Purpose The aims of this study were to demonstrate the feasibility of zero echo time (ZTE) MRI for jawbone identification, and to evaluate the quantitative performance of 18F-FDG PET/MRI with ZTE-based attenuation correction (ZTE-AC) compared with PET/CT and PET/MRI with Dixon MR–based AC (Dixon-AC) in patients with oral cavity cancer (OCC). Materials and Methods Thirteen OCC patients underwent whole-body 18F-FDG PET/CT and subsequent regional PET/MRI with Dixon-AC and ZTE-AC in 1 day....
FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic...
Brown adipose tissue (BAT), which produces energy and is known to play a role as a hibernating gland, is sometimes visualized on 18F-FDG PET in children or in slender young adults in a cold environment. Because BAT is activated by catecholamines, FDG uptake in BAT is also observed in patients with pheochromocytoma or paraganglioma. We present the case of an elderly woman with remarkable FDG uptake in BAT. Activation of BAT by a β3-adrenergic receptor agonist (mirabegron) prescribed for overactive...
99mTc-MIBI has long been used to localize hyperfunctioning parathyroid tissue in patients with hyperparathyroidism. This tracer can also concentrate in various neoplastic tissues including prostate adenocarcinoma. We herein report a case with parathyroid hormone-secreting metastatic prostate cancer mimicking an ectopic parathyroid adenoma on the 99mTc-MIBI scan. We conclude that metastatic prostate cancer should be included as one of the differential diagnoses when interpreting 99mTc-MIBI scan. ...
Peer review can be utilized to increase the quality of care for patients by upgrading the performance of all the providers by identifying learning opportunities. Peer review can identify providers whose care is below the standard of care and recommend actions to correct the situation. Peer review is also important to satisfy requirements of the government and The Joint Commission. Ongoing professional practice evaluation and focused professional practice evaluation have been required since 2008 to...
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Key points Individuals with Hereditary Sensory & Autonomic Neuropathy type III (HSAN III), also known as Riley‐Day syndrome or Familial Dysautonomia, do not have functional muscle spindle afferents but do have essentially normal cutaneous mechanoreceptors Lack of muscle spindle feedback from the legs may account for the poor proprioception at the knee and the ataxic gait typical of HSAN III Given that functional muscle spindle afferents are also absent in the upper limb, we assessed whether...
Key points The primary motor cortex (M1) is fundamentally important for the acquisition of skilled motor behaviours. We tested the excitability changes of distinct M1 circuits at movement onset with TMS H‐reflex conditioning. Human subjects trained a discrete spatiotemporal motor skill. Practice was associated with reduced kinematic variability and improved motor performance. Performance improvements were paralleled by task‐specific excitability increases of the fastest corticospinal connections...
Key points In this study, we focused on MSNA burst size and occurrence separately as subcomponents of the sympathetic baroreflex in older adults, and we found that the distribution (variation) of burst size against burst occurrence was greater in women than men. Older women had greater carotid artery stiffness compared with older men, while blood pressure (BP) distribution (variation) was comparable between sexes. Sympathetic baroreflex sensitivity assessed with bust incidence was less sensitive...
Key points Extracellular matrix is highly remodelled in obesity and associates with the development of metabolic disorders, such as insulin resistance. Previously, we have shown that the lack of specific collagen XVIII isoforms impairs adipocyte differentiation in mice. Here, we show that mice lacking the medium and long isoforms of collagen XVIII develop insulin resistance and glucose intolerance and show elevated serum triglycerides and fat accumulation in the liver. We report that collagen...
Key points Dietary nitrate is a prominent therapeutic strategy to mitigate some metabolic deleterious effects related to obesity. Mitochondrial dysfunction is causally linked to adipose tissue inflammation and insulin resistance. Whole‐body glucose tolerance is prevented by nitrate independent of body weight and energy expenditure. Dietary nitrate reduces epididymal adipose tissue inflammation and mitochondrial reactive oxygen species emission while preserving insulin signalling. Metabolic...
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The novel coronavirus SARS-CoV2 emerged in December 2019 and is now pandemic. Initial analysis suggests that 5% of infected patients will require critical care, and that respiratory failure requiring intubatio...
Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the ches...
