Compositional Variations between Adult and Infant Skin Microbiome: An Update.

Human skin and its commensal microbiome form the first layer of protection to the outside world. A dynamic microbial ecosystem of bacteria, fungi and viruses, with the potential to respond to external insult, the skin microbiome has been shown to evolve over the life course with an alteration in taxonomic composition responding to altered microenvironmental conditions on human skin. This work sought to investigate the taxonomic, diversity and functional differences between infant and adult leg skin microbiomes.

Multi-disciplinary community respiratory team management of patients with chronic respiratory illness during the COVID-19 pandemic.

The Greater Glasgow & Clyde NHS Trust Community Respiratory Response Team was established to manage patients with chronic respiratory disease at home during the COVID-19 pandemic. The team aimed to avert hospital admission while maximally utilising remote consultations. This observational study analysed outcomes of the triage pathway used, use of remote consultations, hospital admissions and mortality among patients managed by the team.

Alteration of barrier properties, stratum corneum ceramides and microbiome composition in response to lotion application on cosmetic dry skin.

Xerosis, commonly referred to as dry skin, is a common dermatological condition affecting almost a third of the population. Successful treatment of the condition traditionally involves the application of cosmetic products facilitating the moisturisation of the skin with a range of ingredients including glycerol and fatty acids. While the effectiveness of these treatments is not in question, limited information exists on the impact on the skin microbiome following use of these products and the improvement in skin hydration.

Effect of the PIVO Device on the Procedure of Phlebotomy from Peripheral IV Catheters.

Short peripheral catheters (SPC) are an existing conduit into many patients' veins and line draws from SPC are a desired method of routine blood collection especially in difficult venous access patients. The PIVO device facilitates blood collection through SPC and is being used clinically in a number of hospitals. This study aimed to determine the appropriate wait time following a flush and the minimum waste volume required to obtain an undiluted blood sample when using the PIVO device and how that differed from current guidelines from SPC line draws.

PA32540 for the secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers.

Prescribed in patients with a history of myocardial infarction, stroke, transient ischemic attack, coronary intervention or bypass surgery, aspirin is one of the medications most commonly used in the secondary prevention of cardiovascular diseases. It has become a mainstay of therapy after years of solid evidence supporting its efficacy in clinical trials. However, a number of risks and side effects accompany its benefits, including the notable risk of bleeding and gastrointestinal side effects.

Heart failure patient adherence: epidemiology, cause, and treatment.

Poor adherence to therapeutic regimens is a significant impediment to improving clinical outcomes in the HF population. Typical rates of adherence to prescribed medications, low-sodium diets, and aerobic exercise programs remain lower than that needed to decrease morbidity and mortality associated with HF. Factors contributing to poor adherence include multiple comorbidities, clinical depression, and decreased cognitive functioning.

Saphenous vein graft disease: review of pathophysiology, prevention, and treatment.

Saphenous vein graft (SVG) disease after coronary artery bypass grafting (CABG) occurs in three phases: thrombosis, intimal hyperplasia, and atherosclerosis. Within the first month, thrombosis plays a major role. From month 1 to month 12, intimal hyperplasia occurs.

Safety, effectiveness, and outcomes of cardiac catheterization in nonagenarians.

With an aging population, nonagenarians (≥90 years of age) are increasingly being considered for cardiac catheterization. Because of the paucity of outcomes data in this population, we sought to evaluate the acute and intermediate outcomes of nonagenarians undergoing cardiac catheterization. A retrospective cohort of 44 nonagenarians undergoing 53 cardiac catheterizations from 2002 to 2010 was identified.

Change in intrathoracic impedance measures during acute decompensated heart failure admission: results from the Diagnostic Data for Discharge in Heart Failure Patients (3D-HF) Pilot Study.

Background: Despite the high number of admissions for acute decompensated heart failure (ADHF), there are no specific criteria for discharge readiness. A number of patients have implantable devices that might provide data to assist in determining readiness for discharge.

