Notes

Insufficient SREBP1c modulates autophagy mediated lipid droplet catabolism during oleic acid brought on steatosis.
Urine output criteria classified four times as many patients with AKI than creatinine criteria (95 [67%] v 21 [15%]). Chaetocin Most patients meeting KDIGO urine output criteria for AKI postoperatively did not satisfy KDIGO creatinine criteria for AKI within one week (77 of 95 [81%]) or six-to-12 months (27 of 29 [93%]). Higher AKI stage assessed by urine output was not associated with higher NGAL, IL-18, or longer hospital or intensive care unit stays.

Acute kidney injury classified by KDIGO urine output criteria was not associated with other biomarkers of kidney injury or worse patient outcomes. These data suggested that KDIGO urine output criteria after cardiac surgery may overclassify AKI stage; further research is needed.
Acute kidney injury classified by KDIGO urine output criteria was not associated with other biomarkers of kidney injury or worse patient outcomes. These data suggested that KDIGO urine output criteria after cardiac surgery may overclassify AKI stage; further research is needed.
The objective was to assess the effectiveness and safety of peripheral regional anesthesia in congenital cardiac surgical patients undergoing thoracotomy for aortic coarctation.

A retrospective chart review of pediatric patients (<18 years) who underwent surgical repair of congenital heart diseases via thoracotomy between September 2013 and July 2018 was done. Among patients who underwent coarctation repair, a propensity score was used to match patients who received a regional catheter (C) versus traditional medical treatment only (M).

A single center children's hospital.

The median age was 172 days (IQR 64-1315) in group C and 176 days (IQR 71-1146) in group M (SMD = 0.07). The median weight was 6.8 kg (IQR 4.8-13.6) in group C and 7.7 kg (4.6-17.4) in group M (SMD = 0.003).

Outcomes assessed were postoperative hospital length of stay, median pain scores in the first 24 and 48 hours, and total morphine equivalent use in the first 24 and 48 hours. Complications related to the catheters were reviewed. The median oral morphine equivalent dose administered in the first 24 hours was lower in group C than group M (0.8 mg/kg, IQR 0.5-1.1 vs. 1.4 mg/kg, IQR 0.9-1.7, p = 0.019). There were no major complications related to the catheters, including hematoma.

Peripheral regional catheters may be used to reduce opioid requirements in patients after CoA repair. Due to the low risk of these catheters, they should be considered as part of a pain management strategy for pediatric patients undergoing thoracotomy and should be incorporated into strategies to improve outcomes.
Peripheral regional catheters may be used to reduce opioid requirements in patients after CoA repair. Due to the low risk of these catheters, they should be considered as part of a pain management strategy for pediatric patients undergoing thoracotomy and should be incorporated into strategies to improve outcomes.DOPPLER echocardiography is a useful noninvasive tool for the assessment of cardiac hemodynamics. However, it is subject to limitations that can have important clinical implications, especially in the setting of valve prosthesis. link2 Elevation in mean transvalvular gradient is a finding that has a variety of etiologies. One such etiology is the pressure-recovery (PR) phenomenon, a consequence of stream convergence and energy conversion across a narrowing, which is an artifact of Doppler echocardiographic calculations of valvular flow. The elevated gradient measured with Doppler echocardiography as a result of PR is not present on cardiac catheterization and does not represent true problematic valve hemodynamics. PR should be suspected with an elevated gradient on Doppler echocardiography with normal leaflet motion, especially in the setting of a small proximal aorta. Understanding and awareness of PR are important because PR can lead to overestimation of disease severity in the clinical setting.Congenital factor V deficiency is an extremely rare abnormality and may be associated with significant bleeding as a result of trauma or surgery. Perioperative management primarily includes the administration of fresh frozen plasma to replace the deficient clotting factor. Acute administration of multiple blood products is a risk factor for transfusion-associated circulatory overload. Herein, the case of a 71-year-old man with an ejection fraction of 13% and a history of congenital factor V deficiency who was at risk for significant bleeding and transfusion-associated circulatory overload who underwent successful complex extraction of a right atrial pacing lead is reported.With the advent of high-quality portable ultrasound machines, point-of-care ultrasound (POCUS) has gained interest as a promising diagnostic tool for patients with high altitude illness. Although POCUS is used successfully in hospital environments to detect interstitial pulmonary edema and increased intracranial pressure, the relationship between specific sonographic criteria and high altitude illness is still unclear. We report the case of a healthy 32-y-old male who developed acute respiratory distress and neurologic impairment at 4321 m while participating in a high altitude medical research expedition. We discuss the potential of POCUS to diagnose acute high altitude illness by lung ultrasound, optic nerve sheath diameter measurement, and echocardiography. link3 Ultrasound in combination with clinical findings helped us to exclude relevant differential diagnoses, start on-site treatment, and organize an evacuation. We used serial clinical and ultrasound examinations to assess the patient over time. Although its role in high altitude medicine needs further investigation, we believe that POCUS can be a valuable tool to aid clinical decision-making in remote, high altitude environments.
The few epidemiologic studies published previously about different forms of mountain running (ie, fell running, sky running, and ultratrail running) have not reported on fatal events. This report aims to contribute to the literature on mountain running fatalities, recording and classifying fatal events related to mountain running competitions found in online literature searches over a 12-y period.