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Pathogenic enterotoxigenic Escherichia coli (ETEC) has been considered a major cause of diarrhea which is a serious public health problem in humans and animals. This study was aimed at examining the effect of γ-aminobutyric acid (GABA) supplementation on intestinal secretory immunoglobulin A (SIgA) secretion and gut microbiota profile in healthy and ETEC-infected weaning piglets. A total of thirty-seven weaning piglets were randomly distributed into two groups fed with the basal diet or supplemented...
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Clinical alarms, including those for mechanical ventilation, have been one of the leading causes of health technology hazards. It has been reported that < 15% of alarms studied rose to the level of being clinically relevant or actionable. Most alarms in health care, whether by default or intention, are set to a hypothetical average patient, which is essentially a one size fits most approach. A method of tuning to individual patient characteristics is possible, similar to the treatment philosophy...
Critical illness can threaten the adequacy of O2 delivery or CO2 excretion. Monitoring seeks to identify the adequacy of oxygenation and ventilation and to detect deterioration early. Advances in oximetry, capnography, and transcutaneous CO2 monitoring offer new opportunities for more accurate estimation of gas exchange, noninvasive monitoring of parameters previously not amenable (eg, total hemoglobin measurement), detection of disease, and prediction of fluid responsiveness.
Transport of critically ill patients within and between hospitals is a common undertaking in an effort to improve patient outcomes. Intrahospital transports are frequently conducted to aid in diagnosis through advanced imaging techniques or to allow image-guided procedures. Interhospital transport is most frequently conducted to bring patients to specialized care, including centers of excellence for cardiac, trauma, transplant, and respiratory failure. Transport outside the hospital can be accomplished...
Ventilator graphic monitoring is common in ICUs. The graphic information provides clinicians with immediate clues regarding patient–ventilator interaction and ventilator function. These display tools are aimed at reducing complications associated with mechanical ventilation, such as patient–ventilator asynchrony. It is also useful to assess respiratory mechanics in mechanically ventilated patients using both scalar and plot displays on the ventilator. Additional information can be gained by observing...
Mechanical ventilation in critically ill patients must effectively unload inspiratory muscles and provide safe ventilation (ie, enhancing gas exchange, protect the lungs and the diaphragm). To do that, the ventilator should be in synchrony with patient’s respiratory rhythm. The complexity of such interplay leads to several concerning issues that clinicians should be able to recognize. Asynchrony between the patient and the ventilator may induce several deleterious effects that require a proper physiological...
Lung volume measurement performed during invasive mechanical ventilation can be used to determine functional residual capacity, changes in end-expiratory lung volume with the application of PEEP, and lung strain. However, many bedside measurements provide useful information without the use of specialized equipment. Ventilation distribution through the lung has traditionally been assessed with computed tomography, but more recently electrical impedance tomography has brought the ability to monitor...
The estimation of pleural pressure with esophageal manometry has been used for decades, and it has been a fertile area of physiology research in healthy subject as well as during mechanical ventilation in patients with lung injury. However, its scarce adoption in clinical practice takes its roots from the (false) ideas that it requires expertise with years of training, that the values obtained are not reliable due to technical challenges or discrepant methods of calculation, and that measurement...
Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both their underlying disease states and the mechanical ventilation itself. Intensive monitoring is required to identify early signs of clinical worsening and to minimize the risk of iatrogenic harm. Pulse oximetry and capnography are used to ensure that...
Monitoring respiratory values such as breathing frequency, minute ventilation, breathing effort, and dyspnea are common in acute care. There is evidence that accurate monitoring and interpretation of these values leads to early identification and treatment of impending respiratory failure. Despite this evidence, some values, such as breathing frequency, are largely undervalued in the clinical setting. The undervaluation of breathing frequency is complex and will require a multifaceted approach, including...
Respiratory compromise is a common and potentially dangerous complication of patients admitted to general care units of hospitals. There are several distinct and disparate pathophysiologic trajectories of respiratory deterioration that hospitalized patients may suffer. Obstructive sleep apnea and preexisting cardiopulmonary disease increase the risk of respiratory failure after major surgery. Patients in general care units of hospitals currently receive only intermittent monitoring of vital signs....