Methods And Results: The 3D-HF (Diagnostic Data for Discharge in Heart Failure Patients) study was a prospective observational pilot study enrolling HF patients with Optivol-capable cardiac devices within 48 hours of a hospital admission characterized by worsening HF symptoms.

Safety of iodinated intravenous contrast medium administration in sickle cell disease.

Background: Increased sickling of erythrocytes following intravenous iodinated contrast has been described in patients with sickle cell disease. In vitro, the effect is correlated with the tonicity, viscosity, acidity, and ionic nature of contrast media. Less erythrocyte sickling is observed in vitro with second-generation low- and iso-osmolar contrast agents.

Reporting of clinical trials: publication, authorship, and trial registration.

Transparency is the foundation on which all of research integrity rests. The public trust from patients, providers, and policy makers depends on fidelity to the mandates of accountability and access. Two important foundational practices for maintaining transparency in research and the reporting of clinical trials discussed in this review concern manuscript authorship and clinical trial registry, recognizing recent controversies regarding honorary and ghost authorship in the publication of industry-sponsored studies.

Review of advanced heart failure device diagnostics examined in clinical trials and the potential benefit from monitoring capabilities.

Over the past decade, emerging clinical trial data supported the usefulness of implanted therapeutic cardiac devices (pacemakers and defibrillators) for the treatment of heart failure (HF). Interest has now developed in evaluating the potential of device diagnostics to identify HF patients at risk for clinical events and to be used in the management of HF patients. Initial studies have provided inconsistent results.

Peroxisome proliferator-activated receptor delta agonists inhibit T helper type 1 (Th1) and Th17 responses in experimental allergic encephalomyelitis.

Multiple sclerosis (MS) is a neurological disorder that affects more than a million people world-wide. The aetiology of MS is not known and there is no medical treatment available that can cure MS. Experimental autoimmune encephalomyelitis (EAE) is a T-cell-mediated autoimmune disease model of MS.

Sleep-disordered breathing and heart failure: focus on obstructive sleep apnea and treatment with continuous positive airway pressure.

Background: Among patients with heart failure, sleep-disordered breathing is a common problem, with a prevalence ranging from 24% to 76%. Encompassed within the general category of sleep-disordered breathing are 2 types of sleep apnea: obstructive sleep apnea (OSA) occurs when the oropharyngeal musculature relaxes, causing a collapse of the upper airway, and central sleep apnea occurs when the brain stem fails to stimulate breathing.

Methods And Results: This article focuses on the relationship between heart failure and OSA, the treatment of OSA with continuous positive airway pressure (CPAP), and the role of CPAP in improving such effects of heart failure as ejection fraction, blood pressure, sympathetic activity, sleepiness, heart rate, and mortality.

Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting.

Objective: Preoperative use of clopidogrel increases the risk of bleeding, but its postoperative use has not been studied. We studied early postoperative clopidogrel use in on-pump and off-pump coronary artery bypass grafting.

Methods: Data were obtained from the University HealthSystem Consortium database.

Lifestyle risk factors and utilization of preventive services in disabled elderly adults in the community.

Lifestyle risk factor counseling and preventive health services are important to disabled elderly adults to prevent adverse health outcomes. We aimed to examine the prevalence of lifestyle risk factors and utilization of preventive health services in community-dwelling 2,982 adults, aged 60 years or older, with or without disability, in Southeastern Pennsylvania in 2004. The severity of disability was classified as no [independent activities of daily living (ADL) and instrumental activities of daily living (IADL)], some (independent ADL, dependent IADL), and severe limitation (dependent ADL).

Prevalence of hypovitaminosis D in cardiovascular diseases (from the National Health and Nutrition Examination Survey 2001 to 2004).

