Successful removal of a Life-threatening PE using the INARI flow triever device.

The authors report a case of a 75-year-old male with pulmonary embolism (PE) successfully treated using the INARI FlowTriever System, a mechanical thrombectomy device. Imaging confirmed deep vein thrombosis and PE presented after two days of left lower extremity (LLE) pain and dyspnea on exertion with history of peripheral vascular disease, coronary artery disease, insulin dependent diabetes mellitus, hyperlipidemia and LLE percutaneous coronary intervention with coronary stent placement. PE treatment with single session clot burden reduction resulted in immediate improvement in oxygenation and echocardiogram confirmed relief of right heart strain. The patient's immediate hemodynamic improvement without thrombolytic therapy, which can take hours for morbidity reduction, supports the expansion of the use of thrombectomy devices for the treatment of submassive symptomatic PE in clinical practice, with further research indicated.

Successful removal of an acute deep vein thrombosis by the INARI ClotTriever system.

Pulmonary embolism is most feared sequela of a proximal deep vein thrombosis (DVT). Currently, first-line DVT treatment is anticoagulation to prevent post-thrombotic sequelae like pedal edema as well as a life threatening pulmonary embolism . Advanced therapy considerations for limb- or life-threatening DVT include catheter-directed thrombolysis and thrombectomy. Thrombectomy is necessary when thrombolytics are contraindicated secondary to increased bleeding risk. The authors present a DVT case treated with the mechanical thrombectomy device, ClotTriever (Inari Medical, Irvine, CA), resulting in the efficient and effective removal of thrombus with near-complete resolution of venous symptoms and prompt hospital discharge.

Specific HLA alleles, paired with TCR V- and J-gene segment usage, link to distinct multiple myeloma survival rates.

Multiple myeloma (MM) immunogenomics studies related to T-cell characterizations and involving large patient sets have been lacking, particularly in comparison to solid tumor types. Thus, we evaluated (i) HLA alleles, and (ii) T-Cell Receptor (TCR) V- and J-gene segment, HLA allele combinations, based on TCR recombinations in blood samples, for their potential associations with overall survival distinctions among an MM cohort. Two HLA alleles, and seven TCR V- or J-gene segment, HLA allele combinations were found to be associated with distinct overall survival rates. For examples, HLA-C*08:02, and the TRAV19, HLA-C*07:01 combination, were found to be associated with negative outcomes. In addition, anti-cytomegalovirus immune receptor sequences, from blood samples, were found to be associated with a positive outcome (p = 0.012, n = 278). These data, and other related immunogenomics data, indicate a potential opportunity to use personal immunogenetics parameters as guides to prognosis and therapies.

A Novel Association Between Loop Diuretic Therapy and Repigmentation in Two Patients With Vitiligo.

Two patients with longstanding vitiligo presented with repigmentation in sun-exposed areas as a previously unreported phenomenon coinciding with initiating loop diuretic therapy. Loop diuretics antagonize Na-K-Cl cotransporters and have been associated with a variety of cutaneous adverse effects, such as bullous pemphigoid and photosensitivity, but have yet to be cited as drugs associated with vitiligo repigmentation. This report explores the direct and indirect influence loop diuretics may have on inducing pigmentation changes.

Erythema multiforme as a consequence of COVID-19 infection.

Cutaneous manifestations of the 2019 coronavirus disease (COVID-19) are diverse and may be the only clinical evidence of infection, particularly in children [1]. The authors report a 10-year-old girl with erythematous vesicular papules and targetoid lesions of the extremities two weeks after polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus two (SARS-COV-2) infection. Biopsy depicted classic erythema multiforme (EM) and serology confirmed positive COVID-19 antibodies. This report demonstrates one of the first reported pediatric cases of typical clinical and histopathologic EM in relation to confirmed COVID-19.

TRBV and TRBJ usage, when paired with specific HLA alleles, associates with distinct head and neck cancer survival rates.

Common or dominant, T-cell receptor (TCR), V and J usage, in combination with particular human leukocyte antigen (HLA) alleles, has been associated with differing outcomes in viral infections, autoimmunity, and more recently, in cancer. Cervical cancer in particular represents the most dramatic series of distinctions of outcomes associated with differing combinations of dominant V or J usage and HLA alleles, possibly because of the strong association of cervical cancer with human papilloma virus (HPV), in turn leading to a likely molecular consistency in the mechanism of HPV antigen presentation. Thus, we considered assessing TRB V and J usage, HLA allele combinations, for their associations with survival rates and related data, in the cancer genome atlas head and neck cancer dataset. We obtained the TRB VDJ recombination reads from both the blood and tumor exome files and determined the V and J identities. We then established case ID (patient) subsets of V or J usage, HLA alleles, and determined, for example, that the TRBJ2-7, HLA-B*40:01 combination was associated with a better disease free survival rate than were either the TRBJ1-3, HLA-DPB1*03:01 or the TRBJ2-1, HLA-DPB1*02:01 combinations. Furthermore, these analyses led to the conclusion that TRBJ1-5 usage, and the HLA-C*08:02 and HLA-DRB1*03:01 alleles, had independent associations with distinct overall survival rates. In sum, the results suggest that dominant V or J usage, HLA allele combinations, and in certain cases, dominant V or J usage independently of HLA, could be useful in prognosis and in guiding immunotherapies.

