- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Infective endocarditis (IE) is an infection of the endocardial surfaces of the heart, which includes 1 or more heart valves. The incidence of infective endocarditis hospitalization in the United Stat...
Infective endocarditis (IE) is an infection of the endocardial surfaces of the heart, which includes 1 or more heart valves. The incidence of infective endocarditis hospitalization in the United States is estimated at 12.7 per 100,000, annually. A majority of the patients (57.7%) were male and more than a third were at the age of 70 and older. Several risk factors predispose patients to IE, such as structural heart disease (valvular disease or congenital heart disease), prosthetic heart valves, indwelling cardiovascular device, an intravascular catheter, chronic hemodialysis, human immunodeficiency virus infection, diabetes, or history of infective endocarditis. Other risk factors include male older than 60 years, male gender, intravenous (IV) drug use, poor dentition, or dental infection. Infective endocarditis may present as acute or subacute infection. Acute infections present as a rapidly progressive disease with high fevers, rigors, and sepsis. On the other hand, subacute bacterial endocarditis diagnosis is often delayed and presents as non-specific symptoms such as weight loss, fatigue, dyspnea over several weeks to months. There are several differences between subacute bacterial endocarditis and acute bacterial endocarditis. Most cases of subacute bacterial endocarditis are caused by penicillin sensitive Streptococcus viridans, while Staphylococcus aureus causes most cases of acute bacterial endocarditis. Subacute bacterial endocarditis mostly happens in pre-existing heart disease while acute bacterial endocarditis mostly happens in healthy hearts. After treatment, subacute bacterial endocarditis rarely leads to severe cardiac damage; however, most patients who survive acute bacterial endocarditis often die of cardiac failure within weeks or months. As the incidence of infective endocarditis continues to rise in the United States, healthcare providers must make appropriate decisions regarding antibiotic prophylaxis to prevent further complications. Antibiotic prophylaxis before procedures, especially dental procedures, used to be widely utilized to prevent infective endocarditis despite a lack of established evidence to support this practice. In guidelines published by the American Heart Association (AHA) in 2007, the recommended indications to use antibiotics for endocarditis prophylaxis were significantly restricted. There were several reasons for this change. Firstly, infective endocarditis was more likely to occur with everyday activities such as teeth brushing and flossing rather than with a single medical or dental procedure. Secondly, it was felt that prophylaxis with antibiotics for dental procedures prevented very few IE cases. The cost of antibiotic therapy and the risk of adverse events and risk of promoting antibiotic resistance significantly outweighed the benefit of such prophylaxis. Thirdly, consistently good oral hygiene is considered more beneficial in preventing IE than a single dose of antibiotics.
- Uncovering the association between fatigue and fatigability in multiple sclerosis using cognitive control. [Journal Article]
- MSMult Scler Relat Disord 2018 Oct 27; 27:269-275
- CONCLUSIONS: Using the appropriate tools, this study showed an association between subjective and objective cognitive fatigue in people with MS. The BCNT and cognitive control are useful tools in assessing patients with MS and should be explored in future, larger studies in this population.
- A quality improvement project to improve pediatric medical provider sleep and communication during night shifts. [Journal Article]
- IJInt J Qual Health Care 2018 Nov 13
- Night-shift medical providers frequently experience limited sleep resulting in fatigue, often because of paging activity. Streamlined medical-specific communication interventions are known to improve...
Night-shift medical providers frequently experience limited sleep resulting in fatigue, often because of paging activity. Streamlined medical-specific communication interventions are known to improve sleep and communication among these providers.
- In-training Exams, Performance, and Exam Fatigue. [Journal Article]
- AAnesthesiology 2018; 129(6):1189
- Effect of novel recovery garments utilising nanodiamond- and nanoplatinum-coated materials (DPV576-C) on physical and psychological stress in baseball players: A randomised, placebo-controlled trial. [Journal Article]
- EJEur J Sport Sci 2018 Nov 13; :1-7
- Based on research suggesting that nanomaterial containing nanodiamond- and nanoplatinum-coated fibres (DPV576-C) may reduce the stress response, garments to enhance athletes' recovery from training-i...