This cross-sectional study examined the burden of cardiovascular diseases (CVDs) using serum 25-hydroxyvitamin D (25[OH]D) and prevalence of hypovitaminosis D in adults with CVDs using data from NHANES 2001 to 2004. Serum 25(OH)D levels were divided into 3 categories (> or =30, 20 to 29, and <20 ng/ml), and hypovitaminosis D was defined as vitamin D <30 ng/ml. Of 8,351 adults who had 25(OH)D measured, mean 25(OH)D was 24.

Racial disparity in the relationship between hospital volume and mortality among patients undergoing coronary artery bypass grafting.

Objective: To examine whether the volume-mortality relationship in coronary artery bypass grafting (CABG) differs by race and operative risk.

Summary Background Data: In-hospital mortality after CABG is inversely associated with hospital volume. Racial disparities exist in the outcomes of CABG, possibly due to blacks' high operative risk.

Stat4 isoforms differentially regulate inflammation and demyelination in experimental allergic encephalomyelitis.

Experimental allergic encephalomyelitis (EAE) is a T cell-mediated autoimmune disease model of multiple sclerosis. Signal transducer and activator of transcription 4 (Stat4) is a transcription factor activated by IL-12 and IL-23, two cytokines known to play important roles in the pathogenesis of EAE by inducing T cells to secrete IFN-gamma and IL-17, respectively. We and others have previously shown that therapeutic intervention or targeted disruption of Stat4 was effective in ameliorating EAE.

Modifiable cardiovascular risk factors among individuals in low socioeconomic communities and homeless shelters.

To understand cardiovascular health in low socioeconomic populations, we analyzed the data from 426 low socioeconomic community-dwelling males and females and 287 homeless males in Philadelphia. Despite higher prevalence of smoking and hypertension, the proportion of homeless participants at increased risk for coronary heart disease was comparable with that of low socioeconomic community-dwelling participants. Among various characteristics, emotional stress was significantly associated with coronary heart disease risk in low socioeconomic community-dwelling participants only, suggestive of a differential psychosocial effect of stress.

Relationship of inferior vena cava filter usage in post-surgical patients by various surgical and medical subspecialists.

Venous thromboembolism is a common and often fatal problem in postsurgical patients. These patients are usually treated with either therapeutic anticoagulation or the placement of inferior vena cava (IVC) filters. Controversy surrounds the use of IVC filters, because no data exist proving survival benefit.

Does body mass index really matter in the management of heart failure?: a review of the literature.

Excess body weight increases the risk for many disorders including cardiovascular disease and such patients have a greater risk for developing heart failure (HF). Despite evidence demonstrating the adverse effects of excess weight, the relationship between body mass index (BMI) and mortality in HF patients remains controversial. Paradoxically, several large cohort studies have shown that overweight and obese HF patients seem to have better survival than their healthy weight counterparts.

The changing face of postoperative atrial fibrillation prevention: a review of current medical therapy.

Atrial fibrillation is the most common postoperative arrhythmia with significant consequences on patient health. Postoperative atrial fibrillation (POAF) complicates up to 8% of all noncardiac surgeries, between 3% and 30% of noncardiac thoracic surgeries, and between 16% and 46% of cardiac surgeries. POAF has been associated with increased morbidity, mortality, and longer, more costly hospital stays.

Renal dysfunction in heart failure patients: what is the evidence?

Congestive heart failure (CHF) is an increasingly common medical condition and the fastest growing cardiovascular diagnosis in North America. Over one-third of patients with heart failure also have renal insufficiency. It has been shown that renal insufficiency confers worsened outcomes to patients with heart failure.

The physician-hospital team: a successful approach to improving care in a large academic medical center.

Initiatives to improve the quality and efficiency of care in academic medical centers (AMCs, teaching hospitals) can benefit the performance of academic departments as well as the hospital. However, the value of performance improvement programs in an AMC is often challenging. At Jefferson Medical College, clinical efficiency and bed availability are important priorities to the Department of Medicine.