Renal protection in chronic kidney disease: hypoxia-inducible factor activation vs. angiotensin II blockade.

The 5/6(th) nephrectomy or ablation/infarction (A/I) preparation has been used as a classic model of chronic kidney disease (CKD). We observed increased kidney oxygen consumption (Q(O2)) and altered renal hemodynamics in the A/I kidney that were normalized after combined angiotensin II (ANG II) blockade. Studies suggest hypoxia inducible factor as a protective influence in A/I. We induced hypoxia-inducible factor (HIF) and HIF target proteins by two different methods, cobalt chloride (CoCl(2)) and dimethyloxalyglycine (DMOG), for the first week after creation of A/I and compared the metabolic and renal hemodynamic outcomes to combined ANG II blockade. We also examined the HIF target proteins expressed by using Western blots and real-time PCR. Treatment with DMOG, CoCl(2), and ANG II blockade normalized kidney oxygen consumption factored by Na reabsorption and increased both renal blood flow and glomerular filtration rate. At 1 wk, CoCl(2) and DMOG increased kidney expression of HIF by Western blot. In the untreated A/I kidney, VEGF, heme oxygenase-1, and GLUT1 were all modestly increased. Both ANG II blockade and CoCl(2) therapy increased VEGF and GLUT1 but the cobalt markedly so. ANG II blockade decreased heme oxygenase-1 expression while CoCl(2) increased it. By real-time PCR, erythropoietin and GLUT1 were only increased by CoCl(2) therapy. Cell proliferation was modestly increased by ANG II blockade but markedly after cobalt therapy. Metabolic and hemodynamic abnormalities were corrected equally by ANG II blockade and HIF therapies. However, the molecular patterns differed significantly between ANG II blockade and cobalt therapy. HIF induction may prove to be protective in this model of CKD.

The arginine metabolite agmatine protects mitochondrial function and confers resistance to cellular apoptosis.

Agmatine, an endogenous metabolite of arginine, selectively suppresses growth in cells with high proliferative kinetics, such as transformed cells, through depletion of intracellular polyamine levels. In the present study, we depleted intracellular polyamine content with agmatine to determine if attrition by cell death contributes to the growth-suppressive effects. We did not observe an increase in necrosis, DNA fragmentation, or chromatin condensation in Ha-Ras-transformed NIH-3T3 cells administered agmatine. In response to Ca(2+)-induced oxidative stress in kidney mitochondrial preparations, agmatine demonstrated attributes of a free radical scavenger by protecting against the oxidation of sulfhydryl groups and decreasing hydrogen peroxide content. The functional outcome was a protective effect against Ca(2+)-induced mitochondrial swelling and mitochondrial membrane potential collapse. We also observed decreased expression of proapoptotic Bcl-2 family members and of execution caspase-3, implying antiapoptotic potential. Indeed, we found that apoptosis induced by camptothecin or 5-fluorourocil was attenuated in cells administered agmatine. Agmatine may offer an alternative to the ornithine decarboxylase inhibitor difluoromethyl ornithine for depletion of intracellular polyamine content while avoiding the complications of increasing polyamine import and reducing the intracellular free radical scavenger capacity of polyamines. Depletion of intracellular polyamine content with agmatine suppressed cell growth, yet its antioxidant capacity afforded protection from mitochondrial insult and resistance to cellular apoptosis. These results could explain the beneficial outcomes observed with agmatine in models of injury and disease.

Videoconferencing and Web-based conferencing to enhance learning communities.

Preparing nursing students to develop the leadership and management skills necessary to adapt to ever-changing practice environments is a challenge for educators. Videoconferencing and Web-based conferencing allow for expansion of traditional classroom walls to develop partnerships among peers, exchange perspectives, and gain a more global understanding of nursing care delivery systems. A collaborative leadership seminar using videoconferencing was used to connect two large colleges of nursing in the midwestern United States, and through Web-based conferencing, one of the midwestern colleges was connected to a university in the United Kingdom. Objectives for students were exposure to different schools of thought, management of care via technology, network and cultivation of global perspectives on health care delivery, and experience of novel educational approaches.

Low-income mothers' decisions regarding when and why to introduce solid foods to their infants: influencing factors.

Preventive measures for long-life illnesses such as asthma, obesity, and diabetes can start as early as in infant feeding practices. The American Academy of Pediatrics recommends introducing babies to solid foods, anything other than breast milk or formula, no earlier than 4-6 months of age (Kleinman, 2004). This study's purpose was to assess beliefs and attitudes of mothers enrolled in Medicaid about the introduction of solid foods and other infant feeding behaviors. Six focus groups (N = 23) were conducted with Black and Caucasian mothers with infants under 1 year old. The Theory of Planned Behavior was used as a framework for moderator questions and interpretation of themes. Maternal knowledge about infant feeding, maternal perceptions of applicability of infant feeding guidelines, and manner and type of information useful for infant feeding decisions emerged as themes. Implications of themes for informing an educational program for mothers to delay the introduction of solid foods are discussed.

