MUSICAL TIMESPub Date : 2019-11-01Epub Date: 2019-09-16DOI: 10.1017/ice.2019.236
Ying P Tabak, Arjun Srinivasan, Kalvin C Yu, Stephen G Kurtz, Vikas Gupta, Steven Gelone, Patrick J Scoble, L Clifford McDonald
{"title":"Hospital-level high-risk antibiotic use in relation to hospital-associated <i>Clostridioides difficile</i> infections: Retrospective analysis of 2016-2017 data from US hospitals.","authors":"Ying P Tabak, Arjun Srinivasan, Kalvin C Yu, Stephen G Kurtz, Vikas Gupta, Steven Gelone, Patrick J Scoble, L Clifford McDonald","doi":"10.1017/ice.2019.236","DOIUrl":"10.1017/ice.2019.236","url":null,"abstract":"<p><strong>Objective: </strong>Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).</p><p><strong>Methods: </strong>We analyzed 2016-2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides. A CDI case was a positive stool C. difficile toxin or molecular assay result from a patient without a positive result in the previous 8 weeks. Hospital-associated (HA) CDI cases included specimens collected >3 calendar days after admission or ≤3 calendar days from a patient with a prior same-hospital discharge within 28 days. We used the multivariable Poisson regression model to estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, controlling for confounders.</p><p><strong>Results: </strong>The median days of therapy for high-risk antibiotic use was 241.2 (interquartile range [IQR], 192.6-295.2) per 1,000 days present; the overall HA CDI rate was 33 (IQR, 24-43) per 10,000 admissions. The overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), and higher correlation was observed in teaching hospitals (0.38; P = .002). For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04-1.21; P = .002) after adjusting for confounders.</p><p><strong>Conclusions: </strong>High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"141 1","pages":"1229-1235"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90645728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MUSICAL TIMESPub Date : 2019-09-01DOI: 10.1177/1352458519856847
Rachel Brandstadter, Ilana Katz Sand, James F Sumowski
{"title":"Beyond rehabilitation: A prevention model of reserve and brain maintenance in multiple sclerosis.","authors":"Rachel Brandstadter, Ilana Katz Sand, James F Sumowski","doi":"10.1177/1352458519856847","DOIUrl":"10.1177/1352458519856847","url":null,"abstract":"<p><p>Persons with multiple sclerosis (MS) experience cognitive and physical decline despite more effective disease-modifying therapies (DMTs), and symptomatic treatments currently have limited efficacy. The best treatment of MS disability may, therefore, be prevention of decline. Here, we present a working model of <i>reserve</i> and <i>brain maintenance</i>, with a focus on modifiable risk and protective factors. At disease onset, patients have varying degrees of reserve, broadly conceptualized as the dynamic availability of cerebral resources to support functional capacity. A clinical focus on prevention aims to minimize factors that deplete reserve (e.g. disease burden, comorbidities) and maximize factors that preserve reserve (e.g. DMTs, cardiovascular health). We review evidence for cardiovascular health, diet, and sleep as three potentially important modifiable factors that may modulate cerebral reserve generally, but also in disease-specific ways. We frame the brain as a limited capacity system in which inefficient usage of available cerebral capacity (reserve) leads to or exacerbates functional deficits, and we provide examples of factors that may lead to such inefficiency (e.g. poor mood, obesity, cognitive-motor dual-tasking). Finally, we discuss the challenges and responsibilities of MS neurologists and patients in pursuing comprehensive brain maintenance as a preventive approach.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"62 1","pages":"1372-1378"},"PeriodicalIF":4.8,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90855435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MUSICAL TIMESPub Date : 2019-09-01Epub Date: 2019-07-23DOI: 10.1007/s13555-019-0309-y
Philip R Cohen, Christof P Erickson, Antoanella Calame
