Zimmerman Associates (United States)

Urolithiasis is a common and recurrent urological condition with significant clinical and economic implications worldwide. In light of new evidence on evaluating and managing urolithiasis, this review summarizes the current literature and guidelines. The development of urolithiasis is influenced by a complex interplay of dietary, metabolic, environmental, and genetic factors, with calcium-based stones constituting the majority of cases. Patients may present with a wide spectrum of symptoms, ranging from severe renal colic to incidental, asymptomatic findings. Accurate diagnosis requires the appropriate use of laboratory testing and imaging modalities. Non-contrast CT is considered the gold standard for diagnosis, and ultrasonography is recommended as the primary initial tool in many clinical settings. Management strategies depend on stone size, location, symptom severity, and the presence of complications, such as infection or obstruction. Most stones are expelled spontaneously; however, effective treatment options are available, including nonsteroidal anti-inflammatory drugs for pain control, medical expulsive therapy, and minimally invasive procedures such as extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. These options allow for individualized and highly successful care. Ongoing advances in imaging, medical therapy, and surgical techniques enhance outcomes, reduce recurrence rates, and lessen the overall healthcare burden posed by urolithiasis.

Journalists serving rural communities are crucial sources of information across the U.S.; they also face challenges and opportunities unlike those of their peers at large urban outlets. In this study, we take the COVID-19 pandemic as an opportunity to examine how these journalists define their group identities. We focus on local news creators to ask: How has COVID-19 influenced the identities of small-town and rural journalists in the U.S.? Using an approach informed by actor-network theory and social identity theory, we analyze interviews conducted during the height of the pandemic with 35 rural and small-town journalists across the Midwest, Appalachia, and Gulf South regions to understand the effects of COVID-19 on journalistic identities. We find that the pandemic disrupted the newsgathering process, depunctualizing it in a way that highlighted the centrality of relationships to the rural journalist’s identity. First, by physically distancing journalists from their sources, COVID-19 highlighted the importance of in-person connections. Second, by increasing the amount of contentious news available to report on, COVID-19 highlighted the tension between preserving news values and protecting community relationships. Our findings highlight the far-reaching effects of one actant in a network and the ways journalists in crisis situations negotiate conflicting pressures.

The critical care management of patients after cardiac arrest is burdened by a lack of high-quality clinical studies and the resultant lack of high-certainty evidence. This results in limited practice guideline recommendations, which may lead to uncertainty and variability in management. Critical care management is crucial in patients after cardiac arrest and affects outcome. Although guidelines address some relevant topics (including temperature control and neurological prognostication of comatose survivors, 2 topics for which there are more robust clinical studies), many important subject areas have limited or nonexistent clinical studies, leading to the absence of guidelines or low-certainty evidence. The American Heart Association Emergency Cardiovascular Care Committee and the Neurocritical Care Society collaborated to address this gap by organizing an expert consensus panel and conference. Twenty-four experienced practitioners (including physicians, nurses, pharmacists, and a respiratory therapist) from multiple medical specialties, levels, institutions, and countries made up the panel. Topics were identified and prioritized by the panel and arranged by organ system to facilitate discussion, debate, and consensus building. Statements related to postarrest management were generated, and 80% agreement was required to approve a statement. Voting was anonymous and web based. Topics addressed include neurological, cardiac, pulmonary, hematological, infectious, gastrointestinal, endocrine, and general critical care management. Areas of uncertainty, areas for which no consensus was reached, and future research directions are also included. Until high-quality studies that inform practice guidelines in these areas are available, the expert panel consensus statements that are provided can advise clinicians on the critical care management of patients after cardiac arrest.

Casimir Bumiller/Bernhard Rüth/Ewin Ernst Weber (Hg.): Mäzene, Sammler, Chronisten. Die Grafen von Zimmern und die Kultur des schwäbischen Adels. Im Auftrag der Landkreise Rottweil und Sigmaringen sowie der Gesellschaft Oberschwaben für Geschichte und Kultur. Stuttgart: Belser 2012; 351 S., ca. 150 farbige Abb., 34,95 EUR

Background:Sarcoidosis is a granulomatous multisystem disease of uncertain aetiology. The disease has major inflammatory and immune components; however, the immunopathogenesis is not well understood. Micro ribonucleic acids (microRNAs or miRNAs) are classes of miniature, single-stranded, non-coding RNAs. Their key recognised role includes mediating the silencing of target genes post-transcriptionally. Recently, the role of miRNAs has gained interest in numerous disorders, suggested as being involved in the pathogenesis of those diseases and acting as disease markers. Very little is known about the role of miRNAs in sarcoidosis, with nothing known regarding miRNAs in South African patients, this needs evaluation. The main objective of this research, therefore, was to investigate the serum expression of approximately 800 miRNAs in patients with sarcoidosis compared with race-, age- and gender-matched healthy controls.Methods:A total of six patients and six matched controls participated in this study. Whole blood samples were collected in EDTA tubes, processed and the plasma retained. RNA was extracted from the stored plasma samples using the QIAGEN miRNeasy Mini Kit® and concentrated using a salt-ethanol precipitation. The extracted miRNA was profiled using an nCounter® miRNA human v3 expression assay and data analysed using the nSolver™ Analysis Software.Results:After excluding one sample/control pair because of cellular RNA contamination, the remaining five patient and five matched control samples were analysed, and 145 miRNAs were found to be potentially differentially expressed. On applying a Bonferroni correction, the only miRNA that was significantly different was miRNA let-7a-5p, which was significantly overexpressed (141-fold change; p<0.0003) in patients compared with controls.Conclusion:This is the first miRNA report of differentially expressed miRNAs in the serum of patients with sarcoidosis and matched healthy controls in South Africa. The results obtained suggest that miRNAs may play a role in sarcoidosis pathogenesis. Whether these molecules have diagnostic or prognostic implications, needs the performance of these tests in future studies recruiting larger patient cohorts.

