In patients receiving invasive ventilation, PPIs reduce upper GI bleeding but did not affect mortality at 90 d.

Cook D, Deane A, Lauzier F, et al; REVISE Investigators. N Engl J Med. 2024;391:9-20.

Hepatitis C Virus Antiviral Drug Resistance and Salvage Therapy Outcomes Across Australia.

Background: Hepatitis C virus (HCV) infection can now be cured with well-tolerated direct-acting antiviral (DAA) therapy. However, a potential barrier to HCV elimination is the emergence of resistance-associated substitutions (RASs) that reduce the efficacy of antiviral drugs, but real-world studies assessing the clinical impact of RASs are limited. Here, an analysis of the impact of RASs on retreatment outcomes for different salvage regimens in patients nationally who failed first-line DAA therapy is reported.

In drug-refractory IBS, group CBT with interoceptive exposure improved symptoms and QoL at 13 wk.

Kikuchi S, Oe Y, Ito Y, et al. Am J Gastroenterol. 2022;117:668-77.

Building psychosocial capacity through training of front-line health professionals to provide brief therapy: lessons learned from the PROMPT study.

Purpose: This report describes the views of front-line health professionals who participated in a randomised controlled trial examining a model of care in which depressed cancer patients received a brief psychosocial intervention. Health professionals from four cancer centres received focused training, skill development and clinical supervision in order to deliver the intervention.

Methods: We interviewed 20 health professionals asking them about their perceptions of participation in the study and their views about more widespread implementation of this model of care.

Reamed locked intramedullary nailing for studying femur fracture and its complications.

Morbidity associated with femur fractures in polytrauma patients is known to be high. The many unsolved clinical questions include the immunological effect of the fracture and its fixation, timing of fracture fixation, management of fracture non-union, effect of infection and critical size of bone defects. The aim of this study was to establish a clinically-relevant and reproducible animal model with regards to histological, biomechanical and radiological changes during bone healing.

A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial).

Purpose: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care.

Methods: Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater.

A randomised trial of hypertonic saline during hospitalisation for exacerbation of cystic fibrosis.

Background: The mucoactive effects of hypertonic saline should promote exacerbation resolution in people with cystic fibrosis (CF).

Objectives: To determine the effects of hypertonic saline inhalation during hospitalisation for exacerbation of CF on length of stay, lung function, symptoms, oxygenation, exercise tolerance, quality of life, bacterial load and time to next hospitalisation.

Methods: 132 adults with an exacerbation of CF were randomised to inhale three nebulised doses a day of either 4 mL 7% saline or a taste-masked control of 0.

The interpretation of intra-abdominal pressures from animal models: the rabbit to human example.

Introduction: The importance of the abdominal wall characteristics in intraabdominal pressure (IAP), intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are poorly understood. The applicability of laboratory research findings to human scenarios is unknown due to the potential differences in abdominal wall elastance (AWE) amongst species. The aims of the study are to describe the AWE curve in rabbits and to compare it to the available human data.

Hubert Ingham Clements: a pioneer of Australian anaesthesia.

Hubert Ingham Clements was an inventor, designer and engineer who manufactured many pieces of apparatus for use in the scientific and medical practice, particularly in the field of anaesthesia from 1917 when he designed and manufactured suction pumps and anaesthetic machines. His products were ingenious, light and portable where desirable, but sturdy, extraordinarily reliable, of low maintenance and high performance. His contribution to the specialty of anaesthesia is acknowledged.

Intracrine control of estrogen action in human gestational tissues at parturition.

Objective: We examined whether estrogen action in human parturition is regulated by an intracrine mechanism mediated by target tissue expression of specific 17beta-hydroxysteroid dehydrogenase (17betaHSD) isozymes that interconvert estrone (E1) and estradiol (E2), such that the onset of labor is associated with an increase in local E2 bioavailability.

Methods: The extent of 17betaHSD-1, -2, -3, -4, -5, and -7 expression (measured by quantitative reverse transcriptase polymerase chain reaction) and the capacity to interconvert E1 and E2 were compared in amnion, chorion, placenta, decidua, and myometrium obtained from women at term before (n = 6) and after (n = 6) the onset of labor.

Results: In chorion, abundance of 17betaHSD-1 (converts E1 to E2) mRNA decreased 2.

Myometrial progesterone responsiveness and the control of human parturition.

Objective: The goal of this review is to assess the body of literature addressing the mechanism of progesterone withdrawal in the control of human parturition and in particular the recent advances in testing the hypothesis that human parturition is initiated by decreased myometrial responsiveness to progesterone, ie, functional progesterone withdrawal.

Methods: Published studies of progesterone responsiveness of the pregnant human myometrium in the context of parturition control were reviewed.

Results: Advances in understanding the molecular basis for progesterone receptor (PR)-mediated control of progesterone responsiveness has led to the hypothesis that functional progesterone withdrawal in human parturition is mediated by specific changes in myometrial PR expression, function, or both.

Prostaglandins differentially modulate progesterone receptor-A and -B expression in human myometrial cells: evidence for prostaglandin-induced functional progesterone withdrawal.

We tested the hypothesis that prostaglandin (PGs), PGE2, and PGF2 alpha, stimulate labor and delivery in women, in part, by inducing functional progesterone withdrawal in myometrial cells by increasing the progesterone receptor (PR)-A/PR-B expression ration. PHM1-31 cells (an immortal pregnant human myometrial cell line) were exposed to PGE2, PGF2 alpha, cyclic-8-bromoadenosine monophosphate (8-Br-cAMP) and phorbol 12-myristate 13-acetate (PMA) at various concentrations for 24h. Effects on PR-A and PR-B expression were then assessed by quantitative RT-PCR.

Island flap perineoplasty decreases the incidence of wound breakdown following overlapping anterior sphincter repair.

Objective: Overlapping anterior sphincter repair is the accepted treatment for faecal incontinence resulting from sphincter disruption, however, wound breakdown has been reported to occur in up to 30% of patients. The aim of this study was to assess whether the type of wound closure affected the incidence of wound breakdown, and in particular whether island flap perineoplasty decreased this incidence.

Methods: An historical control study was performed evaluating wound outcomes in patients undergoing different methods of wound closure after sphincter repair.

Simple chamber for temperature-controlled planar chromatography.

This article describes a construction of a simple developing device designed for temperature control of thin-layer chromatographic plates. The plates can be developed by the ascending technique under temperature gradient or non-gradient conditions. Saturated or unsaturated chamber conditions can be easily selected.

Prediction of preterm delivery using plasma corticotrophin-releasing hormone and other biochemical variables.

Preterm delivery is responsible for the vast majority of neonatal mortality in developed countries and is also associated with substantial long-term morbidity. The incidence of preterm birth remains between 6-10% despite many advances in our understanding of the physiology of human parturition. Biochemical markers have been used in an attempt to identify more accurately those women, amongst high and low-risk groups who will deliver preterm, from their counterparts who will go on to deliver at term.

Island flap perineoplasty for coverage of perineal skin defects after repair of cloacal deformity.

Background: Traumatic cloacal defect is an injury sustained during childbirth in which the anovaginal septum is completely disrupted and the anus and vagina open as a common channel. Such injuries result in complete faecal incontinence and are difficult to repair both in terms of improving function and obtaining skin closure.

Methods: Four cases of traumatic cloacal defect with a delayed presentation are illustrated here.