Colon Cancer Metastatic to the Thyroid Gland in the Setting of Pathologically Diagnosed Papillary Thyroid Cancer: A Review and Report of a Case.

Colon cancer metastases to the thyroid gland are a particularly rare occurrence. Despite the relative amenability of the gland to clinical, radiologic, and pathologic assessment, preoperative distinction between primary and secondary thyroid neoplastic processes remains difficult. Here we describe a case of a patient with a known history of stage IV colon cancer with multiple pulmonary metastases, presenting with a thyroid lesion initially diagnosed as papillary thyroid cancer on fine-needle aspiration biopsy but found to be metastatic colonic adenocarcinoma on post-thyroidectomy pathologic evaluation utilizing immunohistochemical techniques.

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation.

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach.

An overview of frailty in kidney transplantation: measurement, management and future considerations.

The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre- and post-kidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT.

Impact of the implementation of a rapid meningitis/encephalitis multiplex polymerase chain reaction panel on IV acyclovir duration: multicenter, retrospective cohort of adult and pediatric patients.

The standard for diagnosing meningoencephalitis includes cerebrospinal fluid (CSF) culture and viral polymerase chain reaction (PCR). Approval of the FilmArray® BioFire® Meningitis/Encephalitis (ME) panel has reduced time to detection of several pathogens and improved diagnostic sensitivity. The objective of this study was to determine the impact on intravenous (IV) acyclovir duration of the ME panel compared to previously utilized CSF studies within a large health system with a central laboratory.

Oral Narrow-Spectrum Antibiotics for the Treatment of Urinary Tract Infection in Infants Younger Than 60 Days.

Data on the outcome of infants younger than 60 days treated with a combination of intravenous and oral antibiotics for urinary tract infection are limited. This study examined susceptibility and successful outcomes of treatment with narrow-spectrum oral antibiotics. In addition, we describe the effects of antimicrobial stewardship education intervention on prescribing practices.

A key genomic subtype associated with lymphovascular invasion in invasive breast cancer.

Background: Lymphovascular invasion (LVI) is associated with the development of metastasis in invasive breast cancer (BC). However, the complex molecular mechanisms of LVI, which overlap with other oncogenic pathways, remain unclear. This study, using available large transcriptomic datasets, aims to identify genes associated with LVI in early-stage BC patients.

Anthropometric Dimensions of Individuals With High Body Mass Index.

Objective: This study presents anthropometric data for individuals with high body mass index (BMI). Modified anthropometric dimensions were also developed to address the challenges of obtaining accurate and repeatable data for this population segment.

Background: The prevalence of obesity affects approximately 40% of the U.

The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients.

Objective: To measure effects of ED crowding on lung-protective ventilation (LPV) utilization in critically ill ED patients.

Methods: This is a retrospective cohort study of adult mechanically ventilated ED patients admitted to the medical intensive care unit (MICU), over a 3.5-year period at a single academic tertiary care hospital.

Quality of Life after Dietary Self-Management Intervention for Persons with Early Stage CKD.

Dietary recommendations that potentially delay the progression of chronic kidney disease (CKD) can be perceived as restrictive and unpalatable, negatively impacting quality of life (QOL). This pilot study examined the effect of a six-week small group intervention, "Self-Management of Dietary Intake Using Mindful Eating," on QOL, health literacy, and dietary self-efficacy among persons with CKD Stages 1-3. Improvements (n=19) were found from pre-test to post-test in total scores for Kidney Disease Quality of Life Short Form-36 (p=0.

Robot-assisted microsurgical vasovasostomy: the learning curve for a pure microsurgeon.

Vasovasostomy success rates improved with the application of the operative microscope in 1975. The robotic platform offers potential advantages including: a stable, ergonomic, scalable control system with three-dimensional visualization and magnification, the elimination of physiological tremor, and simultaneous control of three instruments and a camera. A previous publication revealed a fellowship-trained microsurgeon (PKK) could transition to robot-assisted microsurgical vasovasostomy (RAVV) with comparable outcomes.

Clinical Utility of Methicillin-Resistant Staphylococcus aureus Nasal Screening for Antimicrobial Stewardship: A Review of Current Literature.

