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Conrad S.A.,Louisiana State University Health Sciences Center | Grier L.R.,Louisiana State University Health Sciences Center | Scott L.K.,Wake forest University | Green R.,Louisiana State University Health Sciences Center | Jordan M.,University Health
Critical Care Medicine | Year: 2015

Objective: Extracorporeal membrane oxygenation provides support for patients with severe acute cardiopulmonary failure, allowing the application of lung or myocardial rest in anticipation of organ recovery, or as a bridge to long-term support. Advances in technology have improved the safety and ease of application of extracorporeal membrane oxygenation. Percutaneous cannulation is one of these advances and is now preferred over surgical cannulation in most cases. Percutaneous cannulation is increasingly performed by intensivists, cardiologists, interventional radiologists, and related specialties. The objective of this study is to review the experience of percutaneous cannulation by intensivists at a single institution. Design: A retrospective review of 100 subjects undergoing percutaneous cannulation for extracorporeal membrane oxygenation. Setting: Adult ICUs and PICUs at a tertiary academic medical institution. Patients: Critically ill neonatal, pediatric, and adult subjects with severe respiratory and/or cardiac failure undergoing percutaneous cannulation for extracorporeal membrane oxygenation. Modes of support included venoarterial, venovenous, venovenoarterial, and arteriovenous. Interventions Percutaneous extracorporeal membrane oxygenation. Measurements and Main Results: Case reports submitted to the Extracorporeal Life Support Organization and hospital records of the subjects were retrospectively reviewed. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. One hundred ninety cannulations with cannula sizes from size 12 to 31F were performed by four intensivists in 100 subjects. Twenty-three were arterial (12-16F) and 167 were venous (12-31F). Preinsertion ultrasound was performed in 93 subjects (93%), fluoroscopic guidance in 79 subjects (85% of nonarteriovenous subjects), and ultrasound-guided insertion was performed in 65 subjects (65%). Two major complications occurred, each associated with mortality. Cannulation was successful in all other subjects (98% of subjects and 99% of cannulations). There were no cases of cannula-related bloodstream infection. Conclusions: Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists can be performed with a high rate of success and a low rate of complications when accompanied by imaging support. © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

Tschudi-Madsen H.,University of Oslo | Kjeldsberg M.,University of Oslo | Natvig B.,University of Oslo | Natvig B.,National Resource Center for Rehabilitation in Rheumatology | And 6 more authors.
BMC Musculoskeletal Disorders | Year: 2011

Background: There is a lack of knowledge about the pattern of symptom reporting in the general population as most research focuses on specific diseases or symptoms. The number of musculoskeletal pain sites is a strong predictor for disability pensioning and, hence, is considered to be an important dimension in symptom reporting. The simple method of counting symptoms might also be applicable to non-musculoskeletal symptoms, rendering further dimensions in describing individual and public health. In a general population, we aimed to explore the association between self-reported non-musculoskeletal symptoms and the number of pain sites. Methods. With a cross-sectional design, the Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record pain at ten different body sites and 13 non-musculoskeletal symptoms, respectively, among seven age groups in Ullensaker, Norway (n = 3,227). Results: Results showed a strong, almost linear relationship between the number of non-musculoskeletal symptoms and the number of pain sites (r = 0.55). The number and type of non-musculoskeletal symptoms had an almost equal explanatory power in the number of pain sites reported (27.1% vs. 28.2%). Conclusion: The linear association between the number of non-musculoskeletal and musculoskeletal symptoms might indicate that the symptoms share common characteristics and even common underlying causal factors. The total burden of symptoms as determined by the number of symptoms reported might be an interesting generic indicator of health and well-being, as well as present and future functioning. Research on symptom reporting might also be an alternative pathway to describe and, possibly, understand the medically unexplained multisymptom conditions. © 2011 Tschudi-Madsen et al; licensee BioMed Central Ltd.