"Eating-together" mealtimes with African-American fathers and their toddlers.

The prevalence of obesity is increasing at an alarming rate in African-American children. Fathers influence mealtime behaviors but are often overlooked in nutrition education. A sample of six African-American fathers of toddlers participated in a focus group to describe mealtime behaviors with their toddlers. The focus group was audiotaped and transcribed verbatim. Five thematic categories were identified: mealtime rituals and routines, division of responsibility, family constellation, nutritional knowledge, and tension during mealtimes. Fathers expressed frustration with the toddler's "picky-eater" developmental stage. Fathers need to be included in nutrition education that promotes healthy mealtime habits with their toddlers.

Classroom Interpreting and Visual Information Processing in Mainstream Education for Deaf Students: Live or Memorex?

This study examined visual information processing and learning in classrooms including both deaf and hearing students. Of particular interest were the effects on deaf students' learning of live (three-dimensional) versus video-recorded (two-dimensional) sign language interpreting and the visual attention strategies of more and less experienced deaf signers exposed to simultaneous, multiple sources of visual information. Results from three experiments consistently indicated no differences in learning between three-dimensional and two-dimensional presentations among hearing or deaf students. Analyses of students' allocation of visual attention and the influence of various demographic and experimental variables suggested considerable flexibility in deaf students' receptive communication skills. Nevertheless, the findings also revealed a robust advantage in learning in favor of hearing students.

A comparison of peritoneal equilibration tests performed 1 and 4 weeks after PD commencement.

OBJECTIVE: The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. DESIGN: Prospective observational study of an incident PD cohort at a single center. SETTING: Tertiary-care institutional dialysis center. PARTICIPANTS: The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 +/- 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. MAIN MEASUREMENTS: Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. RESULTS: When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 +/- 0.07 vs 0.94 +/- 0.07 respectively; p < 0.05), D/P creatinine (0.55 +/- 0.12 vs 0.66 +/- 0.11, p < 0.001), and D/D0 glucose (0.38 +/- 0.08 vs 0.36 +/- 0.10, p < 0.05). Using Bland-Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted kappa 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement (n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. CONCLUSIONS: Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.

Theory of dependent-care in research with parents of toddlers: the NEAT project.

This paper contains a description of the use of the theory of dependent-care in the Nutrition Aimed at Toddlers project, a nursing intervention study with parents of toddlers, and discusses the research and practice utility of the theory of dependent-care, a corollary theory to Orem's self-care theory. In particular, the concepts of dependent-care, dependent-care agency, therapeutic self-care demand and an educative-supportive nursing system are discussed within the context of the Nutrition Aimed at Toddlers project.

Educating nursing students with disabilities: one nurse educator's journey from questions to clarity.

Nurse educators are increasingly facing accommodation of students with disabilities in their nursing curricula, and questions regarding issues of fairness to all students and patient safety often rise. Several schools and state boards of nursing have turned to writing lists of essential functions of nursing to provide a framework. Before the list is written, educators need to examine their own thoughts on the definition of nursing and the abilities essential to functioning as a nurse.

Increases in peritoneal small solute transport in the first month of peritoneal dialysis predict technique survival.

BACKGROUND: Peritoneal transport of small solutes generally increases during the first month of peritoneal dialysis (PD). The aim of this study was to prospectively evaluate the ability of the peritoneal equilibration test (PET), carried out 1 and 4 weeks after the commencement of PD, to predict subsequent technique survival. METHODS: Fifty consecutive patients commencing PD at the Princess Alexandra Hospital between 1 February 2001 and 31 May 2003 participated in the study. Paired 1 week and 1 month PET data were collated and correlated with subsequent technique survival. RESULTS: A significant increase was observed in the dialysate : plasma creatinine ratio at 4 h (D/P Cr) between 1 and 4 weeks after the onset of PD (0.55 +/- 0.12 vs 0.66 +/- 0.11, P <0.001). Mean death-censored technique survival was superior in patients who experienced > or =20% rise in D/P Cr during the first month of PD compared with those who did not (2.3 +/- 0.2 vs 1.6 +/- 0.2 years, P <0.05). Using a multivariate Cox proportional hazards model analysis, the significant independent predictors of death-censored technique survival were an increase in D/P Cr of greater than 20% during the first month (adjusted hazard ratio [HR] 0.20, 95% CI 0.05-0.75), the absence of diabetes mellitus, the absence of ischaemic heart disease, body mass index and baseline peritoneal creatinine clearance. CONCLUSIONS: A 20% or greater rise in D/P Cr during the first month of commencing PD is independently predictive of PD technique survival. Further investigations of the mechanisms underlying this phenomenon are warranted.