Cardiac Contractility Modulation Therapy in Patients with Amyloid Cardiomyopathy and Heart Failure, Case Report, Review of the Biophysics of CCM Function, and AMY-CCM Registry Presentation.

Cardiac amyloidosis may result in an aggressive form of heart failure (HF). Cardiac contractility modulation (CCM) has been shown to be a concrete therapeutic option in patients with symptomatic HF, but there is no evidence of its application in patients with cardiac amyloidosis. We present the case of TTR amyloidosis, where CCM therapy proved to be effective.

Tenofovir Disoproxil Fumarate Is Associated with a Set-Point Variation in the Calcium-Parathyroid Hormone-Vitamin D Axis: Results from a German Cohort.

Background: Higher levels of parathyroid hormone have been associated with the use of tenofovir disoproxil fumarate (TDF) in people with and without HIV infection. Yet, alterations in calcium levels have never been elucidated in detail.

Objective: To compare the association of parathyroid hormone with serum calcium levels and other markers of calcium and bone metabolism in people living with HIV on TDF- and non-TDF-containing antiretroviral therapy.

Secondary Hyperparathyroidism in HIV-Infected Patients in Central Europe.

Secondary hyperparathyroidism (sHPT) might be a contributor to increased risk of osteoporosis in adult HIV patients but there is little data available on this issue in this particular population. The aim of the study was to investigate the prevalence of sHPT in an HIV-infected population with normal kidney function and to evaluate its risk factors in HIV patients. This cross-sectional study was carried out in a single HIV center in Germany using routine data from patients with normal kidney function attending the clinic between January 1st and December 31st, 2016.

Dolutegravir monotherapy as treatment de-escalation in HIV-infected adults with virological control: DoluMono cohort results.

Background: The potential toxicity of long-term antiretroviral therapy (ART) requires ongoing investigation of novel strategies for treatment of HIV-infected patients. Monotherapy with the integrase inhibitor (INSTI) dolutegravir (DTG) may offer a favourable safety profile. Additionally, DTG has a high barrier of resistance, crucial for successful maintenance of virological control.

Is It Exertional Heatstroke or Something More? A Case Report.

Background: Heat stroke, heat-related illness, and malignant hyperthermia all present with hyperthermia. The former two are common presentations in the emergency department (ED). On the other hand, malignant hyperthermia (MH) is an uncommon but equally dangerous condition that requires prompt recognition and specific treatment with dantrolene sodium and avoidance of certain medications to reduce morbidity and mortality.

The educational value of improvisational actors to teach communication and relational skills: perspectives of interprofessional learners, faculty, and actors.

Objective: To assess the educational value of improvisational actors in difficult conversation simulations to teach communication and relational skills to interprofessional learners.

Methods: Surveys of 192 interprofessional health care professionals, and 33 teaching faculty, and semi-structured interviews of 10 actors. Descriptive statistics, Fisher's exact test and chi-square test were used for quantitative analyses, and the Crabtree and Miller approach was used for qualitative analyses.

Integrating actors into a simulation program: a primer.

We describe our more than 10 years' experience working with actors and provide a "how-to" guide to recruiting, auditioning, hiring, training, and mentoring actors for work as simulated patients in simulation programs. We contend that trained actors add great realism, richness, and depth to simulation-based training programs. The actors experience satisfaction from their contributions, and their skill and improvisational talent allow programs to offer ethical and relational training, customized to a wide range of practitioners and adapted across a variety of health care conversations.

Anesthesiology trainees face ethical, practical, and relational challenges in obtaining informed consent.

Background: Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees' perspectives and educational needs through a qualitative analysis of narratives.

Methods: The Program to Enhance Relational and Communication Skills-Anesthesia used professional actors to teach communication skills and relational abilities associated with informed consent.

BRAF(V599E) mutation is the leading genetic event in adult sporadic papillary thyroid carcinomas.