From 2008 to 2019, searches on mountain sport, mountain races, and newspaper websites were periodically performed, looking for fatal events related to running competitions in the mountains. Data are presented as mean±SD or percentage, as appropriate.

Fifty-one fatal events, involving 45 men (88%) and 6 women (12%), aged 50±11 and 46±6 y, respectively, were recorded in the 2008 to 2019 period in Western Europe. These events occurred during races (n=35; 69%), during training (n=13; 25%), and after races (n=3; 6%); 43% were sudden cardiac death, 32% due to falls (blunt trauma), 16% due to hypothermia, 4% due to b stresses the need for preparticipation cardiovascular screenings. Further longitudinal studies are necessary to better understand the real impact of fatal events on the mountain running population.
Hospitalized children experience moderate-to-severe pain after laparoscopic appendectomy, but knowledge of children's pain experiences after discharge home is limited. Accurate pain assessments are needed to guide appropriate pain treatment.

To describe children's pain at home after laparoscopic appendectomy.

Prospective exploratory and descriptive METHODS A convenience sample of 100 patients, aged 10-17 years, who spoke or wrote in English or Spanish, volunteered to complete 14-day pain diaries at home after laparoscopic appendectomy. Visual analytic techniques were used to analyze patterns of pain experiences.

Diaries were returned by 45 patients/parents, the majority of whom were White (64%), male (56%), adolescents (mean age 14 years) with no previous surgical history (70%), and whose appendix was inflamed (87%) but not perforated. More than 50% reported severe pain (4 or 5 on a 0-5 scale) on the first full day home after laparoscopic appendectomy. On day 7, 40% reported pain and on day 14, 16% were still reporting pain. Only rarely were pain scores not clinically significantly lower 1 hour after pain treatment, regardless of treatment type (e.g., nondrug, nonopioid, opioid). Reported pain intensity steadily decreased over time as did frequency of recorded pain scores.

Adolescents experience severe pain at home after laparoscopic appendectomy and some experience pain for 7 to 14 days after hospital discharge. Visual analytics better represent the dynamics of pain experiences than measures of central tendency.
Adolescents experience severe pain at home after laparoscopic appendectomy and some experience pain for 7 to 14 days after hospital discharge. Visual analytics better represent the dynamics of pain experiences than measures of central tendency.
Fifty million American adults have chronic pain, and nearly 20 million have high-impact, or disabling, chronic pain, with higher prevalence associated with advancing age. Patient-centered pain management has been cited as a national priority to ensure that patient values and preferences guide clinical decisions. However, explicit, and practical strategies for implementing patient-centered pain management have not been disseminated.

The aim of this study was to elicit perceptions, beliefs, and experiences of patient-centered pain management among adults with chronic pain as well as among providers that could be used to develop recommendations for implementation and evaluation of patient-centered pain management.

A descriptive qualitative study.

Fourteen adults with chronic pain were recruited from the communities. Besides, five providers caring for patients with chronic pain at an outpatient spine center affiliated to one academic hospital joined this study.

Each focus group lasted about 1 hour, whicnts resulted from suboptimal pain management.
Patients emphasized their desire for a provider that listens, genuinely cares, and sees them holistically to provide the best individual and tailored care for them. Providers focused on setting realistic expectations, vocalizing the significance of pain education at a young age, and balancing patient satisfaction and opioid prescriptions. While patients can be empowered to self-manage their chronic pain due to patient-centered pain care, provider mental exhaustion and mistrust of providers among patients resulted from suboptimal pain management.
The presence of an intact distal fibula is reported as a prerequisite when considering total ankle replacement and its lack is usually considered a contraindication. The purpose of the study was to describe the results of a surgical technique to reconstruct the distal fibula (Milanese fibular reconstruction technique) in the setting of a total ankle replacement and insufficient fibula.

Retrospective analysis of 15 patients (15 ankles) who underwent rotational fibular reconstruction technique with minimum follow-up of 24 months. Patients were evaluated preoperatively and at the last follow-up with AOFAS Ankle and Hindfoot score, VAS pain scale, SF-12 and range of motion. Standard weightbearing radiographs were used for radiographic assessment.

The average of all clinical scores significantly improved (P<.001). The average radiographic parameters showed a neutral alignment. No cases of reabsorption of the new lateral malleolus were observed even in cases with complications that accounted for 2 superficial wound infection and 2 deep infections.
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