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Cambridge, United States

Simone M.J.,Mount Auburn Hospital | Simone M.J.,Harvard University | Tan Z.S.,Harvard University | Tan Z.S.,Brigham and Womens Hospital
CNS Neuroscience and Therapeutics

Aims: To review recent evidence that suggests inflammation plays a similar role in the pathogenesis of delirium and dementia. Methods: We performed a literature search of original research and review articles in PubMed using the keywords: delirium, dementia, and inflammation. We summarized the evidence linking inflammation to the pathogenesis of delirium and dementia. Discussion: Delirium and dementia share similarities in clinical and pathogenic features, leading to the speculation that instead of being distinct clinical entities, the two age-related conditions may be linked by a common pathogenic mechanism. Inflammatory markers have been shown to be elevated in both delirium and dementia, thereby implicating inflammation as a possible mediating factor in their genesis. There is evidence in both basic science and clinical research literature that elevated cytokines play a crucial role in the development of cognitive dysfunction observed in both dementia and delirium. Conclusion: Mounting evidence supports the role of inflammation in the development of both dementia and delirium. Further studies are needed to elucidate the mechanisms underlying these relationships. © 2010 Blackwell Publishing Ltd. Source

Williams M.E.,Beth Israel Deaconess Medical Center | Sandeep J.,Mount Auburn Hospital | Catic A.,Beth Israel Deaconess Medical Center
Seminars in Dialysis

The disproportionate increase in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the elderly is now recognized as a national and global reality. Among the major contributing factors are the aging of the population, a growing prevalence of CKD, greater access to care, and increased comorbidities. The utilization of renal replacement therapy in the geriatric population has concomitantly increased. It is imposing enormous challenges to the practice of ESRD care, the largest of which may be to determine the best application of clinical performance targets to a population with limitations in life expectancy. Concurrently, increased focus on quality of life will be required. The effective dialysis practitioner will need to adapt to the aging ESRD demographics with an increased focus on physical and mental well-being of the geriatric patient. © 2012 Wiley Periodicals, Inc. Source

Mackenzie M.W.,Mount Auburn Hospital
Journal of Minimally Invasive Gynecology

Reliable knot tying is a cornerstone of surgical technique, and the square knot and surgeon's knot constitute the greatest part of most surgeons' knot-tying skills. Traditionally, laparoscopic intracorporeal knot tying of a square knot or surgeon's knot is a direct translation from an open instrument tying technique. Given the technical and mechanical challenges imposed by standard laparoscopic instrumentation, performance of such a basic task is sometimes difficult and elusive, even for accomplished surgeons. Consequently, myriad technologies and techniques are used as work-arounds for this basic surgical task. However, the sometimes necessary tying of a snug and reliable intracorporeal knot is unavoidable. That laparoscopic intracorporeal knot tying must be translated from a 2-handed open surgical technique using flat knots deserves reassessment. Cinch knots, with unusual sliding and tightening properties, are currently used in surgery. With apparent complexity and exacting construction requirements, however, primary intracorporeal knot tying has not been described. Described herein is a technique for doing so. Also included is a review of cinch knot mechanics, an understanding of a fundamental scheme for their construction, and basic instrument maneuvers that enable easier intracorporeal tying of a most reliable knot, useful for multiport and, in particular, single-port laparoscopic knot tying. © 2012 AAGL. Source

Leder K.,Monash University | Leder K.,Royal Melbourne Hospital | Chen L.H.,Mount Auburn Hospital | Chen L.H.,Harvard University | Wilson M.E.,Harvard University

Vaccine recommendations for travellers are based on individual risk assessments of multiple factors, most importantly the destination and duration of the impending trip. Many people undertake frequent trips, but existing WHO, CDC and national advisory board recommendations do not explicitly consider cumulative travel-associated risks. Given the period of protection provided by many vaccines, in particular rabies, hepatitis A, hepatitis B and yellow fever vaccines, an aggregate multi-trip risk assessment which views vaccines as an investment for future travel health may be more appropriate than separately evaluating the risks for each trip. © 2012 Elsevier Ltd. Source

Nickell L.T.,Baylor University | Lichtenberger J.P.,U.S. Air force | Khorashadi L.,Mount Auburn Hospital | Abbott G.F.,Massachusetts General Hospital | Carter B.W.,University of Houston

Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9–17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease. © RSNA, 2014. Source

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