| Records |
| Author |
Radbel, J.; Boutsikaris, D. |
| Title |
The New Usual Care |
Type |
Journal Article |
| Year |
2017 |
Publication |
Emergency Medicine Clinics of North America |
Abbreviated Journal |
Emerg Med Clin North Am |
| Volume |
35 |
Issue |
1 |
Pages |
11-23 |
| Keywords |
Anti-Bacterial Agents/therapeutic use; Catheterization, Central Venous; Clinical Protocols/standards; Evidence-Based Medicine; Fluid Therapy; Humans; Sepsis/diagnosis/*therapy; ARISE trial; Early goal-directed therapy (EGDT); ProCESS trial; ProMISe trial; Sepsis; Usual care |
| Abstract |
Recent literature continues to refine which components of the early goal-directed therapy (EGDT) algorithm are necessary. Given it utilizes central venous pressure, continuous central venous oxygen saturation, routine blood transfusions, and inotropic medications, this algorithm can be timely, invasive, costly, and potentially harmful. New trials highlight early recognition, early fluid resuscitation, appropriate antibiotic treatment, source control, and the application of a multidisciplinary evidence-based approach as essential components of current sepsis management. This article discusses the landmark sepsis trials that have been published over the past several decades and offers recommendations on what should currently be considered 'usual care'. |
| Address |
Department of Emergency Medicine, Saint Peters University Hospital, 254 Easton Ave, New Brunswick, NJ 08901, USA; Division of Pulmonary and Critical Care, Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Johnson Place, New Brunswick, NJ 08903, USA. Electronic address: boutsida@rwjms.rutgers.edu |
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English |
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ISSN  |
0733-8627 |
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| Notes |
PMID:27908328 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
100293 |
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| Author |
Saleh, H.M.; Tawfik, M.M.; Abouellail, H. |
| Title |
Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection |
Type |
Randomized Controlled Trial |
| Year |
2017 |
Publication |
Journal of Vascular Surgery |
Abbreviated Journal |
J Vasc Surg |
| Volume |
66 |
Issue |
5 |
Pages |
1427-1431.e1 |
| Keywords |
Aged; Anti-Bacterial Agents/therapeutic use; Catheter-Related Infections/blood/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; *Device Removal/adverse effects; Disease-Free Survival; Egypt; Equipment Design; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prospective Studies; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome |
| Abstract |
BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter. The aim of this study was to compare the clinical outcome of CRBSI treated with two different strategies: GE vs CR with new catheter insertion 3 to 7 days later. METHODS: This prospective randomized study analyzed the outcomes of all cases of long-term hemodialysis CRBSI during a 5-year period. The catheter infection-free survival time was analyzed in the two groups of patients (GE group, 339 patients; CR group, 339 patients). Three weeks of systemic antibiotic therapy was used according to culture in both groups. The catheter infection-free survival was analyzed using Kaplan-Meier analysis. RESULTS: No statistically significant difference was found in catheter infection-free survival time for GE and CR groups (P = .69), which is not affected by age, sex, presence of diabetes mellitus, or type of causative organism. CONCLUSIONS: Our study did not demonstrate a difference in the clinical outcome of CRBSI treated with GE or CR with new catheter insertion 3 to 7 days later. However, guidewire catheter exchange saves veins for future access, reduces the cost and number of procedures, and avoids complications of new venipuncture. |
| Address |
Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt |
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English |
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0741-5214 |
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| Notes |
PMID:28822660 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
99317 |
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| Author |
Saleh, H.M.; Tawfik, M.M.; Abouellail, H. |
| Title |
Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection |
Type |
Randomized Controlled Trial |
| Year |
2017 |
Publication |
Journal of Vascular Surgery |
Abbreviated Journal |
J Vasc Surg |
| Volume |
66 |
Issue |
5 |
Pages |
1427-1431.e1 |
| Keywords |
Aged; Anti-Bacterial Agents/therapeutic use; Catheter-Related Infections/blood/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; *Device Removal/adverse effects; Disease-Free Survival; Egypt; Equipment Design; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prospective Studies; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome |
| Abstract |
BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter. The aim of this study was to compare the clinical outcome of CRBSI treated with two different strategies: GE vs CR with new catheter insertion 3 to 7 days later. METHODS: This prospective randomized study analyzed the outcomes of all cases of long-term hemodialysis CRBSI during a 5-year period. The catheter infection-free survival time was analyzed in the two groups of patients (GE group, 339 patients; CR group, 339 patients). Three weeks of systemic antibiotic therapy was used according to culture in both groups. The catheter infection-free survival was analyzed using Kaplan-Meier analysis. RESULTS: No statistically significant difference was found in catheter infection-free survival time for GE and CR groups (P = .69), which is not affected by age, sex, presence of diabetes mellitus, or type of causative organism. CONCLUSIONS: Our study did not demonstrate a difference in the clinical outcome of CRBSI treated with GE or CR with new catheter insertion 3 to 7 days later. However, guidewire catheter exchange saves veins for future access, reduces the cost and number of procedures, and avoids complications of new venipuncture. |
| Address |
Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt |
