Impact of Piperacillin-Tazobactam Dosing in Septic Shock Patients Using Real-World Evidence: An Observational, Retrospective Cohort Study.

Background: Sepsis and septic shock are associated with significant morbidity and mortality. Rapid initiation of appropriate antibiotic therapy is essential, as inadequate therapy early during septic shock has been shown to increase the risk of mortality. However, despite the importance of appropriate antibiotic initiation, in clinical practice, concerns for renal dysfunction frequently lead to antibiotic dose reduction, with scant evidence on the impact of this practice in septic shock patients.

Utility of flow cytometry and gene rearrangement analysis in tissue and blood of patients with suspected cutaneous T‑cell lymphoma.

Cutaneous T‑cell lymphoma (CTCL) is difficult to diagnose at an early stage. Current diagnostic tools include clinical examination, histomorphologic analysis, immunohistochemistry, flow cytometry of peripheral blood and/or lesional tissue, and evaluation of T‑cell receptor (TCR) clonality by gene rearrangement analysis (TCRGR). Advances in genomic sequencing, including high‑throughput sequencing (HTS), can be used to identify specific clones of rearranged TCR genes.

Basaloid Follicular Hamartoma: A Case Report and a Novel Cosmetic Treatment.

Basaloid follicular hamartoma (BFH) is a rare, benign neoplasm of the hair follicle, characterized by multiple brown papules involving the face, scalp, and trunk. It is described by multiple clinical forms, and can present as localized or generalized. Diagnosis is made histologically via biopsy, which is important in order to distinguish BFH from basal cell carcinoma (BCC) or other malignant epithelial neoplasms.

Biomechanics of an Articulated Screw in Acute Scapholunate Ligament Disruption.

 An injury to the scapholunate interosseous ligament (SLIL) leads to instability in the scapholunate joint. Temporary fixation is used to protect the ligament during reconstruction or healing of the repair. Rigid screw fixation-by blocking relative physiological motion between the scaphoid and lunate-can lead to screw loosening, pullout, and fracture.

Left atrial appendage closure with amplatzer septal occluder in patients with atrial fibrillation: CT-based morphologic considerations.

Objectives: This study analyzed left atrial appendage (LAA) dimensions measured by computed tomography (CT) scan to define optimal selection of Amplatzer septal occluders for LAA closure.

Background: Patients with atrial fibrillation and contraindications to anticoagulation have limited options for LAA closure until approval of dedicated closure devices. Off-label use of available cardiac devices represents one option.

Assessment of a novel software tool in the selection of aortic valve prosthesis size for transcatheter aortic valve replacement.

Background: Transcatheter aortic valve replacement (TAVR) can be complicated by significant paravalvular leak (PVL). Optimal selection of TAVR prosthesis size can minimize the risk of clinically significant PVL. The aim of this study was to assess the utility of a proprietary software package, HeartNavigator (Philips), in selecting TAVR prosthesis to minimize PVL.

Prognostic evaluation of COPD patients: GOLD 2011 versus BODE and the COPD comorbidity index COTE.

Background: The Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The added value provided by quantifying comorbidities and integrating them to multidimensional indices has not been explored.

Objective: Compare the prognostic value of the GOLD ABCD categories versus the BMI, Obstruction, Dyspnea, Exercise (BODE) index, and explore the added prognostic value of comorbidities evaluation to this multidimensional assessment.

Evidence supporting the role of calpain in the α-processing of amyloid-β precursor protein.

Amyloid plaques are a hallmark of the aging and senile dementia brains, yet their mechanism of origins has remained elusive. A central issue is the regulatory mechanism and identity of α-secretase, a protease responsible for α-processing of amyloid-β precursor protein (APP). A remarkable feature of this enzyme is its high sensitivity to a wide range of cellular stimulators, many of which are agonists for Ca(2+) signaling.

Scientific truth or false hope? Understanding Alzheimer's disease from an aging perspective.

In this paper, we argue that the current official definition for Alzheimer's disease is misleading, since it defines senile dementia (SD), a long-known incurable senile/geriatric condition, as a discrete/curable disease. This overly optimistic definition was incepted in the 1970s amid the public's fear of the upcoming SD crisis and desperate hope for a cure. Scientifically, however, it has overturned Alois Alzheimer's age-based concept for disease classification-the essence of modern Geriatric Medicine and the National Institute of Aging.

Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome.

In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings.

A case of ventricular tachycardia related to caffeine pretreatment.

Suboptimal seizure duration is commonly encountered in electroconvulsive therapy practice, especially in older patients with higher seizure thresholds. Intravenous caffeine is commonly used to improve seizure duration and quality in such patients and is generally well tolerated aside from occasional reports of relatively benign ventricular ectopy. We describe a patient with no previous history of cardiac disease or arrhythmia who developed sustained bigeminy and 2 brief runs of ventricular tachycardia after caffeine administration.

Osteomyelitis of the mandibular symphysis caused by brown recluse spider bite.

Background: Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury.

Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD.

Rationale: The distance walked in the 6-min walk test (6MWT) predicts mortality in patients with severe COPD. Little is known about its prognostic value in patients with a wider range of COPD severity, living in different countries, and the potential additional impact of oxygen desaturation measured during the test.

Methods: We enrolled 576 stable COPD outpatients in Spain and the United States and observed them for at least 3 years (median, 60 months).

Electroconvulsive therapy in a patient with a cavernous hemangioma.

Intracranial space-occupying lesions are felt to be a relative contraindication to electroconvulsive therapy (ECT), although there have been several reports of safely treating patients with a variety of intracranial vascular malformations. We report a patient with a parietal cavernous hemangioma (CH), whose ECT proceeded without incident. We elected to mitigate the expected increase in blood pressure during the procedure with esmolol, although this precaution may have been unnecessary as CHs are low-flow malformations.

Enzymatic debriding agents are safe in wounds with high bacterial bioburdens and stimulate healing.

Background: Debridement is essential for successful wound management. Enzymatic debridement is commonly utilized in wound care but has been reported to be unsafe in wounds with significant bacterial bioburden, unless used in conjunction with topical antimicrobials. We examine this hypothesis with 2 commercially available, commonly used preparations of enzymatic debriding agents.

Wound healing in patients with cancer.

Objective: The treatment of patients with cancer has advanced into a complex, multimodal approach incorporating surgery, radiation, and chemotherapy. Managing wounds in this population is complicated by tumor biology, the patient's disease state, and additional comorbidities, some of which may be iatrogenic. Radiation therapy, frequently employed for local-regional control of disease following surgical resection, has quantifiable negative healing effects due to local tissue fibrosis and vascular effects.

Psychiatric and behavioral manifestations of vascular dementia.

Vascular dementia (VaD) is the second most common cause of dementia, accounting for about 20% of all cases. Psychiatric and behavioral problems are at least as common in VaD as in Alzheimer's disease but are very different qualitatively. Patients with VaD, and especially those with small vessel disease, typically manifest symptoms related to damage to the frontal-subcortical system of the brain, including loss of executive function (which is not generally detected with most conventional tests of cognitive function), loss of drive, and disinhibited behaviors.

Spatial-temporal current source correlations and cortical connectivity.

The purpose of this study was to explore spatial-temporal correlations between 3-dimensional current density estimates using Low Resolution Electromagnetic Tomography (LORETA). The electroencephalogram (EEG) was recorded from 19 scalp locations from 97 subjects. LORETA current density was computed for 2,394 gray matter pixels.