Literature survey reveals that few spectrophotometric, high performance liquid chromatographic (HPLC)and High performance thin layer chromatographic (HPTLC)methods were reported for the estimation of Amlodipine and perindopril in bulk and combined pharmaceutical dosage forms. But there is no any stability indicating high performance liquid chromatography study is reported for amlodipine. So the present study was aimed to development of simple, accurate, rapid and economical HPLC stability indicating assay method were established for the determination of Amlodipine and Peridopril in bulk and tablet dosage form. A High-performance liquid chromatograph WATERS, software: Empower 2,2695 separation module, 996 PDA detector, using Phenomenex Luna C18 (4.6mm×250mm) 5µm or equivalent column, with mobile phase composition of Methanol: Phosphate Buffer pH3.0 (70:30v/v) was used. The flow rate of 1.0ml min-1 and effluent was detected at 230nm. The retention time of Amlodipine and Perindopril was found to be 1.870min and 2.499minutes respectively. Linearity was observed over concentration range of 10-50µg ml-1 for Amlodipine and 16-80µg ml-1 for Perindopril respectively. The accuracy of the proposed method was determined by recovery studies and the Amlodipine was found to be 99.1% and Perindopril was found to be 98.8% respectively. The proposed method is applicable to routine analysis of Amlodipine and Perindopril in bulk and pharmaceutical formulations. The proposed method was validated for various ICH parameters like linearity, limit of detection, limits of quantification, accuracy, precision, range and specificity.

We investigated whether certain occupations were over-represented among surgically treated carpal tunnel syndrome and ulnar entrapment at the elbow, and if manual occupation affected surgical outcome. We included 9030 patients operated for CTS and 1269 for UNE registered in the Swedish National Quality Register for Hand Surgery (HAKIR) 2010-2016. Occupational data was retrieved from Statistics Sweden. Outcome was assessed using the QuickDASH questionnaire. In patients operated for CTS, there were more assistant nurses, attendants/care providers/personal assistants, nannies/student assistants, carpenters/bricklayers/construction workers, cleaners, nurses, and vehicle mechanics than in the general population. In the UNE population, assistant nurses and attendants/care providers/personal assistants were over-represented. Manual workers with CTS scored the preoperative QuickDASH higher than non-manual workers. Manual workers are overrepresented among surgically treated CTS and UNE. Manual workers with CTS have more symptoms preoperatively than non-manual workers.

21 cm

Introduction/Hypothesis: To develop and validate a deep learning model to automatically segment and measure left atrial (LA) volumes from routine noncontrast chest CTs and evaluate for outcomes prognosis. Methods: A prototype AI algorithm, with a conditional variational auto-encoder architecture, was initially developed and trained using training data from 1313 patients (paired CTA and non-contrasted exams; “training group”). Left atrium contours from contrasted cases were used to train the model on corresponding non-contrasted dataset. We then retrospectively evaluated 274 patients (mean age 67.9 years, 54.6% male, 57.2% caucasian) who underwent a routine non ECG-gated, noncontrast chest CT for coronary artery calcium or lung cancer screening for validation of the AI model (“validation group”). Outcomes included heart failure (HF) hospitalization and new-onset atrial fibrillation within 5 years. Simple logistic regressions with appropriate univariate statistics were used for modelling outcomes. Results: In the validation group, there was excellent correlation between AI and expert results with a LA volume index (LAVi) intraclass correlation coefficient of 0.950 (0.936-0.960). Bland-Altman plot demonstrated that the AI underestimated LAVi by a mean 5.86 mL/m2. AI-LAVi independently predicted new-onset atrial fibrillation (AUC = 0.855, OR = 1.12, 95% CI 1.08 - 1.18; p&lt;0.0001). AI-LAVi was independently associated with HF hospitalization (AUC = 0.903, OR = 1.08, 95% CI 1.04 - 1.13, p = 0.0009). Conclusion: In this large validation cohort, AI for automated measurement of LA volume on routine noncontrast chest CTs had excellent agreement with manual quantification. AI-LAVi is independently predictive for new-onset atrial fibrillation and HF hospitalization within 5 years.