Thom D.H.,University of California at San Francisco | Rortveit G.,University of Bergen | Rortveit G.,University Health
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

Objective. To investigate the prevalence of urinary incontinence within the first year postpartum. Design. A systematic review of population-based studies. Population. General female populations up to 1 year postpartum. Methods. Studies on incontinence in population-based sample defined as from one or more district hospitals or from multiple clinics covering a defined geographic area. Studies of women from a single outpatient clinic or who were referred for care (e.g. for being high risk) were excluded. In addition, studies had to have a sample size of over 100 participants and a response rate 50% or over. Main outcome measures. Prevalence from individual studies as well as mean prevalence is given. Pooled prevalence is estimated for nonheterogenous studies. Results. During the first 3 months postpartum, the pooled prevalence of any postpartum incontinence was 33% (95% confidence interval (CI) 32-36%) in all women. The mean prevalence of weekly and daily incontinence was 12% (95% CI 11-13%) and 3% (95% CI 3-4%), respectively. The mean prevalence was double in the vaginal delivery group (31%, 95% CI 30-33%) compared to the cesarean section group (15%, 95% CI 11-18%). Longitudinal studies within the first year postpartum showed small changes in prevalence over time. Conclusions. The prevalence of postpartum incontinence was high. Prevalence was substantially less for more frequent incontinence. Urinary incontinence after cesarean section was half the prevalence after vaginal delivery. © 2010 Informa Healthcare.

News Article | August 16, 2016
Site: www.cemag.us

Researchers from Polytechnique Montréal, Université de Montréal, and McGill University have just achieved a spectacular breakthrough in cancer research. They have developed new nanorobotic agents capable of navigating through the bloodstream to administer a drug with precision by specifically targeting the active cancerous cells of tumors. This way of injecting medication ensures the optimal targeting of a tumor and avoids jeopardizing the integrity of organs and surrounding healthy tissues. As a result, the drug dosage that is highly toxic for the human organism could be significantly reduced. This scientific breakthrough has just been published in the prestigious journal Nature Nanotechnology in an article titled “Magneto-aerotactic bacteria deliver drug-containing nanoliposomes to tumor hypoxic regions.” The article notes the results of the research done on mice, which were successfully administered nanorobotic agents into colorectal tumors. “These legions of nanorobotic agents were actually composed of more than 100 million flagellated bacteria — and therefore self-propelled — and loaded with drugs that moved by taking the most direct path between the drug’s injection point and the area of the body to cure,” explains Professor Sylvain Martel, holder of the Canada Research Chair in Medical Nanorobotics and Director of the Polytechnique Montréal Nanorobotics Laboratory, who heads the research team’s work. “The drug’s propelling force was enough to travel efficiently and enter deep inside the tumors.” When they enter a tumor, the nanorobotic agents can detect in a wholly autonomous fashion the oxygen-depleted tumor areas, known as hypoxic zones, and deliver the drug to them. This hypoxic zone is created by the substantial consumption of oxygen by rapidly proliferative tumor cells. Hypoxic zones are known to be resistant to most therapies, including radiotherapy. But gaining access to tumors by taking paths as minute as a red blood cell and crossing complex physiological micro-environments does not come without challenges. So Professor Martel and his team used nanotechnology to do it. To move around, bacteria used by Martel’s team rely on two natural systems. A kind of compass created by the synthesis of a chain of magnetic nanoparticles allows them to move in the direction of a magnetic field, while a sensor measuring oxygen concentration enables them to reach and remain in the tumor’s active regions. By harnessing these two transportation systems and by exposing the bacteria to a computer-controlled magnetic field, researchers showed that these bacteria could perfectly replicate artificial nanorobots of the future designed for this kind of task. “This innovative use of nanotransporters will have an impact not only on creating more advanced engineering concepts and original intervention methods, but it also throws the door wide open to the synthesis of new vehicles for therapeutic, imaging and diagnostic agents,” Martel adds. “Chemotherapy, which is so toxic for the entire human body, could make use of these natural nanorobots to move drugs directly to the targeted area, eliminating the harmful side effects while also boosting its therapeutic effectiveness.” The work by Professor Martel obtained the very valuable support of the Consortium québécois sur la découverte du médicament (Québec consortium for drug discovery — CQDM), the Canada Research Chairs, the Natural Sciences and Engineering Research Council of Canada (NSERC), the Research Chair in Nanorobotics of Polytechnique Montréal, Mitacs, the Canada Foundation for Innovation (CFI), and the National Institutes of Health (NIH). Montréal’s Jewish General Hospital, the McGill University Health Centre (MUHC), the Institute for Research in Immunology and Cancer (IRIC), and the Rosalind and Morris Goodman Cancer Research Centre also took part in this promising research work.