Based on research suggesting that nanomaterial containing nanodiamond- and nanoplatinum-coated fibres (DPV576-C) may reduce the stress response, garments to enhance athletes' recovery from training-induced stress have been manufactured. This study examined the effects of wearing recovery garments on the physical and psychological stress of Japanese male baseball players. Thirty-eight players aged 18-21 (19.6 ± 0.2 years) who participated in a two-week intensified training programme were randomly assigned to two groups: 19 wore recovery (DPV576-C) garments (RG group) and 19 wore non-recovery garments (placebo group). Both groups wore the garments overnight. Mood states, using the Profile of Mood States questionnaire, and salivary cortisol levels were measured before (day 0) and after (day 14) the training period. Saliva samples were collected from 07:00-07:30 am. Both groups' fatigue scores significantly increased after the training period (RG: 8.4 ± 0.8-10.1 ± 0.8 score; placebo: 9.8 ± 1.0-11.7 ± 1.0 score). The total mood disturbance (TMD) score increased significantly in the placebo group (21.0 ± 2.3-27.2 ± 3.0 score) but not in the RG group (17.4 ± 2.7-20.2 ± 2.2 score). Salivary cortisol concentrations decreased significantly in the RG group (0.71 ± 0.08-0.49 ± 0.05 μg/dL) but not in the placebo group (0.61 ± 0.06-0.58 ± 0.10 μg/dL). Therefore, wearing the DPV576-C garments overnight attenuated increases in TMD levels and decreased salivary cortisol levels following intensified training. DPV576-C garments may have beneficial effects on training-induced physical and psychological stress among athletes.
- Optimizing Cardiovascular Care in Children With Acute Myeloid Leukemia to Improve Cancer-Related Outcomes. [Journal Article]
- JCJ Clin Oncol 2018 Nov 13; :JCO1801421
- The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management ch...
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 14-year-old African American female presented with fatigue, easy bruising, and fever. On examination, she had scattered bruising, lymphadenopathy, and hepatosplenomegaly. Laboratory evaluation revealed pancytopenia with peripheral blasts, and acute myeloid leukemia (AML; French-American-British M2, t[8;21][q22;q22.1]) was diagnosed on bone marrow biopsy. A baseline echocardiogram revealed normal left ventricular (LV) systolic function (ejection fraction [EF], 60%; shortening fraction [SF], 32%), and conventional chemotherapy was initiated that consisted of two cycles of remission induction (cytarabine, etoposide, and daunorubicin [50 mg/m2 × 3 days per cycle]) followed by intensification 1 (high-dose cytarabine and etoposide), intensification 2 (high-dose cytarabine and mitoxantrone [12 mg/m2/dose daily; four total doses]), and intensification 3 (high-dose cytarabine and l-asparaginase). Of note, an echocardiogram was not repeated before the start of intensification 1. During intensification 1, the patient developed Streptococcus viridans sepsis, which required 4 days in the intensive care unit with antimicrobial and inotropic support. Repeat echocardiogram after recovery from the sepsis episode demonstrated low-normal LV systolic function (EF, 53%; SF, 27%), and she subsequently began intensification 2. On day 3 of intensification 2, the patient developed afebrile tachypnea, tachycardia, and an increasing oxygen requirement. Chest x-ray revealed cardiomegaly and pulmonary vascular congestion. Cardiac troponins were normal, whereas N-terminal pro B-type natriuretic peptide was 10 times the upper limit of normal. Repeat echocardiogram showed an enlarged LV with moderate to severely depressed LV function (EF, 28%; SF, 14%). Day 4 mitoxantrone was omitted and a cardiology consult obtained.
