Neuropathic pain is a debilitating consequence of spinal cord injury (SCI) that correlates with sensory fiber sprouting. Recent data indicates that exercise initiated early after SCI prevents the development of allodynia and modulated nociceptive afferent plasticity. This study determined if delaying exercise intervention until pain is detected would similarly ameliorate established SCI-induced pain. Adult, female Sprague-Dawley rats with a C5 unilateral contusion were separated into SCI allodynic and SCI non-allodynic cohorts at 14 or 28 dpi when half of each group began exercising on automated running wheels. Allodynia, assessed by von Frey testing, was not ameliorated by exercise. Furthermore, rats that began exercise with no allodynia developed paw hypersensitivity within 2 weeks. At the initiation of exercise, the SCI Allodynia group displayed marked overlap of peptidergic and non-peptidergic nociceptive afferents in the C7 and L5 dorsal horn, while the SCI No Allodynia group had scant overlap. At the end of 5 weeks of exercise both the SCI Allodynia and SCI No Allodynia group had extensive overlap of the 2 c fiber types. Our findings show that exercise therapy initiated at early stages of allodynia is ineffective at attenuating neuropathic pain, but rather that it induces allodynia aberrant afferent plasticity in previously pain-free rats. These data, combined with our previous results suggest that there is a critical therapeutic window when exercise therapy may be effective at treating SCI-induced allodynia and that there are post-injury periods when exercise can be deleterious.
Background and Objectives:
Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.
Methods:
Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided into two groups: Those that used PPIs continuously during the therapy and those not on PPIs continuously during the interval of therapy. Outcomes included but were not limited to technical success, clinical success, number of procedures performed, and adverse events.
Results:
From 2013 to 2016, 272 patients underwent WON drainage with successful transmural LAMS placement. The two groups were split evenly into PPI users and non-PPI users, and matched in regards to demographics, etiology of pancreatitis, WON size, and location. There was no difference in the technical success between the two groups (100%
vs.
98.8%,
P
= 1), or in clinical success rates (78.7%
vs.
77.9%). There was a significant difference in the required number of direct endoscopic necrosectomies to achieve clinical success in the PPI
vs.
non-PPI group (3.2
vs.
4.6 respectively,
P
< 0.01). There were significantly more cases of stent occlusion in the non-PPI group
vs.
PPI group (9.5%
vs.
20.1%
P
= 0.012), but all other documented adverse events were not significantly different.
Conclusion:
Discontinuing PPIs during endoscopic drainage and necrosectomy of symptomatic WON appears to reduce the number of endoscopic procedures required to achieve resolution. Continuous PPI results in higher rates of early stent occlusion.
Aim: To assess whether implementation of the care coordination program reduces 30-day readmissions, and identify characteristics that increase susceptibility to readmission.
Methods:Our institution is an urban quaternary care liver transplant center performing approximately 50 liver transplants yearly in highly competitive UNOS Region 2. Our care coordination program focuses on patient education, short-term outpatient follow-up visits, and post-discharge follow-up calls by a transplant coordinator. During inpatient admission, patients deemed high-risk by attending hepatologists were enrolled. A retrospective chart review was conducted for all patients enrolled in care coordination from September 2014-April 2015. Basic demographic information, including age, gender, and ethnicity was collected. In addition, model for end-stage liver disease (MELD) score on index admission, as well as type of cirrhosis decompensation was recorded.Results: A total of 69 patients deemed high-risk for readmission were enrolled in the CC program. Of these patients, 30-day readmissions occured in 46.3%. There was no significant difference between MELD score on index admission for those readmitted within 30 days, and those who were not. Patients that were readmitted twice within a 30 day period, however, had an average MELD on index admission higher than those not readmitted within 30 days, with trend toward significance (24.3 vs. 19.1, p=0.07). Hepatic encephalopathy was the There were no differences between cirrhosis etiology, race, or type of decompensations between groups. A total of 15 post-transplant patients were included. Of those post-transplant patients who were readmitted within 30 days, the majority of them had recurrent HCV cirrhosis.
Conclusion:Higher MELD scores portend increased chance of readmission, with encephalopathy being the most common reason for readmission.
Aim: To assess whether implementation of the care coordination program reduces 30-day readmissions, and identify characteristics that increase susceptibility to readmission.Methods: Our institution is an urban quaternary care liver transplant center performing approximately 50 liver transplants yearly in highly competitive UNOS Region 2. Our care coordination program focuses on patient education, short-term outpatient follow-up visits, and post-discharge follow-up calls by a transplant coordinator. During inpatient admission, patients deemed high-risk by attending hepatologists were enrolled. A retrospective chart review was conducted for all patients enrolled in care coordination from September 2014-April 2015. Basic demographic information, including age, gender, and ethnicity was collected. In addition, model for end-stage liver disease (MELD) score on index admission, as well as type of cirrhosis decompensation was recorded.Results: A total of 69 patients deemed high-risk for readmission were enrolled in the CC program. Of these patients, 30-day readmissions occured in 46.3%. There was no significant difference between MELD score on index admission for those readmitted within 30 days, and those who were not. Patients that were readmitted twice within a 30 day period, however, had an average MELD on index admission higher than those not readmitted within 30 days, with trend toward significance (24.3 vs. 19.1, p=0.07). Hepatic encephalopathy was the There were no differences between cirrhosis etiology, race, or type of decompensations between groups. A total of 15 post-transplant patients were included. Of those post-transplant patients who were readmitted within 30 days, the majority of them had recurrent HCV cirrhosis.
Conclusion:Higher MELD scores portend increased chance of readmission, with encephalopathy being the most common reason for readmission.
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