Small extra-cellular vesicles called exosomes (indicated by the red arrows) being released by the Leishmaniasis parasite. Credit: Dr. Martin Olivier, Research Institute of the McGill University Health Centre A team of international scientists led by Dr. Martin Olivier from the Research Institute of the McGill University Health Centre (RI-MUHC) uncovered an important mechanism behind Leishmania, a deadly parasitic disease transmitted by sandflies that affects over 12 million people worldwide, and with more than 1.3 million new cases reported every year. In a new study published today on the website Cell Reports, researchers described how key molecules known as exosomes, boost the process by which the Leishmania parasite infects humans and other mammals. These findings could lead to the development of new potential vaccine targets and diagnostic tools for Leishmania and other parasitic diseases. "Our study reports the first observation that a pathogen within its insect vector can release extracellular vesicles or exosomes that are an integral part of the parasite's infectious life cycle,'' says study's lead author Dr. Olivier, researcher from the Infectious Diseases and Immunity in Global Health Program of the RI-MUHC and a full professor of Medicine at McGill University. "This means that any bacteria and parasites transmitted via insect blood meals could use a similar strategy to extend their successful infection.'' Exosomes are small cell-derived vesicles that are present in many biological fluids, including blood, urine, saliva, etc. They have been the focus of numerous studies due to their involvement in communication between cells, especially immune and tumour cells. Despite the abundant knowledge obtained through studies using exosomes within in vitro experiments, Dr. Olivier's team, with colleagues from the National Institutes of Health, is the first to describe, step-by-step, their formation and release in a living organism in relation to a specific infectious agent. "By using electron microscopy and proteomic analysis, we discovered that the parasite was releasing exosomes within the gut of the female sandflies,'' explains study's first author Dr. Vanessa Diniz Atayde, who is a research associate in Dr. Olivier's laboratory. "As the insect took a blood meal from its host, both exosomes and Leishmania were transmitted.'' "We also found that by injecting the parasite with its exosomes in mice models, we were enhancing the pathogenicity of the parasite," adds Dr. Olivier. "The inflammatory response, usually caused by an infection, and the number of parasites were increased.'' Leishmania is found in parts of the tropics, subtropics, and southern Europe and is transmitted through the bite of female phlebotomine sandflies. The parasites are injected in the skin and are ingested by immunity cells called macrophages, where they block their immune function and multiply, forming skin lesion and spreading to other tissues in the body depending on Leishmania species involved. This infectious disease can occur in cutaneous forms, which are generally curable, as well as in a more dangerous - and potentially fatal - visceral form. The World Health Organization estimates that 20,000 to 30,000 deaths are caused annually by Leishmania worldwide. In North America, Leishmania is indigenous to México and Texas, but has begun to expand its range northward. Further expansion to the north may be facilitated by climate change as more habitat becomes suitable for insect vectors and reservoir species for the disease. "These findings could open the door to the development of new vaccines targeting the exosome components by neutralizing its ability to boost infection, ''says Dr. Olivier. "Another interesting aspect of this study is that by studying the exosomes of other biting insects that suck blood, such as mosquitoes or black flies, we could develop anti-allergic therapy to tone-down developed skin inflammation in certain persons upon an insect bite. ''

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