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9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p less then 0.001). CONCLUSION The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article Bone Joint J 2020;102-B(6)1-6.BACKGROUND The development of thoracic aortic aneurysm and dissection (TAAD) is mediated by inflammasome activation, which exacerbates the secretion of pro-inflammatory cytokines, chemokines, matrix metalloproteinases (MMPs), and reactive oxygen species (ROS). The glycolytic enzyme pyruvate kinase M2 (PKM2) has shown a protective role against various disorders with an inflammatory basis, such as sepsis, tumorigenesis, and diabetic nephropathy. However, its potential role in TAAD has not been investigated so far. APPROACH AND RESULTS We analyzed aortic tissues from TAAD patients and the β-aminopropionitrile fumarate (BAPN)-induced mouse model of TAAD and observed elevated levels of PKM2 in the aortic lesions of both. Treatment with the PKM2 activator TEPP-46 markedly attenuated the progression of TAAD in the mouse model as demonstrated by decreased morbidity and luminal diameter of the aorta. In addition, the thoracic aortas of the BAPN-induced mice showed reduced monocytes and macrophages infiltration and lower levels of IL-1β, MMPs, and ROS when treated with TEPP-46. Furthermore, TEPP-46 treatment also suppressed the activation of the NOD-like receptor (NLR) family and pyrin domain-containing protein 3 (NLRP3) inflammasome by downregulating p-STAT3 and HIF1-α. CONCLUSION Pyruvate kinase M2 plays a protective role in TAAD development, and its activation is a promising therapeutic strategy against the progression of TAAD.BACKGROUND We aim to describe the access to palliative care (PC) in hospitalized children during end-of-life care and compare the circumstances surrounding the deaths of hospitalized children as a basis for implementing a pediatric PC program at our institution. METHODS We performed a retrospective chart review of deceased pediatric patients at a tertiary referral hospital in Colombia. The study group was selected by randomly drawing a sample of 100 observations from the 737 deceased children from 2013 to 2016. A 11 propensity score (PS) matching was performed to compare the characteristics and outcomes between PC and non-PC treated patients. RESULTS We included 87 patients. After PS matching, we found that patients under the care of non-PC physicians were more likely to die in the pediatric intensive care unit (non-PC 6/10 vs PC 1/10; P = .02), to be on vasopressor agents and mechanical ventilation (non-PC 7/10 vs PC 1/10; P = .02), and to receive cardiopulmonary resuscitation at the end of life (non-PC 5/10 vs PC 0/10; P = .03). In contrast, a significantly higher proportion of patients under the care of the pediatric PC team died with comfort measures (non-PC 2/10 vs 8/10; P = .02) and nonescalation of care in physician orders (non-PC 5/10 vs PC 10/10; 0.03). CONCLUSION In this study, only 10 of 87 patients were treated by the pediatric PC team at the end of life. The latter finding is concerning and is a call to action to improve access to pediatric PC at our institution.Aim Variation of exercise ventilation confers poor prognosis in heart failure. Sedentary men have higher exercise ventilatory variability than athletes. However, the impact of lifestyle intervention on exercise ventilatory variability in sedentary people is unknown and this is the aim of this study. Materials & methods Prospective controlled single-blinded interventional study that randomly assigned healthy sedentary individuals to diet and exercise (intervention group, n=12) or no intervention (control group, n=12) for 12 weeks. Exercise ventilatory variability was accessed before and after intervention. Results Despite similar values at baseline, there was a 15% reduction in respiratory rate variability (root mean square of the successive differences/n) in intervention group. Conclusion Diet and exercise training reduced exercise ventilatory variability.Intra-aortic balloon pump is an invasive procedure used in critically unwell population and carries risks of possible complications. The most common complications include thrombocytopenia and fever, occurring approximately 50 and 36% of the time. Rare complications include vascular tears, limb ischemia, occurring approximately 1-2% of the time and balloon rupture and/or entrapment approximately 0.5% of the time. Current literature suggests the most common etiology of entrapment is due to balloon rupture and the formation of clot within the balloon causing difficulty in removal. Herein, we demonstrate a case series of intra-aortic balloon pump entrapment without balloon rupture.Listeria monocytogenes (Lm), the etiological agent of listeriosis diseases in humans, is a serious pathogenic microorganism threatening the food safety especially in ready-to-eat food products. Adhesion on both biotic and abiotic surfaces is making it a potential source of contamination by Lm. Also, this bacterium has become more tolerant in food processing conditions, including in the presence of adverse conditions such as cold and dehydration. One of the attractive and effective methods to inhibit the growth of Lm in the food products is using natural antimicrobial agents, which can be a suitable alternative to synthetic preservatives for producing organic food products. The use of pure natural antimicrobials has some limitations including low stability against harsh conditions, low solubility and absorption, and un-controlled release, which can decrease their functions. β-Estradiol purchase These limitations have been overcome by using new advanced encapsulation techniques, which have boosted the anti-listerial activity of natural agents.
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