- Fatigue and microgap behaviour of a three-unit implant-fixed dental prosthesis combining conventional and dynamic abutments. [Journal Article]
- JMJ Med Eng Technol 2018 Nov 13; :1-9
- This is an in vitro study composed by a fatigue test followed by an optical microscopy analysis. Dynamic abutments concept, recently introduced on screw-retained implant dental prosthesis, consists o...
This is an in vitro study composed by a fatigue test followed by an optical microscopy analysis. Dynamic abutments concept, recently introduced on screw-retained implant dental prosthesis, consists on the screw channel customisation according to the individual needs of each rehabilitation. Geometry and tightening torque differences advise the assessment of their mechanical performance. Clarify whether the combination of dynamic and conventional abutments in a three-unit implant-fixed prosthesis has detrimental effects either on the mechanical performance under cyclic loading or on the implant-abutment microgap dimensions. The fatigue test was performed in agreement with the ISO standard 14801. Then on the samples that resisted 5 million cycles, the implant-abutment microgap was measured on dynamic and conventional abutments using optical microscopy. Two unloaded samples were used as control group. The samples supported a load of 1050 N. The implant-abutment microgap measurement did not show statistically significant differences (p = .086) between loaded and unloaded groups, but the loaded conventional abutments showed a significant lower implant-abutment microgap (p = .05) than the loaded dynamic abutments. The combination of conventional and dynamic abutments do not seem to produce a decrease in fatigue resistance to a level below the mastication forces or an increase in the joint dimensions.
- Design of Fe-based Bulk Metallic Glasses with Improved Wear Resistance. [Journal Article]
- AAACS Appl Mater Interfaces 2018 Nov 13
- The application of bulk metallic glasses (BMGs) as advanced wear-resistant materials has remained limited despite optimistic expectations. In this work, we develop a series of novel Fe-based BMGs wit...
The application of bulk metallic glasses (BMGs) as advanced wear-resistant materials has remained limited despite optimistic expectations. In this work, we develop a series of novel Fe-based BMGs with improved wear resistance by altering the Cr and Mo contents in an Fe-Cr-Mo-C-B-Y glass forming system. Experimental results demonstrate that increasing Cr and Mo contents enhance the thermal stability and hardness (Hv) of the resulting BMGs without reducing their fracture toughness (Kc). The enhanced hardness is mainly attributed to the increased fraction of the stiff (Cr, Mo)-C covalent bonds in the resultant BMGs, as revealed by X-ray photoelectron spectrograph measurement. Worn surface/subsurface observations and stress field modeling reveal the activity of two kinds of wear mechanisms, i.e., hardness-controlled abrasion wear and toughness-controlled fatigue wear. We further clarify the enhanced wear performance of the Fe-based BMGs according to an effective indicator Kc3/4Hv1/2 that correlates positively with the wear resistance of the samples. The optimal Fe-based BMG sample possessed versatile properties, including a strong glass-forming ability (i.e., a minimum critical diameter of 8 mm), a high hardness of 1335 Hv, and a very low specific wear rate of ~1.3×10-6 mm3 N-1m-1, which represents one of the most outstanding Fe-based BMGs reported thus far.
- Biomechanical properties of plate constructs for feline ilial fracture gap stabilization. [Journal Article]
- VSVet Surg 2018 Nov 13
- CONCLUSIONS: Double plating improved stiffness and resistance to failure of comminuted feline ilial fracture constructs compared with all other fixations. Single locking plates produced superior constructs compared with single nonlocking constructs.Locking implants are recommended to repair comminuted feline ilial fractures for their extended fatigue life and resistance to screw loosening. Orthogonal plating offers a strong nonlocking alternative.
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- The development of national multisectoral action plans for the prevention and control of noncommunicable diseases: experiences of national-level stakeholders in four countries. [Journal Article]
- GHGlob Health Action 2018; 11(1):1532632
- CONCLUSIONS: Although the development of multisectoral action plans to tackle NCDs is recommended, the process is a challenging one. Reflections from those countries which have experience in developing such action plans is important in identifying common challenges as well as recommending best practice, such that other countries may learn from their experiences.