AF reduces the rate of new silent isch-aemic lesions at 1month without increasing the rate of new haemorrhage.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒Early anticoagulation after mild-to-moderate acute ischaemic stroke due to AF might be safe,howev-er,the results require further validation with ran-domised trials.
基金supported by UNSW and Ethicon Endo-Surgery,Inc.,University of New South Wales,Sydney,Australia.
文摘Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease(GORD),including treatment costs,safety profile and effectiveness.Methods A literature review was performed of randomized-controlled trials,systematic reviews,Cochrane reports and National/Societal guidelines of themedical,endoscopic and surgicalmanagement of GORD.Proton pump inhibitor(PPI)prescribing patterns and expenditure were reviewed in different countries,including Australia,Canada,New Zealand,UK and USA.Results Proton pump inhibitors(PPIs)are primarily indicated for control of GORD,Helicobacter pylori eradication(combined with antibiotics),preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease.There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration,with substantial expense for national health providers.Despite a favourable short-term safety profile,there are observational associations of adverse effects with long-term PPIs.These include nutrient malabsorption,enteric infections and cardiovascular events.The prevalence of PPI use makes their long-termsafety profile clinically relevant.Cost-benefit,symptom control and quality-oflife outcomes favour laparoscopic fundoplication rather than chronic PPI treatment.Laparoscopic fundoplication in long-termmanagement of PPI-responsive GORD is supported by SAGES,NICE and ACG,and PPI-refractory GORD by AGA and SAGES guidelines.The importance of establishing a definitive diagnosis prior to invasive management is emphasized,especially in PPI-refractory heartburn.Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals.This narrative review presents the advantages and disadvantages of surgical,endoscopic and medical management of GORD,which may assist in shared decision making and treatment choice in individual patients.
文摘background Rectal biopsy for the diagnosis for Hirschsprung's disease(HD)can be performed in several ways.Suction rectal biopsy(SRB)is the most widely used method for neonates and younger infants while open strip biopsy(OSB)is reserved for older children.Current notions suggest that SRB should not be used in older infants due to perceived thicker fibrous tissue in their rectal walls leading to higher rates of inconclusive results.This study aims to compare the inconclusive rates of both methods in children of different age groups.Methods A retrospective study were carried out with patients aged 13 years who underwent SRB or OSB during a 4-year period in a single center.Rectal biopsies were performed on patients with HD with previous endorectal pull-through surgeries excluded.Primary outcomes were rates of inconclusive results for SRB and OSB overall and when divided into different age groups.results 79 biopsies(57 SRB and 22 OSB)were included in the study.12 biopsies(9 SRB and 3 OSB)were deemed inconclusive.There was no significant difference in the rate of inconclusive results between patients underwent SRB and OSB overall(15.8%vs 13.6%,p=1.000).The same results were obtained when patients were divided into under one year and over one year groups or other different age groups(30.0%vs 33.3%,p=1.000).Conclusions Despite low biopsy numbers,our study suggests that SRB provides comparable rates of inconclusive results with OSB in children of all age groups.
