Notes

The randomised managed trial of 7.5-mm and 7.0-mm tracheal pontoons vs. Some.5-mm along with Some.0-mm tracheal hoses for males and some women during laparoscopic medical procedures.
Patients in intensive care have increased nutritional needs but are often incapable of eating independently. When should intravenous parenteral nutrition be started, and what is the optimal dose? Here we review the recently updated European guidelines on nutritional support in intensive care patients.BACKGROUND Treatment of stroke in Norway is decentralised; patients with stroke are treated at 50 different hospitals. We have surveyed the treatment of stroke in these hospitals and collated this with data from the Norwegian Stroke Registry. We wished to investigate whether there was any variation in treatment interventions and treatment outcomes between university hospitals and local hospitals. MATERIAL AND METHOD A questionnaire survey among all Norwegian hospitals examined treatment interventions and resource availability. Data from the Norwegian Stroke Registry in 2015-2016 (n = 17 183) were used to compare patient characteristics and treatment outcomes for patients in university hospitals (n = 5 312) and local hospitals (n = 11 871). Treatment quality was measured using the quality indicators in the Norwegian Stroke Registry. RESULTS The median age in the university hospitals was 75 years (interquartile range 65-83), and 44.1% of the patients were women. The median age in the local hospitals was 76 years (interquartile range 67-85); 46.7% women. Goal achievement on five out of ten quality indicators was high; for example, more than 90% of the patients were treated in a stroke unit, irrespective of the type of hospital. At the university hospitals, 1 038 (19.0%) of patients received thrombolytic therapy, compared to 1 612 (17.2%) in the local hospitals. Adjusted for age and level of consciousness, the probability of being self-reliant three months after the stroke was higher in local hospitals (OR 1.15, CI 1.04-1.27). INTERPRETATION The decentralised stroke treatment in Norway accomplishes high and moderate goal achievement on the Norwegian Stroke Registry's quality indicators. The quality of treatment in local hospitals appears to be equally good or better than that provided in university hospitals.More than 10 % of schoolchildren suffer from lower urinary tract dysfunction, often leading to contact with the healthcare system. The problem is socially limiting as well as mentally and physically demanding for children and their parents, and it is important to offer treatment. This article describes a structured approach that can form the basis for correct diagnosis and treatment.BACKGROUND Pharmacological treatment and follow-up of gout is often inadequate.The patients risk repeated, painful arthritis flares and some develop chronic tophaceous gout and joint damage. MATERIAL AND METHOD Since 1 March 2017, a structured care pathway has been established for patients with gout at the Department of Rheumatology, Haukeland University Hospital. Patients were placed on preventive medication, the majority on allopurinol, and were regularly monitored. Patient education is key to the care pathway. The treatment goal is to lower the concentration of serum urate to a level below a defined threshold value (360 µmol/l for non-tophaceous gout or 300 µmol/l for tophaceous gout). Patient data were collected on a continuous basis and recorded in a research database. The care pathway is assessed after 18 months. RESULTS A total of 103 patients have been included, of whom 93 (90 %) are men, with an average age of 63 years and large variations in duration of the disease (min.-max. 0-36 years). Eight patients left the care pathway during the project. The average level of serum urate at inclusion was 446 µmol/l (min.-max. 144-751 µmol/l). The average maximum dose of allopurinol was 333 mg (min.-max. 100-700 mg). Survival analysis showed that three months after the start of urate-lowering therapy, 49 % of the patients had achieved their analytical treatment goal. Altogether 83 % achieved the goal within six months. The majority (70 %) were free of flares after achieving the treatment goal. INTERPRETATION A standardised care pathway for gout enables adaptation of preventive treatment through regular monitoring. The care pathway helps the vast majority of patients to achieve treatment goals, which is crucial to avoid arthritis flares.BACKGROUND Bing-Neel syndrome is a rare neurological manifestation of Waldenström's macroglobulinaemia that can occur both before and after the diagnosis is set. CASE PRESENTATION A man in his seventies with Waldenström's macroglobulinaemia under treatment with ibrutinib contacted the outpatient clinic due to bilateral pain distal to the knees. We initially suspected it was a side effect of ibrutinib and discontinued the drug. Autophagy inhibitor A few days later, he returned with reduced general condition, fever, shivers and a limping gait, and was hospitalised. Clinical examination revealed only pulmonary crackles. With stable low IgM, CRP > 200 mg/L and fever we suspected a serious infection and started broad-spectrum antibiotic treatment. Microbiological tests were negative, and he developed no focal symptoms of infection, but the pain increased. The symptoms had commenced with paraesthesias, and neurological examination revealed ataxia, intentional tremor, decreased sensation distal to the knees and dysdiadochokinesia. Waldenström's macroglobulinaemia was present in the central nervous system, consistent with Bing-Neel syndrome. Brain MRI illustrated pathologically thickened and enhanced meninges and thickened, wavy cauda equine roots. Lumbar puncture showed monoclonal B-cells consistent with lymphoplasmacytic lymphoma. Two weeks after admission IgM had increased from 3.21 g/L to 17.2 g/L. We restarted ibrutinib at a higher dosage, and shortly after his neurological symptoms regressed and IgM normalised. INTERPRETATION The literature consists mainly of retrospective case reports, and there is no true consensus regarding diagnostic criteria or guidelines for treatment. We suspect Bing-Neel syndrome might be underdiagnosed and consider it important to bring awareness of the disease to clinicians.BACKGROUND This study aimed to investigate the effects of RKI-1447, a selective inhibitor of Rho-associated ROCK kinases, in a mouse model of nonalcoholic fatty liver disease (NAFLD) induced by a high-fat diet, and in oleic acid-treated HepG2 human hepatocellular carcinoma cells in vitro. MATERIAL AND METHODS Four study groups of mice included the control group; the high-fat diet (HFD) group; the HFD+RKI-1447 (2 mg/kg) group; and the HFD+RKI-1447 (8 mg/kg) group. Mice were fed a high-fat diet for 12 weeks. Mice in the HFD+RKI-1447 groups were fed a high-fat diet for 12 weeks and treated with RKI-1447 twice weekly for three weeks. The HepG2 human hepatocellular carcinoma cells were treated with or without RKI-1447 for 2 h and treated with oleic acid for 24 h. RESULTS In the mouse model of NAFLD, RKI-1447 reduced insulin resistance and the levels of alanine aminotransferase (ALT), aspartate transaminase (AST), total cholesterol, triglyceride, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), malondialdehyde (MDA), and superoxide dismutase (SOD).
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