Palliation of heart failure.

Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure.

Clinical and immunohistologic typing of salivary duct carcinoma: a report of 50 cases.

Background: Due to the low incidence of salivary duct carcinoma (SDC), only limited data in regard to the biologic behavior of this tumor and its immunohistochemical characteristics are available. The authors analyzed the clinical, molecular, and genetic profile of SDC and identified prognostic factors.

Methods: The follow-up of 50 patients with SDC was obtained and paraffin-embedded tumor samples were examined immunohistochemically.

Increased frequency of non-fumigatus Aspergillus species in amphotericin B- or triazole-pre-exposed cancer patients with positive cultures for aspergilli.

Invasive aspergillosis (IA) can occur despite prior prophylactic or empiric use of triazoles or amphotericin B (AMB). Although profound immunosuppression may account for breakthrough IA, resistance of Aspergillus to antifungals may also play a role. To examine this question, we measured the minimal inhibitory concentration of 105 Aspergillus isolates recovered from 105 cancer patients (64 with IA, 41 with Aspergillus colonization) to AMB, itraconazole (ITC), and voriconazole (VRC) using the National Committee for Clinical Laboratory Standards (NCCLS) M38-A microdilution and E-test methods.

Toll-deficient Drosophila flies as a fast, high-throughput model for the study of antifungal drug efficacy against invasive aspergillosis and Aspergillus virulence.

Invasive aspergillosis (IA) is the most important opportunistic mycosis in immunosuppressed patients. The lack of a sufficient number of effective antifungals and our incomplete understanding of the pathogenesis of IA contribute to its overall unfavorable prognosis. Studies of drug efficacy against IA and Aspergillus virulence rely on conventional animal models that are laborious and use limited numbers of animals; alternative, less cumbersome in vivo models are desirable.

Equivalence of the bioimpedance and thermodilution methods in measuring cardiac output in hospitalized patients with advanced, decompensated chronic heart failure.

Background: An accurate and reliable noninvasive method for determining cardiac output/cardiac index would be valuable for patients with acutely decompensated advanced systolic heart failure.

Objectives: To determine whether a correlation exists for cardiac output and index determined by using bioimpedance and thermodilution in patients with acutely decompensated complex heart failure and if differences between results with the 2 methods could be explained by the patients' advanced condition.

Methods: Cardiac output and index were determined by using bioimpedance and thermodilution in 33 patients.

Ventricular dysrhythmias in heart failure.

Left-ventricular systolic dysfunction, or heart failure (HF), is a chronic, progressive condition with a poor prognosis. Approximately 50% of deaths, especially in mild to moderate cases, are sudden. Most sudden deaths are thought to be due to ventricular tachycardia; however, premature ventricular contractions and couplets parallel severity of HF and have been associated with increased mortality risk as opposed to dysrhythmic death.

Ipsilateral motor cortex activity during unimanual hand movements relates to task complexity.

Functional imaging studies have revealed recruitment of ipsilateral motor areas during the production of sequential unimanual finger movements. This phenomenon is more prominent in the left hemisphere during left-hand movements than in the right hemisphere during right-hand movements. Here we investigate whether this lateralization pattern is related specifically to the sequential structure of the unimanual action or generalizes to other complex movements.

The sciatic nerve block in emergency settings: a comparison between a new anterior and the classic lateral approaches.

Background: Anterior and lateral approaches to the sciatic nerve block are performed with the patient in the supine position. This could be an important advantage when mobilization to the limb involved is limited or painful, particularly in emergency conditions. The aim of this prospective, randomized study was to compare these two sciatic nerve blockades performed in an emergency setting.

Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design.

Heart failure (HF) affects >5 million patients in the United States, and its prevalence is increasing every year. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors and beta-blockers reduce hospitalizations and mortality rates in patients with HF, these lifesaving therapies continue to be underused. Several studies in a variety of clinical settings have documented that a significant proportion of eligible patients with HF are not receiving treatment with these guideline-recommended, evidence-based therapies.

Surgical management of heart failure.

This article introduces the mechanisms and theories behind the surgical treatments for heart failure; however, heart failure is a complex problem and requires multiple solutions. Surgery offers treatment strategies that target underlying physiologic changes and may provide both quality of life and survival benefit to patients who have specific clinical characteristics consistent with the aims of the procedure. Nurses must include surgical treatment early in their hierarchy of treatment plans, especially when coronary artery occlusion, hibernating myocardium, or mitral valve regurgitation is the cause of heart failure.