Significant clinical and financial consequences are associated with both inadequate and unnecessary exposure to broad-spectrum antibiotics. As such, antimicrobial stewardship programs seek objective, reliable, and cost-effective tests to identify patients at highest or lowest risk for drug-resistant organisms to guide empirical antimicrobial selection. Use of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA in lower respiratory tract infections has led to significant reductions in duration of vancomycin therapy.

Validity and reliability of sleep promotion questionnaire and predictors of quality of care.

Background: Sleep disturbance is common among hospitalized patients. However, sleep promotion is not a high priority for most healthcare providers, which potentially impacts quality of care. Due to a paucity of validated tools to assess sleep promotion, little is known about the relationship between sleep promotion and quality of care.

Prevention of Infection: A Systematic Review of Evidence-Based Practice Interventions for Management in Patients With Cancer.

Background: Cancer-related infections lead to increases in mortality, antibiotic use, and hospital stays. Other adverse outcomes include dose delays and reductions, which can result in suboptimal treatment outcomes.

Objectives: Effective implementation of risk assessment and evidence-based interventions for the prevention and treatment of infection are essential to improve care and reduce costs related to infections in patients with cancer receiving immunosuppressive therapy.

Protective effect of genetic deletion of pannexin1 in experimental mouse models of acute and chronic liver disease.

Pannexins are transmembrane proteins that form communication channels connecting the cytosol of an individual cell with its extracellular environment. A number of studies have documented the presence of pannexin1 in liver as well as its involvement in inflammatory responses. In this study, it was investigated whether pannexin1 plays a role in acute liver failure and non-alcoholic steatohepatitis, being prototypical acute and chronic liver pathologies, respectively, both featured by liver damage, oxidative stress and inflammation.

Increasing patient recall of nurse leader rounding.

Nursing staff in a medical/surgical acute care 34-bed hospital unit were challenged by low percentages of patients able to recall nurse leader rounding activity (NLR). NLR occurred daily for all patients, yet many did not recall visits by nursing leaders when surveyed at discharge. Care giver credibility suffered as non-nursing executives questioned if NLR consistently occurred.

Recognizing and managing adrenal disorders in the emergency department [digest].

Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement.

Induction of mitochondrial biogenesis protects against acetaminophen hepatotoxicity.

Mitochondrial biogenesis (MB) is an adaptive response to maintain metabolic homeostasis after mitochondrial dysfunction. Induction of MB during APAP hepatotoxicity has not been studied. To investigate this, mice were treated with toxic doses of APAP and euthanized between 0 and 96 h.

Connexin hemichannel inhibition reduces acetaminophen-induced liver injury in mice.

Historically, connexin hemichannels have been considered as structural precursors of gap junctions. However, accumulating evidence points to independent roles for connexin hemichannels in cellular signaling by connecting the intracellular compartment with the extracellular environment. Unlike gap junctions, connexin hemichannels seem to be mainly activated in pathological processes.

The Advantage of Discordance: An Example Using the Highly Subjective Nuclear Grading of Breast Cancer.

Discordance among multiple assessments has been a reason to criticize a biomarker. But, if different assessments are all relevant, the meaning of discordance requires explanation. As an example, for 1085 breast cancers, a low (score 1), intermediate (score 2) or high nuclear grade (NG) (score 3) was assigned in years 2013, 2015, 2016.

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease.

Using mindful eating to improve specific dietary recommendations has not been adequately studied. This feasibility study examined an intervention, self-management of dietary intake using mindful eating, with 19 participants that had mild to moderate chronic kidney disease, using a prospective, single group, pretest-posttest design. The intervention had six weekly classes focused on self-management using mindful eating, goal-setting, problem-solving, and food label reading.

Reductive carboxylation is a major metabolic pathway in the retinal pigment epithelium.

The retinal pigment epithelium (RPE) is a monolayer of pigmented cells that requires an active metabolism to maintain outer retinal homeostasis and compensate for oxidative stress. Using C metabolic flux analysis in human RPE cells, we found that RPE has an exceptionally high capacity for reductive carboxylation, a metabolic pathway that has recently garnered significant interest because of its role in cancer cell survival. The capacity for reductive carboxylation in RPE exceeds that of all other cells tested, including retina, neural tissue, glial cells, and a cancer cell line.