Activating mutations of BRAF have been identified in a variety of human cancers, most notably melanomas and papillary thyroid carcinomas (PTCs). The aim of the present study was to disclose the role of BRAF mutations in thyroid carcinoma development. Seventy-two thyroid tumors, including 60 PTCs, six follicular adenomas, five follicular carcinomas, and one anaplastic carcinoma, were studied.

Use of nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors: indications and complications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications-both prescription and over the counter-in the United States. Gastrointestinal side effects from NSAIDs are responsible for significant patient morbidity and mortality as well as healthcare cost. With the development of cyclooxygenase-2 (COX-2) specific inhibitors, these serious adverse reactions have been significantly reduced without affecting therapeutic benefit; however, the need for careful monitoring of patients on therapy with traditional NSAIDs and COX-2 inhibitors continues.

COX-2-specific inhibition: implications for clinical practice.

Although conventional nonsteroidal anti-inflammatory drugs (NSAIDs) have long been a major therapeutic choice for the management of arthritic conditions, the potential adverse effects of these agents sometimes compromise their clinical utility. New modes of therapy have recently been introduced, and data on the cyclooxygenase-2 (COX-2)-specific inhibitors celecoxib and rofecoxib suggest that these agents will meet the need for safe and effective therapeutic alternatives to conventional NSAIDs.

COX-2--specific inhibition: Implications for clinical practice.

Although conventional nonsteroidal anti-inflammatory drugs (NSAIDs) have long been a major therapeutic choice for the management of arthritic conditions, the potential adverse effects of these agents sometimes compromise their clinical utility. New modes of therapy have recently been introduced, and data on the cyclooxygenase-2 (COX-2)-specific inhibitors celecoxib and rofecoxib suggest that these agents will meet the need for safe and effective therapeutic alternatives to conventional NSAIDs.

Effects of fentanyl administration on respiratory system compliance in infants.

Objective: To determine if the analgesic doses of fentanyl used in a pediatric intensive care unit (ICU) setting adversely affect dynamic total respiratory system compliance in awake, intubated infants.

Design: Prospective case-control study.

Setting: Pediatric and pediatric cardiac ICUs of a tertiary university hospital.

[Obesity among patients admitted to a medical department at the Terni Hospital].

The Authors report the results of a study intended to asses the prevalence of obesity in Terni's medical department. Body mass index (BMI) was used as a measure of obesity: it can easily be calculated from weight and height (W/H2) for any individual. A sample of 1195 patients (569 males and 626 females) was studied; obesity was found in 30% of the females and in 10% of the males.

Chest wall motion of infants during spinal anesthesia.

To test the extent to which diaphragmatic contraction moves the rib cage in awake supine infants during quiet breathing, we studied chest wall motion in seven prematurely born infants before and during spinal anesthesia for inguinal hernia repair. Infants were studied at or around term (postconceptional age 43 +/- 8 wk). Spinal anesthesia produced a sensory block at the T2-T4 level, with concomitant motor block at a slightly lower level.

Comparison of a sidestream and mainstream capnometer in infants.

This study was designed to compare capnograms obtained from a sidestream and mainstream capnometer during rapid mechanical ventilation in infants. Ten infants were studied during elective anesthesia and surgery. Simultaneous recordings of exhaled CO2 were made with a sidestream and a mainstream machine; arterial blood gases were measured for comparison.

Head trauma in the child.

Head injury, either alone or in combination with multiple injuries, is common in children. Its pattern is different in children compared to adults, with diffuse cerebral swelling rather than localized hematoma being most common. The pathophysiology of pediatric head trauma is not yet clearly elucidated, but may be closely related to changes in the regulation of cerebral blood flow.

Reye's syndrome.

Although most cases of Reye's syndrome that were initially reported were fatal, the overall mortality is now 20 to 30 per cent, with an even lower rate in some series. Improvement is due to both increased awareness of this disease and advances in care for the critically ill child. A good outcome depends on recognition of the early manifestations of the syndrome and appropriate initial therapy based on the stage of the disease.