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English |
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0741-5214 |
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| Notes |
PMID:28822660 |
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no |
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ref @ user @ |
Serial |
100347 |
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Luedi, M.M.; Singh, S.K.; Mosley, J.C.; Hatami, M.; Gumin, J.; Sulman, E.P.; Lang, F.F.; Stueber, F.; Zinn, P.O.; Colen, R.R. |
| Title |
A Dexamethasone-regulated Gene Signature Is Prognostic for Poor Survival in Glioblastoma Patients |
Type |
Journal Article |
| Year |
2017 |
Publication |
Journal of Neurosurgical Anesthesiology |
Abbreviated Journal |
J Neurosurg Anesthesiol |
| Volume |
29 |
Issue |
1 |
Pages |
46-58 |
| Keywords |
Animals; Antineoplastic Agents, Hormonal/*pharmacology; Apoptosis; Blotting, Western; Brain Neoplasms/*mortality; Cell Line, Tumor; Cell Survival; Dexamethasone/*pharmacology; Flow Cytometry; Gene Expression Regulation, Neoplastic/*drug effects; Glioblastoma/*mortality; Humans; Mice; Prognosis; Stem Cells/drug effects; Survival Analysis |
| Abstract |
BACKGROUND: Dexamethasone is reported to induce both tumor-suppressive and tumor-promoting effects. The purpose of this study was to identify the genomic impact of dexamethasone in glioblastoma stem cell (GSC) lines and its prognostic value; furthermore, to identify drugs that can counter these side effects of dexamethasone exposure. METHODS: We utilized 3 independent GSC lines with tumorigenic potential for this study. Whole-genome expression profiling and pathway analyses were done with dexamethasone-exposed and control cells. GSCs were also co-exposed to dexamethasone and temozolomide. Risk scores were calculated for most affected genes, and their associations with survival in The Cancer Genome Atlas and Repository of Molecular Brain Neoplasia Data databases. In silico Connectivity Map analysis identified camptothecin as antagonist to dexamethasone-induced negative effects. RESULTS: Pathway analyses predicted an activation of dexamethasone network (z-score: 2.908). Top activated canonical pathways included “role of breast cancer 1 in DNA damage response” (P=1.07E-04). GSCs were protected against temozolomide-induced apoptosis when coincubated with dexamethasone. Altered cellular functions included cell movement, cell survival, and apoptosis with z-scores of 2.815, 5.137, and -3.122, respectively. CCAAT/enhancer binding protein beta (CEBPB) was activated in a dose dependent manner specifically in slow-dividing “stem-like” cells. CEBPB was activated in dexamethasone-treated orthotopic tumors. Patients with high risk scores had significantly shorter survival. Camptothecin was validated as potential partial neutralizer of dexamethasone-induced oncogenic effects. CONCLUSIONS: Dexamethasone exposure induces a genetic program and CEBPB expression in GSCs that adversely affects key cellular functions and response to therapeutics. High risk scores associated with these genes have negative prognostic value in patients. Our findings further suggest camptothecin as a potential neutralizer of adverse dexamethasone-mediated effects. |
| Address |
*Department of Anesthesiology, Bern University Hospital Inselspital, Bern, Switzerland Departments of daggerCancer Systems Imaging double daggerDiagnostic Imaging section signNeurosurgery and Brain Tumor Center parallelRadiation Oncology, Division of Radiation Oncology #Neurosurgery, Cancer Systems Imaging, and Cancer Biology **Cancer Systems Imaging, and Diagnostic Imaging, The University of Texas MD Anderson Cancer Center paragraph signDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX |
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English |
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0898-4921 |
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| Notes |
PMID:27653222 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
96635 |
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| Author |
Nourallah, B.; Digpal, R.; Jena, R.; Watts, C. |
| Title |
Irradiating the Subventricular Zone in Glioblastoma Patients: Is there a Case for a Clinical Trial? |
Type |
Journal Article |
| Year |
2017 |
Publication |
Clinical Oncology (Royal College of Radiologists (Great Britain)) |
Abbreviated Journal |
Clin Oncol (R Coll Radiol) |
| Volume |
29 |
Issue |
1 |
Pages |
26-33 |
| Keywords |
Adult; Brain Neoplasms/*radiotherapy; Glioblastoma/*radiotherapy; Humans; Lateral Ventricles/*radiation effects; Male; Neoplastic Stem Cells/radiation effects; Stem Cell Niche/radiation effects; Cancer stem cells; glioblastoma; neural stem cells; radiotherapy; subventricular zone |
| Abstract |
Glioblastoma is the most common and aggressive adult brain tumour. Over the last 10 years it has emerged that the subventricular zone (SVZ), the largest adult neural stem cell niche, has an important role in the disease. Converging evidence has implicated transformation of adult neural stems in gliomagenesis and the permissive stem cell niche in disease recurrence. Concurrently, clinical studies have suggested that SVZ involvement is a negative prognostic marker. It would follow that irradiating the SVZ may improve outcomes in glioblastoma by directly targeting this putative sanctuary site. To investigate this potential strategy, 11 retrospective studies and 1 prospective study examined the relationship between dose to the SVZ and survival outcomes in glioblastoma patients. This review summarises the theoretical underpinning of this strategy, provides a critical evaluation of the existing evidence and discusses the rationale for a clinical trial. |
| Address |
John van Geest Centre for Repair, Cambridge, UK; Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrookes Hospital, Cambridge, UK. Electronic address: cw209@cam.ac.uk |
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0936-6555 |
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| Notes |
PMID:27729188 |
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no |
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ref @ user @ |
Serial |
96633 |
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