Case series: raw, whole, plant-based nutrition protocol rapidly reverses symptoms in three women with systemic lupus erythematosus and Sjögren's syndrome.

Systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) are chronic autoimmune diseases. Symptoms of SLE can vary widely but often include fatigue, pain, photosensitivity, and, in some cases, nephritis. SS is frequently characterized by extreme dry eye and mouth, resulting from damage to moisture-producing glands, and is often present in combination with SLE.

Site-specific effects of dobutamine on cardiac conduction and refractoriness.

Background: Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost.

Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation.

Background: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).

Objectives: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.

Novel agents in development for multidrug-resistant Gram-negative infections: potential new options facing multiple challenges.

Purpose Of Review: To review novel antiinfective agents in development for multidrug-resistant (MDR) Gram-negative bacterial infections.

Recent Findings: Four novel agents are in various phases of development (tebipenem, durlobactam-sulbactam, cefepime-taniborbactam, and xeruborbactam). Tebpipenem is an oral carbapenem with a recently completed phase III trial for complicated urinary tract infections while durlobactam-sulbactam represents a potential alternative for drug-resistant Acinetobacter baumannii .

Temporal Changes and Clinical Implications of Delayed Peridevice Leak Following Left Atrial Appendage Closure.

Objectives: The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure.

Background: Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL >5 mm may prohibit discontinuation of OAC.

Mediastinal Mass: An Unusual Location for a Paraganglioma.

A 50-year-old man presented to the hospital for workup of a symptomatic inguinal hernia. At presurgical workup, findings from a contrast material-enhanced CT of the chest, abdomen, and pelvis revealed a large, well-defined and enhancing middle mediastinal mass arising from the right ventricular outflow tract. The mass was ultimately deemed resectable due to preserved fat planes between the mass and other mediastinal structures and the preservation of the right and left coronary arteries.

Clinical predictors of heart block during atrioventricular nodal reentrant tachycardia ablation: A multicenter 18-year experience.

Background: Catheter ablation is considered the first-line treatment of symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). It has been associated with a risk of heart block (HB) requiring a pacemaker. This study aims to determine potential clinical predictors of complete heart block as a result AVNRT ablation.

Post-Extubation Stridor Complicating COVID-19-Associated Acute Respiratory Distress Syndrome: A Case Series.

Post-extubation stridor is a known complication of mechanical ventilation that affects a substantial number of all critical care patients and leads to increased morbidity and mortality. Common risk factors for the development of post-extubation stridor include female gender, older age, and prolonged length of mechanical ventilation. There may be an increased incidence of post-extubation stridor in patients who require mechanical ventilation to manage the respiratory complications of COVID-19.

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein.

Background: Idiopathic ventricular arrhythmias (IVAs) from the left ventricular (LV) summit may be successfully ablated from the distal great cardiac vein (dGCV). Using a 12-lead electrocardiogram (ECG) to localize IVAs that can be ablated from the dGCV is valuable for ablation planning.

Objective: To determine if a "w" wave, a notch in the Q wave in lead I, and other ECG features can identify IVAs that can be successfully ablated from the dGCV.

Effect of Chloroquine, Hydroxychloroquine, and Azithromycin on the Corrected QT Interval in Patients With SARS-CoV-2 Infection.

Background: The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the global coronavirus disease 2019 pandemic. Small studies have shown a potential benefit of chloroquine/hydroxychloroquine±azithromycin for the treatment of coronavirus disease 2019. Use of these medications alone, or in combination, can lead to a prolongation of the QT interval, possibly increasing the risk of Torsade de pointes and sudden cardiac death.

Kinematic adaptions to induced short-term pelvic limb lameness in trotting dogs.

Background: Lameness due to paw injuries is common in the clinical practice. Although many studies investigated gait adaptations to diseases or injuries, mainly of the hip and knee, our understanding of the biomechanical coping mechanisms that lame dogs utilize is limited. Therefore, this study evaluated the kinematic changes associated with an induced, load-bearing pelvic limb lameness in healthy dogs trotting on a treadmill.

Western Validation of a Novel Gastric Cancer Prognosis Prediction Model in US Gastric Cancer Patients.