{"title":"Atrophic Dermatofibroma: A Comprehensive Literature Review.","authors":"Philip R Cohen, Christof P Erickson, Antoanella Calame","doi":"10.1007/s13555-019-0309-y","DOIUrl":"10.1007/s13555-019-0309-y","url":null,"abstract":"<p><strong>Introduction: </strong>An atrophic dermatofibroma is a benign fibrohistiocytic neoplasm. It typically presents as an asymptomatic patch with a depressed central area.</p><p><strong>Methods: </strong>The PubMed database was used to search the following words: atrophic, dermatofibroma, elastic and fibers. The relevant papers and their references generated by the search were reviewed. Images of the clinical and pathological features of two patients with an atrophic dermatofibroma are presented. In addition, a comprehensive review of the characteristics of this unique dermatofibroma is provided.</p><p><strong>Results: </strong>An atrophic dermatofibroma has been reported in 102 patients: 53 women, 11 men and 38 individuals whose gender was not provided. It typically appeared as an asymptomatic solitary patch with a central umbilication-most commonly on the shoulder or lower extremity or back-of women aged 48 years or older. Dermoscopy typically showed white scar-like patches; a patchy pigment network was also noted in some lesions. The pathology of an atrophic dermatofibroma has the same features that can be observed in a common fibrous dermatofibroma; there is acanthosis, basal layer hyperpigmentation, and induction of basal cell carcinoma-like features, hair follicle formation or sebaceous hyperplasia in the epidermis and a proliferation of spindle-shaped fibroblasts in the dermis. However, atrophic dermatofibromas also demonstrate depression of the central surface and thinning of the dermis; in many cases, the dermal atrophy is at least 50%. Elastic fibers are either decreased or absent. Similar to non-atrophic dermatofibromas, the immunoperoxidase profile of atrophic dermatofibromas is factor XIIIa-positive and cluster of differentiation 34 (CD34)-negative. The pathogenesis of atrophic dermatofibromas remains to be established.</p><p><strong>Conclusion: </strong>An atrophic dermatofibroma is an uncommon benign variant of a dermatofibroma. The diagnosis can be suspected based on clinical features and dermatoscopic findings. A biopsy of the lesion will confirm the diagnosis. Periodic evaluation of the lesion site is a reasonable approach to the management of the residual tumor.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"28 1","pages":"449-468"},"PeriodicalIF":3.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90728839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MUSICAL TIMESPub Date : 2019-08-07DOI: 10.1038/s41419-019-1820-x
Charlotte Hill, Juanjuan Li, Dian Liu, Franco Conforti, Christopher J Brereton, Liudi Yao, Yilu Zhou, Aiman Alzetani, Serena J Chee, Ben G Marshall, Sophie V Fletcher, David Hancock, Christian H Ottensmeier, Andrew J Steele, Julian Downward, Luca Richeldi, Xin Lu, Donna E Davies, Mark G Jones, Yihua Wang
{"title":"Autophagy inhibition-mediated epithelial-mesenchymal transition augments local myofibroblast differentiation in pulmonary fibrosis.","authors":"Charlotte Hill, Juanjuan Li, Dian Liu, Franco Conforti, Christopher J Brereton, Liudi Yao, Yilu Zhou, Aiman Alzetani, Serena J Chee, Ben G Marshall, Sophie V Fletcher, David Hancock, Christian H Ottensmeier, Andrew J Steele, Julian Downward, Luca Richeldi, Xin Lu, Donna E Davies, Mark G Jones, Yihua Wang","doi":"10.1038/s41419-019-1820-x","DOIUrl":"10.1038/s41419-019-1820-x","url":null,"abstract":"<p><p>Idiopathic pulmonary fibrosis (IPF), the prototypic progressive fibrotic interstitial lung disease, is thought to be a consequence of repetitive micro-injuries to an ageing, susceptible alveolar epithelium. Ageing is a risk factor for IPF and incidence has been demonstrated to increase with age. Decreased (macro)autophagy with age has been reported extensively in a variety of systems and diseases, including IPF. However, it is undetermined whether the role of faulty autophagy is causal or coincidental in the context of IPF. Here, we report that in alveolar epithelial cells inhibition of autophagy promotes epithelial-mesenchymal transition (EMT), a process implicated in embryonic development, wound healing, cancer metastasis and fibrosis. We further demonstrate that this is attained, at least in part, by increased p62/SQSTM1 expression that promotes p65/RELA mediated-transactivation of an EMT transcription factor, Snail2 (SNAI2), which not only controls EMT but also regulates the production of locally acting profibrogenic mediators. Our data suggest that reduced autophagy induces EMT of alveolar epithelial cells and can contribute to fibrosis via aberrant epithelial-fibroblast crosstalk.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"19 1","pages":"591"},"PeriodicalIF":9.0,"publicationDate":"2019-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90707235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MUSICAL TIMESPub Date : 2017-02-01Epub Date: 2016-07-20DOI: 10.1177/0271678X16638103
