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[Evolution of the therapeutic management of varicoceles: Analysis of French national coding database (2006-2014)]. - Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
The varicocele is a venous abnormality frequently found in humans (1/10). Although the recommendations for management of this pathology are clear, two therapeutic options can be discussed: surgery or radiological embolisation. We wanted to study the evolution of the therapeutic management of varicocele using the French national coding database.Analysis of database from the "Agence technique de l'information sur l'hospitalisation" (ATIH) (number of surgical procedures and interventional radiology used in the treatment of varicocele for the period 2006-2014). The common classification of medical procedures (CCAM) was used to extract the codes for surgery and radiological embolisation. Then we recorded the corresponding "Groupes homogÃ¨nes de malades" (GHM), excluding those with a different primary diagnosis of varicocele cure.The number of surgical procedures and radiological embolisation performed for the treatment of varicocele increased from 3626 to 4007Â procedures (+10.5%) between 2006 and 2014. While the frequency of interventional radiology (embolization pampiniform plexus) increased by 73.9%, surgery procedures (by direct approach or laparoscopy) decreased by 31.4% throughout the study (2006-2014). Thus in 2006, 60.2% of therapeutic procedures were performed surgically and 39.8% by radiological embolisation. In 2014, 37.4% of therapeutic procedures were performed surgically and 62.6% by embolization.The analysis of French national database has confirmed a change in the therapeutic management of varicocele between 2006 and 2014. The minimally invasive treatment by radiological embolisation is currently favored in France and surgery pushed into the background. In 2014, more than one therapeutic management out of two was performed in interventional radiology.4.Copyright Â© 2015 Elsevier Masson SAS. All rights reserved.
Evaluation of general-purpose collimators against high-resolution collimators with resolution recovery with a view to reducing radiation dose in myocardial perfusion SPECT: A preliminary phantom study. - Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
There is a growing focus on reducing radiation dose to patients undergoing myocardial perfusion imaging. This preliminary phantom study aims to evaluate the use of general-purpose collimators with resolution recovery (RR) to allow a reduction in patient radiation dose.Images of a cardiac torso phantom with inferior and anterior wall defects were acquired on a GE Infinia and Siemens Symbia T6 using both high-resolution and general-purpose collimators. Imaging time, a surrogate for administered activity, was reduced between 35% and 40% with general-purpose collimators to match the counts acquired with high-resolution collimators. Images were reconstructed with RR with and without attenuation correction. Two pixel sizes were also investigated. Defect contrast was measured.Defect contrast on general-purpose images was superior or comparable to the high-resolution collimators on both systems despite the reduced imaging time. Infinia general-purpose images required a smaller pixel size to be used to maintain defect contrast, while Symbia T6 general-purpose images did not require a change in pixel size to that used for standard myocardial perfusion SPECT.This study suggests that general-purpose collimators with RR offer a potential for substantial dose reductions while providing similar or better image quality to images acquired using high-resolution collimators.
Porous silicon membrane-modified electrodes for label-free voltammetric detection of MS2 bacteriophage. - Biosensors & bioelectronics
A proof of concept for the label-free detection of bacteriophage MS2, a model indicator of microbiological contamination, is validated in this work as a porous silicon (pSi) membrane-based electrochemical biosensor. PSi membranes were used to afford nanochannel architectures. The sensing mechanism was based on the nanochannel blockage caused by MS2 binding to immobilized capture antibodies. This blockage was quantified by measuring the oxidation current of the electroactive species reaching the electrode surface, by means of differential pulse voltammetry (DPV). The immunosensor showed a limit of detection of 6pfu/mL in buffer, allowing the detection of MS2 to levels commonly found in real-world applications, and proved to be unaffected by matrix effects when analyzing MS2 in reservoir water. This platform enables the straightforward, direct and sensitive detection of a broad range of target analytes and constitutes a promising approach towards the development of portable electronic point of sample analysis devices.Copyright Â© 2016. Published by Elsevier B.V.
Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network. - Infection control and hospital epidemiology
The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1Ã—105 colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections. Infect. Control Hosp. Epidemiol. 2016;1-3.
Simultaneous conduction mapping and intracellular membrane potential recording in isolated atria. - Canadian journal of physiology and pharmacology
We describe a novel approach for simultaneously determining regional differences in action potential (AP) morphology and tissue electrophysiological properties in isolated atria. The epicardial surface of rat atrial preparations was placed in contact with a multi-electrode array (9 Ã— 10 silver chloride electrodes, 0.1 mm diameter and 0.1 mm pitch). A glass microelectrode (100 MÎ©) was simultaneously inserted into the endocardial surface to record intracellular AP from either of 2 regions (A, B) during pacing from 2 opposite corners of the tissue. AP duration at 80% of repolarisation and its restitution curve was significantly different only in region A (p < 0.01) when AP was initiated at different stimulation sites. Alternans in AP duration and AP amplitude, and in conduction velocity were observed during 2 separate arrhythmic episodes. This approach of combining microelectrode array and intracellular membrane potential recording may provide new insights into arrhythmogenic mechanisms in animal models of cardiovascular disease.