Background: A novel prediction model for accurate determination of 5-year overall survival of gastric cancer patients was developed by an international collaborative group (G6+). This prediction model was created using a single institution's database of 11,851 Korean patients and included readily available and clinically relevant factors. Already validated using external East Asian cohorts, its applicability in the American population was yet to be determined.

A single visit multidisciplinary model for managing patients with mutations in moderate and high-risk genes in a community practice setting.

The introduction of screening for multiple high and moderate risk mutations in genes has resulted in a complex approach to patient care involving multiple disciplines. We sought to describe the feasibility of a single visit multidisciplinary approach to the management of patients with an identified high/moderate risk gene mutation. Patients who presented to our community hospital over a 1-year period who were found to have a high/moderate risk genetic mutation on a screening panel were referred to the High Risk Genetic Clinic.

Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study.

Background: Gastric adenocarcinoma is an aggressive disease with frequent lymph node (LN) metastases for which lymphadenectomy results in a survival benefit. In the US, the National Comprehensive Cancer Network guidelines recommend D2 lymphadenectomy or a minimum of 15 LNs retrieved. However, retrieval of only 15 LNs is considered by most international guidelines as inadequate.

Clinical Significance of Nonsustained Ventricular Tachycardia on Stored Electrograms in Permanent Pacemaker Patients.

Background: Permanent pacemaker electrograms record a variety of arrhythmias, including nonsustained ventricular tachycardia (NSVT). Little has been reported regarding incidence and clinical significance of NSVT in pacemaker patients after long-term monitoring.

Methods: Records from all patients implanted with Medtronic pacemakers (Medtronic, Minneapolis, MN, USA) at a single institution from January 1, 2009 to February 27, 2012 were reviewed.

Performance of Anatomically Designed Quadripolar Left Ventricular Leads: Results from the NAVIGATE X4 Clinical Trial.

Introduction: The safety and efficacy of a novel family of quadripolar left ventricular (LV) pacing leads designed to pace from nonapical regions of the LV with low pacing capture thresholds was studied in patients undergoing implantation of a cardiac resynchronization therapy defibrillator (CRT-D).

Methods And Results: Patients receiving a CRT-D were implanted with 1 of 3 ACUITY X4 leads (Spiral Long, Spiral Short, or Straight), designed to address coronary venous anatomical variability. Electrical performance and LV lead related complications were evaluated 3 and 6 months post implantation, respectively.

Beyond the whipple operation: radical resections for cancers of the head of the pancreas.

Pancreatic adenocarcinoma is the most common pancreatic malignancy, and it occurs most commonly in the pancreatic head. It has a relatively low incidence; however it is a deadly disease and is the fourth most common cause of cancer deaths for males and females in the United States. Surgical resection in the form of pancreaticoduodenectomy is the mainstay of treatment and can lead to improved overall survival as well as the possibility of a cure, although only 10 % of patients are resectable at presentation.

Colorectal liver metastases: making the unresectable resectable using irreversible electroporation for microscopic positive margins - a case report.

Background: Irreversible electroporation (IRE) is a non-thermal injury tissue ablation technique that uses electrical pulses to cause cell death. IRE damages the endothelial cells of blood vessels; however these cells re-grow, and thus IRE does not result in permanent damage to blood vessels. We report the novel use of IRE for ablation of microscopically positive margins after resection of colorectal liver metastases (CRLM) impinging on hepatic veins.

Kinematic adaptations to tripedal locomotion in dogs.

Limb amputation often represents the only treatment option for canine patients with certain diseases or injuries of the appendicular system. Previous studies have investigated adaptations to tripedal locomotion in dogs but there is a lack of understanding of biomechanical compensatory mechanisms. This study evaluated the kinematic differences between quadrupedal and tripedal locomotion in nine healthy dogs running on a treadmill.

Duodenal adenocarcinoma: why the extreme rarity of duodenal bulb primary tumors?

Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel adenocarcinomas. The duodenum is divided into four segments: D1 (proximal horizontal 5 cm beginning with the 3-cm duodenal bulb), D2 (descending), D3 (distal horizontal), and D4 (ascending).