Shin-Lei Peng, Harshan Ravi, Min Sheng, Binu P Thomas, Hanzhang Lu
{"title":"Searching for a truly \"iso-metabolic\" gas challenge in physiological MRI.","authors":"Shin-Lei Peng, Harshan Ravi, Min Sheng, Binu P Thomas, Hanzhang Lu","doi":"10.1177/0271678X16638103","DOIUrl":"10.1177/0271678X16638103","url":null,"abstract":"<p><p>Hypercapnia challenge (e.g. inhalation of CO<sub>2</sub>) has been used in calibrated fMRI as well as in the mapping of vascular reactivity in cerebrovascular diseases. An important assumption underlying these measurements is that CO<sub>2</sub> is a pure vascular challenge but does not alter neural activity. However, recent reports have suggested that CO<sub>2</sub> inhalation may suppress neural activity and brain metabolic rate. Therefore, the goal of this study is to propose and test a gas challenge that is truly \"iso-metabolic,\" by adding a hypoxic component to the hypercapnic challenge, since hypoxia has been shown to enhance cerebral metabolic rate of oxygen (CMRO<sub>2</sub>). Measurement of global CMRO<sub>2</sub> under various gas challenge conditions revealed that, while hypercapnia (P = 0.002) and hypoxia (P = 0.002) individually altered CMRO<sub>2</sub> (by -7.6 ± 1.7% and 16.7 ± 4.1%, respectively), inhalation of hypercapnic-hypoxia gas (5% CO<sub>2</sub>/13% O<sub>2</sub>) did not change brain metabolism (CMRO<sub>2</sub> change: 1.5 ± 3.9%, P = 0.92). Moreover, cerebral blood flow response to the hypercapnic-hypoxia challenge (in terms of % change per mmHg CO<sub>2</sub> change) was even greater than that to hypercapnia alone (P = 0.007). Findings in this study suggest that hypercapnic-hypoxia gas challenge may be a useful maneuver in physiological MRI as it preserves vasodilatory response yet does not alter brain metabolism.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"128 1","pages":"715-725"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90621458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MUSICAL TIMESPub Date : 2016-02-01DOI: 10.1161/CIRCOUTCOMES.115.002473
Jessica K Paulus, Benjamin S Wessler, Christine Lundquist, Lana L Y Lai, Gowri Raman, Jennifer S Lutz, David M Kent
{"title":"Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease.","authors":"Jessica K Paulus, Benjamin S Wessler, Christine Lundquist, Lana L Y Lai, Gowri Raman, Jennifer S Lutz, David M Kent","doi":"10.1161/CIRCOUTCOMES.115.002473","DOIUrl":"10.1161/CIRCOUTCOMES.115.002473","url":null,"abstract":"<p><strong>Background: </strong>Several widely used risk scores for cardiovascular disease (CVD) incorporate sex effects, yet there has been no systematic summary of the role of sex in clinical prediction models (CPMs). To better understand the potential of these models to support sex-specific care, we conducted a field synopsis of sex effects in CPMs for CVD.</p><p><strong>Methods and results: </strong>We identified CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Registry, a comprehensive database of CVD CPMs published from January 1990 to May 2012. We report the proportion of models including sex effects on CVD incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 592 CVD-related CPMs, 193 (33%) included sex as a predictor or presented sex-stratified models. Sex effects were included in 78% (53/68) of models predicting incidence of CVD in a general population, versus only 35% (59/171), 21% (12/58), and 17% (12/72) of models predicting outcomes in patients with coronary artery disease, stroke, and heart failure, respectively. Among sex-including CPMs, women with heart failure were at lower mortality risk in 8 of 8 models; women undergoing revascularization for coronary artery disease were at higher mortality risk in 10 of 12 models. Factors associated with the inclusion of sex effects included the number of outcome events and using cohorts at-risk for CVD (rather than with established CVD).</p><p><strong>Conclusions: </strong>Although CPMs hold promise for supporting sex-specific decision making in CVD clinical care, sex effects are included in only one third of published CPMs.</p>","PeriodicalId":51900,"journal":{"name":"MUSICAL TIMES","volume":"78 1","pages":"S8-15"},"PeriodicalIF":6.9,"publicationDate":"2016-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90946128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"艺术学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}