Followership characteristics among infection preventionists in U.S. hospitals: Results of a national survey. - American journal of infection control
Infection prevention practices vary across U.S. hospitals. Although the importance of leadership in infection prevention has been described, little is known about how followership influences such efforts. Our national survey found that hospitals with truly exemplary followers in infection control roles may be more likely to use recommended prevention practices.Published by Elsevier Inc.
Leaky ryanodine receptors contribute to diaphragmatic weakness during mechanical ventilation. - Proceedings of the National Academy of Sciences of the United States of America
Ventilator-induced diaphragmatic dysfunction (VIDD) refers to the diaphragm muscle weakness that occurs following prolonged controlled mechanical ventilation (MV). The presence of VIDD impedes recovery from respiratory failure. However, the pathophysiological mechanisms accounting for VIDD are still not fully understood. Here, we show in human subjects and a mouse model of VIDD that MV is associated with rapid remodeling of the sarcoplasmic reticulum (SR) Ca(2+) release channel/ryanodine receptor (RyR1) in the diaphragm. The RyR1 macromolecular complex was oxidized, S-nitrosylated, Ser-2844 phosphorylated, and depleted of the stabilizing subunit calstabin1, following MV. These posttranslational modifications of RyR1 were mediated by both oxidative stress mediated by MV and stimulation of adrenergic signaling resulting from the anesthesia. We demonstrate in the murine model that such abnormal resting SR Ca(2+) leak resulted in reduced contractile function and muscle fiber atrophy for longer duration of MV. Treatment with Î²-adrenergic antagonists or with S107, a small molecule drug that stabilizes the RyR1-calstabin1 interaction, prevented VIDD. Diaphragmatic dysfunction is common in MV patients and is a major cause of failure to wean patients from ventilator support. This study provides the first evidence to our knowledge of RyR1 alterations as a proximal mechanism underlying VIDD (i.e., loss of function, muscle atrophy) and identifies RyR1 as a potential target for therapeutic intervention.
Achilles Tendon Properties in Minimalist and Traditionally Shod Runners. - Journal of sport rehabilitation
Tendon adapts to load through alterations in its composition and mechanical properties. Mechanical adaptation to increased load often involves increases in cross sectional area, stiffness and modulus. Runners exhibit these adaptations.We sought to determine if runners wearing minimalist shoes had larger and stiffer Achilles tendons (AT) compared to traditionally shod runners.Cross-sectional study of well-trained, traditionally and minimally shod runners.Laboratory assessment of trained runners.Twenty three men (11 traditional, 12 minimalist) and eight women (6 traditional, 2 minimalist) participated in the study. Runners wearing minimalist shoes had 4.2 Â± 1.6 yrs of training experience in minimalist shoes.We utilized diagnostic ultrasound and isokinetic dynamometry to generate a force elongation curve and its derivatives.Minimalist runners had a greater cross sectional area: mean difference (MD) = 9.2mm2; increased stiffness (MD=268.1 NÂ·-1) and modulus (MD= 202.9 MPa). ATs of minimalist runners experienced greater stress (MD 8.6 N/mm2) during MVIC of the plantarflexor muscles due to greater force of contraction (MD 798.9 N).The AT in minimalist runners adapts by increasing size, stiffness and modulus which is consistent with our understanding of mechanical adaptation of tendon to increased loading. Increased stress to the AT likely requires a slow transition to minimalist running to allow the Achilles to adapt without evidence of injury.
Qualitative validation of the CAUTI Guide to Patient Safety assessment tool. - American journal of infection control
Hospital-acquired infection, including catheter-associated urinary tract infection (CAUTI), is common. Although CAUTI is usually preventable, hospital units may struggle to reduce CAUTI rates. The CAUTI guide to patient safety (GPS) was developed to assess a unit's CAUTI prevention activities. Our aim was to qualitatively validate the GPS.We interviewed participants from 2 units in each of 4 hospitals. Each unit's nurse manager completed the GPS and then discussed their answers with a trained research assistant. Semistructured interviews were conducted with unit nurses and physicians. We compared the nurse managers' answers to the unit physicians' and nurses' responses and assessed agreement.A total of 49 participants from 4 medical intensive care units and 4 medical-surgical units were interviewed. Nurse managers found the GPS helpful and complete. There was higher agreement between nurse managers and unit nurses than with physicians. Some questions generated more disagreement than others. Our findings suggest that the GPS is comprehensive and may be best used to stimulate discussions between stakeholders to address key issues.Using the GPS to assess several stakeholders' views could allow a given unit to move its CAUTI prevention efforts forward in a more informed manner.Copyright Â© 2016. Published by Elsevier Inc.
Encrusted Uretero-pyelitis: Case Report. - Urology case reports
Encrusted uretero-pyelitis is a rare and serious disease, related to the presence of calcifications in the pelvicalyceal system and ureter, associated with chronic urinary tract infection. In most cases, the causal agent of this infection lithiasis is corynebacterium urealyticum. The specific aspect of calcifications on CT scan can help to suggest diagnosis. To avoid a delay in diagnosis (which is frequent), an accurate exploration by the bacteriologist is crucial. The combination of a glycopeptides antibiotherapy and urine acidification has proved its effectiveness, as described in the medical literature. We report the case of a 77-year-old male patient, successfully treated for a bilateral encrusted uretero-pyelitis by local acidification (Thomas's solution) followed by oral acidification (ammonium chloride).
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