Sequential exposure of Aspergillus fumigatus to itraconazole and caspofungin: evidence of enhanced in vitro activity.

We investigated the in vitro activity of sequential itraconazole and caspofungin against 10 isolates of Aspergillus fumigatus. Previous exposure of A. fumigatus to itraconazole resulted in dose-dependent enhanced effects of caspofungin and vice versa.

Determination of velocity of tubar transport with dynamic hysterosalpingoscintigraphy.

Transport of 99mTc labelled albumin macroaggregates (MAA) can be used as a substitute for assessing transport of spermatozoa within the female genital tract. As yet, the velocity of tubar MAA transport has not been systematically studied in a large group. Dynamic hysterosalpingoscintigraphy (HSS) was performed after intrauterine instillation of 10-20 MBq 99mTc-MAA in 88 pre-ovulatory women suffering from infertility.

Cardiac resynchronization therapy through biventricular pacing in patients with heart failure and ventricular dyssynchrony.

Cardiac resynchronization therapy provides a new adjunct in the armamentarium of therapies available to patients who remain symptomatic despite optimized standard therapies. It does not cure heart failure; patients must maintain evidence-based therapies promoted by the American Heart Association and American College of Cardiology. Therapy benefits can be influenced by lead placement and device programming, so it is essential that qualified personnel are consulted to initiate and monitor therapy.

Gender differences in quality of life are minimal in patients with heart failure.

Background: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction.

Methods: Data from a sample of 640 men and women (50% each) matched on New York Heart Association functional classification and age were used for this secondary analysis.

Combination of caspofungin with inhibitors of the calcineurin pathway attenuates growth in vitro in Aspergillus species.

Work in Saccharomyces cerevisiae and Cryptococcus neoformans suggests that caspofungin could interact with the calcineurin pathway. We examined the in vitro interaction of caspofungin with calcineurin inhibitors (FK506, cyclosporin, FK520 and L685,818) and the TOR inhibitor rapamycin in 13 isolates of Aspergillus species. Caspofungin activity was enhanced by calcineurin/TOR inhibitors for all Aspergillus isolates studied.

The Minnesota Living With Heart Failure Questionnaire: sensitivity to differences and responsiveness to intervention intensity in a clinical population.

Background: The Minnesota Living With Heart Failure Questionnaire (LHFQ) is a commonly used measure of health-related quality of life in persons with heart failure. Researchers have questioned whether LHFQ is sensitive to subtle differences and sufficiently responsive to clinical interventions because the instrument has demonstrated variable performance in clinical trials.

Objectives: A secondary analysis was conducted to assess the LHFQ for sensitivity to different clinical states and responsiveness to varying intensities of clinical intervention.

Overexpression of Sbe2p, a Golgi protein, results in resistance to caspofungin in Saccharomyces cerevisiae.

Caspofungin inhibits the synthesis of 1, 3-beta-D-glucan, an essential cell wall target in fungi. Genetic studies in the model yeast Saccharomyces cerevisiae have shown that mutations in FKS1 and FKS2 genes result in caspofungin resistance. However, direct demonstration of the role of gene overexpression in caspofungin resistance has been lacking.

Bioimpedance monitoring: better than chest x-ray for predicting abnormal pulmonary fluid?

Bioimpedance monitoring may aid in treating heart failure. Mean thoracic electrical impedance (Zo) is inversely proportional to thoracic fluid volume and may offer greater sensitivity for detecting thoracic fluid. OBJECTIVE.

Improving the care of patients dying of heart failure.

Patients with heart failure have special palliative care needs, but palliative measures for treating the symptoms of end-stage heart failure have been largely ignored. A formal disease-management program for heart failure should include palliative care.

Effective observation unit treatment of decompensated heart failure.

There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED-OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation.

Nurses's knowledge of heart failure education principles.

Objective: The goal of this study was to determine nurses' knowledge of heart failure (HF) self-management education principles.

Design: The study was exploratory and descriptive and included a convenience sample.

Setting: Research took place in a large midwestern health care system that included a university-based hospital, community hospitals, and home or palliative care.