The diaphragm is vulnerable to injury during mechanical ventilation, and diaphragm dysfunction is both a marker of severity of illness and a predictor of poor patient outcome in the ICU. A combination of factors can result in diaphragm weakness. Both insufficient and excessive diaphragmatic contractile effort can cause atrophy or injury, and recent evidence suggests that targeting an appropriate amount of diaphragm activity during mechanical ventilation has the potential to mitigate diaphragm dysfunction....
The electronic health record allows the assimilation of large amounts of clinical and laboratory data. Big data describes the analysis of large data sets using computational modeling to reveal patterns, trends, and associations. How can big data be used to predict ventilator discontinuation or impending compromise, and how can it be incorporated into the clinical workflow? This article will serve 2 purposes. First, a general overview is provided for the layperson and introduces key concepts, definitions,...
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Abstract Purpose of Review Surgical stabilization of rib fractures (SSRF) has been shown to decrease morbidity and mortality in patients with multiple rib fractures. This has led to a concomitant increase in the procedure, but the complications are just now being described in the literature. The purpose of this review is to focus on the current understanding of hardware failure after rib fixation. ...
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Purpose of review The success of organ transplant is determined by number of demographic, clinical, immunological and genetic variables. Artificial intelligence tools, such as artificial neural networks (ANNs) or classification and regression trees (CART) can handle multiple independent variables and predict the dependent variables by deducing the complex nonlinear relationships between variables. Recent findings In the last two decades, several researchers employed these tools to identify...
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I’d like to thank Conyers and Wright1 for their intriguing article which reflects on the principles of design thinking when applied to career decisions in medicine. I’d like to touch on a few salient discussion points that are relevant to us medical students and our medical educators, particularly as we reach our senior years and face the first few of many life-changing decisions. As a senior medical student soon to decide what foundation programme rotations I’d like to apply for, I am faced for...
A 46-year-old woman presented to our hospital with acute-onset vomiting and altered mental status. She had a history of depression with an episode of antipsychotic drug overdose 10 years ago. On arrival, she was comatose and had a strong wood creosote-like smell. Her physical examination revealed miosis, discoloration and blisters on her face without oropharyngeal mucosal erosion. She continuously excreted black urine for a day, which stopped following admission (figures 1 and 2). The patient’s family...
Deliberate accountability has arrived in the medical arena, producing an age of reward for measured performance and belief in publicising metrics to ensure clarity, with winning defined as hitting targets, whereby staff are incentivised by arbitrary objectives. Finite game theory declares that players are known, rules are fixed and the objective agreed upon, but infinite game theory asserts that players are both known and unknown, rules are changeable, and the objective is to perpetuate the game;...
BackgroundTo assess the prevalence of depression among medical students in their clinical years (fourth, fifth, and sixth years) in a government university in Eastern Province, Saudi Arabia, and its association with the students' sociodemographic characteristics, academic factors, perceived health problems and their perceived readiness to their future specialties. MethodsA cross-sectional study was conducted among 527 clinical-year medical students. The Patient Health Questionnaire (PHQ-9) and...
IntroductionDesign thinking is both a mindset and a practice; it is a method for problem solving that uses specific approaches, including empathy and prototyping, to discover creative solutions via an iterative, human-centred process. These methods were originally applied to the designing of goods and services, and it has been lauded for inspiring creativity that emerges from a genuine understanding of the needs of the end user. Design thinking is now taught in many fields, including business, information...
A 59-year-old man was diagnosed with kappa light chain multiple myeloma (MM), CS IIIA (DS), I (ISS), carrying del(17 p), 80% of plasma cell bone marrow infiltration and lytic bone lesions of the skull, left humerus and ileum, and lumbar vertebral column. He was treated with bortezomib, cyclophosphamide and dexamethasone with partial response and progression disease at +9 months from diagnosis. He showed a progressively increasing mass over the skull (figure 1). CT scan of head (figure 2) and 3D volume...
IntroductionThere is a reduction in Foundation trainee applications to speciality training and this is attributed to an administrative job role, with subsequent fears of burnout. This pilot study presents the findings of a real-time self-reporting tool to map a group of Foundation doctors’ elective activities. Self-reporting is efficient, low cost to run and allows for repeated measures and scalability. It aimed to example how a time-map could be used by departments to address any work imbalances...
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