Sedation in the Ambulatory Endoscopy Center: Optimizing Safety, Expectations and Throughput.

In the United States, sedation and analgesia are the standard of practice when endoscopic procedures are performed in the ambulatory endoscopy center. Over the last 30 years, there has been a dramatic shift of endoscopic procedures from the hospital outpatient department to ambulatory endoscopy centers. This article will discuss sedation and analgesia in the ambulatory endoscopy center as it relates to optimizing safety, patient expectations, and efficiency.

The western-type diet induces anti-HMGB1 autoimmunity in Apoe(-/-) mice.

Background And Aims: Anti-HMGB1 autoimmunity plays a role in systemic lupus erythematosus (SLE). Because SLE increases atherosclerosis, we asked whether the same autoimmunity might play a role in atherogenesis.

Methods: We looked for the induction of HMGB1-specific B and T cell responses by a western-type diet (WTD) in the Apoe(-/-) mouse model of atherosclerosis.

Cerebral Aneurysm Size before and after Rupture: Case Series and Literature Review.

Background: The conclusions of the International Study of Unruptured Intracranial Aneurysms (ISUIA) demonstrating that anterior circulation aneurysms less than 7 mm in maximal diameter have a 0% risk of rupture continue to be widely cited despite discordance with the anecdotal observation that the majority of ruptured cerebral aneurysms are less than 7 mm. The leading hypothesis to reconcile this discrepancy is that cerebral aneurysms shrink after rupture. Our case series of 6 subjects adds to the scarce published literature that addresses our limited understanding of aneurysm size before and after rupture.

Accuracy of Intravenous Electrocardiography Confirmation of Peripherally Inserted Central Catheter for Parenteral Nutrition.

Background: Parenteral nutrition (PN) is a life-saving therapy for patients with intestinal failure. Safe delivery of hyperosmotic solution requires a central venous catheter (CVC) with tip in the lower superior vena cava (SVC) or at the SVC-right atrium (RA) junction. To reduce cost and delay in use of CVC, new techniques such as intravascular electrocardiogram (ECG) are being used for tip confirmation in place of chest x-ray (CXR).

Visual Diagnosis: A 7-Month-Old Girl With Cyanotic Spells.

Infants can develop acquired methemoglobinemia due to intake of well water high in nitrate concentrations. Although methemoglobinemia usually presents with more severe symptoms, this diagnosis should be considered in an infant with intermittent cyanosis in the absence of underlying heart or lung disease. Well water should be avoided in infancy unless properly tested.

Prevention of Subsequent Catheter-Related Bloodstream Infection Using Catheter Locks in High-Risk Patients Receiving Home Parenteral Nutrition.

Introduction: Catheter-related bloodstream infection (CRBSI) is a serious complication in patients receiving home parenteral nutrition (HPN). Antibiotic lock therapy (ALT) and ethanol lock therapy (ELT) can be used to prevent CRBSI episodes in high-risk patients.

Methods: Following institutional review board approval, all patients enrolled in the Mayo Clinic HPN program from January 1, 2006, to December 31, 2013, with catheter locking were eligible to be included.

Incidental Chylous Ascites at the Time of Cesarean Section.

Chylous ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections, and trauma. It is rarely reported in pregnancy. We report a case of chylous ascites noted at the time of cesarean section performed at 35 weeks of gestation on a patient with preeclampsia and suspected placental abruption.

Coalition for a Healthier Community: Lessons learned and implications for future work.

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls.

Current Molecularly Targeting Therapies in NSCLC and Melanoma.

Surgery, radiation therapy, and chemotherapy are the traditional options to control tumor progression. However, these strategies are fraught with harmful side effects and are ineffective in metastatic and advanced cancers. Biomarkers that are overexpressed in cancers and are involved in cell growth, proliferation, migration, and survival have recently become the focus of new molecular targeting therapies.

A rare case of splenic marginal zone B-cell lymphoma mimicking relapsing polychondritis of the ear.

Relapsing polychondritis (RPC) is a poorly understood phenomenon associated with cartilaginous inflammation of the ear, nose, tracheobronchial tree, and peripheral joints. Many cases of RPC respond to anti-inflammatories and resolve with no further complications. However, RPC has also been linked to more insidious conditions such as malignancies, autoimmune disorders, vasculitis, or underlying infections.

Surgical competency for urethrovesical anastomosis during robot-assisted radical prostatectomy: development and validation of the robotic anastomosis competency evaluation.

Objective: To develop and validate an assessment tool for the performance of urethrovesical anastomosis (UVA).

Methods: A multicenter, prospective, observational study was conducted in 2 phases. Phase 1, development and content validation, used a panel of 5 experienced robotic surgeons to develop a 6-domain scoring system, Robotic Anastomosis Competence Evaluation (RACE), to assess technical skills for performing UVA.

Family and partner interpersonal violence among American Indians/Alaska Natives.

Family and partner interpersonal violence are common among American Indian/Alaska Native (AI/AN) populations. AI/AN women have the second highest prevalence of violence against women among all racial/ethnic groups in the United States, and child abuse prevalence rates in AI/AN populations are among the highest. Elder abuse in AI/AN is also an important concern, although data on this are sparse.

Evaluation of a multivalent vaccine against lymphatic filariasis in rhesus macaque model.

Lymphatic filariasis affects 120 million people worldwide and another 1.2 billion people are at risk of acquiring the infection. Chemotherapy with mass drug administration is substantially reducing the incidence of the infection.

Diagnosis and management of subclinical hypothyroidism in pregnancy.

In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism, and the results were mixed.

Assessment of postpartum depressive symptoms: the importance of somatic symptoms and irritability.

Assessing postpartum depressive symptoms is complicated by the fact that irritability, fatigue, insomnia, and appetite disruptions are also related to normative aspects of the childbearing process. We used multigroup confirmatory factor analysis to compare symptoms in 271 postpartum women with those of 820 non-postpartum women. We found that (a) irritability, insomnia, fatigue, and appetite loss were substantially associated with depressed mood among postpartum women whereas increased appetite was not; (b) irritability, insomnia, fatigue, and appetite changes were as strongly related to depression among postpartum women as they were among non-postpartum women; and (c) after controlling for overall depressed mood, postpartum women reported more irritability, insomnia, and appetite loss than the non-postpartum women.

Oligonucleotides and G-quadruplex stabilizers: targeting telomeres and telomerase in cancer therapy.

Cancer is a leading cause of death worldwide and an estimated 1 in 4 deaths in the United States is due to cancer. Despite recent advances in cancer treatment, adverse effects related to cancer therapy remain a limiting factor for many patients. The ideal cancer treatment would selectively target cancerous cells while sparing normal, healthy cells to offer maximal therapeutic benefit while minimizing toxicity.

Cutting edge: Dexamethasone potentiates the responses of both regulatory T cells and B-1 cells to antigen immunization in the ApoE(-/-) mouse model of atherosclerosis.

The immunosuppressant dexamethasone was shown to preferentially deplete CD4+ effector T cells while sparing regulatory T cells (Tregs) in vivo. In the current study, we show that it also preferentially depletes B-2 cells while sparing B-1 cells. In the ApoE(-/-) mouse model of atherosclerosis, in which both Tregs and B-1 cells are thought to play an atheroprotective role, we show that HSP60-targeted immunization in the presence of dexamethasone raises Ag-reactive Tregs and B-1 cells concomitantly and reduces the severity of atherosclerosis.

T-oligo as an anticancer agent in colorectal cancer.

In the United States, there will be an estimated 96,830 new cases of colorectal cancer (CRC) and 50,310 deaths in 2014. CRC is often detected at late stages of the disease, at which point there is no effective chemotherapy. Thus, there is an urgent need for effective novel therapies that have minimal effects on normal cells.

Heart smart for women: a community-based lifestyle change intervention to reduce cardiovascular risk in rural women.

Purpose: Cardiovascular disease (CVD) is the leading cause of death for rural women in the United States. Lifestyle change interventions in group settings focused on increasing physical activity and improving nutrition have been shown to help reduce the risk for CVD. This paper describes the implementation and evaluation of Heart Smart for Women (HSFW), a 12-week lifestyle behavior change intervention to reduce CVD risk for women in the rural southernmost 7 counties (S7) of Illinois.

Health information preferences among Hispanic/Latino immigrants in the U.S. rural Midwest.

We investigated whether length of residence and other socio-demographic factors affect how rural Hispanic/Latino immigrants in the U.S. prefer to receive general health information.

Lifestyle intervention and cardiovascular disease risk reduction in low-income Hispanic immigrant women participating in the Illinois WISEWOMAN program.

Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP.

Novel delivery system for T-oligo using a nanocomplex formed with an alpha helical peptide for melanoma therapy.

Oligonucleotides homologous to 3'-telomere overhang (T-oligos) trigger inherent telomere-based DNA damage responses mediated by p53 and/or ATM and induce senescence or apoptosis in various cancerous cells. However, T-oligo has limited stability in vivo due to serum and intracellular nucleases. To develop T-oligo as an innovative, effective therapeutic drug and to understand its mechanism of action, we investigated the antitumor effects of T-oligo or T-oligo complexed with a novel cationic alpha helical peptide, PVBLG-8 (PVBLG), in a p53 null melanoma cell line both in vitro and in vivo.