BACKGROUND  Management of iatrogenic esophageal perforation (IEP) is challenging. Endoscopic negative pressure therapy (ENPT) is an emerging and effective tool for the treatment of gastrointestinal and anastomotic leaks. We have used ENPT as first-line therapy for IEP since 2017. The aim of this study was to present our results with this strategy in patients with IEP. METHODS  Nine patients were treated with ENPT for IEP between August 2017 and August 2019. Their treatment characteristics, including duration of therapy, strategy used, and outcomes, were analyzed. Treatment included ENPT with open-pore film drainage (OFD) and open-pore polyurethane foam drainage (OPD). RESULTS  Early diagnosis ( less then  24 hours) of IEP occurred in four patients. After a mean (standard deviation) of 19.0 (13.5) days of ENPT, 6.4 (3.4) endoscopies, and 38.1 (40.3) days of hospitalization, endoscopic treatment was effective and successful in all of the patients. Additional video-assisted thoracic surgery (VATS) was done in four patients. CONCLUSIONS  ENPT is an effective new method for the management of IEP. ENPT with OFD and OPD can be combined with minimally invasive operative methods for sepsis control in IEP. © Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND Sodium-23 magnetic resonance imaging (23Na MRI) allows direct measurement of tissue sodium concentrations. Current knowledge of skin, muscle and bone sodium concentrations in chronic kidney disease (CKD) and renal replacement therapy patients is limited. In this study we measured the tissue sodium concentrations in CKD, hemodialysis (HD) and peritoneal dialysis (PD) patients with 23Na MRI of the lower leg and explored their correlations with established clinical biomarkers. METHODS Ten healthy controls, 12 CKD Stages 3-5, 13 HD and 10 PD patients underwent proton and 23Na MRI of the leg. The skin, soleus and tibia were segmented manually and tissue sodium concentrations were measured. Plasma and serum samples were collected from each subject and analyzed for routine clinical biomarkers. Tissue sodium concentrations were compared between groups and correlations with blood-based biomarkers were explored. RESULTS Tissue sodium concentrations in the skin, soleus and tibia were higher in HD and PD patients compared with controls. Serum albumin showed a strong, negative correlation with soleus sodium concentrations in HD patients (r = -0.81, P  less then  0.01). Estimated glomerular filtration rate showed a negative correlation with tissue sodium concentrations (soleus r = -0.58, P  less then  0.01; tibia r = -0.53, P = 0.01) in merged control-CKD patients. Hemoglobin was negatively correlated with tissue sodium concentrations in CKD (soleus r = -0.65, P = 0.02; tibia r = -0.73, P  less then  0.01) and HD (skin r = -0.60, P = 0.04; tibia r = -0.76, P  less then  0.01). CONCLUSION Tissue sodium concentrations, measured by 23Na MRI, increase in HD and PD patients and may be associated with adverse metabolic effects in CKD and dialysis. © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.Thyrotoxicosis is a general term for excess circulating and tissue thyroid hormone levels, whereas hyperthyroidism specifically denotes disorders involving a hyperactive thyroid gland (Graves disease, toxic multinodular goiter, toxic adenoma). Diagnosis and determination of the cause rely on clinical evaluation, laboratory tests, and imaging studies. Hyperthyroidism is treated with antithyroid drugs, radioactive iodine ablation, or thyroidectomy. Other types of thyrotoxicosis are monitored and treated with β-blockers to control symptoms given that most of these conditions resolve spontaneously.Venous thromboembolism (VTE), which includes both deep venous thrombosis and pulmonary embolism, is a common and potentially fatal condition. Medical inpatients are at high risk for VTE because of immobility as well as acute and chronic illness. Several randomized trials demonstrated that chemoprophylaxis, or low-dose anticoagulation, prevents VTE in selected medical inpatients. The 2018 American Society of Hematology clinical practice guideline on prophylaxis for hospitalized and nonhospitalized medical patients conditionally recommends chemoprophylaxis for non-critically ill medical inpatients, leaving much to the discretion of the treating physician. Here, 2 experts, a hematologist and a hospitalist, reflect on the care of a woman hospitalized with a rheumatologic disorder. They consider the risks and benefits of chemoprophylaxis, discuss VTE risk stratification, and recommend which patients should receive chemoprophylaxis and with which agents.Background Medicare uses the Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) model to predict patients' annualized Medicare costs in value-based payment programs. The CMS-HCC model does not include measures of frailty, and prior research shows that it systematically underpredicts costs for frail Medicare beneficiaries. Objective To determine whether a claims-based frailty index can improve Medicare cost prediction. Design Retrospective cohort study. Setting Medicare Current Beneficiary Survey linked to Medicare claims, 2006 to 2013. Participants 16 535 community-dwelling, fee-for-service beneficiaries representing 26 705 patient-years. Measurements Patient frailty status was classified using a validated claims-based frailty index. The association between the frailty index and annualized Medicare costs was examined, and regression methods were used to compare observed Medicare costs versus predictions based on the standard CMS-HCC model with and without the frailty index. Resnding Source None.BACKGROUND While the popular workflow manager Galaxy is currently made available through several publicly accessible servers, there are scenarios where users can be better served by full administrative control over a private Galaxy instance, including, but not limited to, concerns about data privacy, customisation needs, prioritisation of particular job types, tools development, and training activities. In such cases, a cloud-based Galaxy virtual instance represents an alternative that equips the user with complete control over the Galaxy instance itself without the burden of the hardware and software infrastructure involved in running and maintaining a Galaxy server. RESULTS We present Laniakea, a complete software solution to set up a "Galaxy on-demand" platform as a service. Building on the INDIGO-DataCloud software stack, Laniakea can be deployed over common cloud architectures usually supported both by public and private e-infrastructures. https://www.selleckchem.com/products/AZD6244.html The user interacts with a Laniakea-based service through a simple front-end that allows a general setup of a Galaxy instance, and then Laniakea takes care of the automatic deployment of the virtual hardware and the software components.

There was significant thinning in SFCT between 1-2, 1-3, 1-4, 2-3, 2-4, and 3-4 time intervals within both group A and group B (both P less then 0.001). Comparison of SFCT measurements showed preinjection, 1-, and 2-month values of group A were significantly thicker than those of group C (P less then 0.001), whereas there was no significant difference between 3-month values (P = 0.09). Preinjection, 1-, and 2-month values of group B were significantly thicker than those of group C (P less then 0.001), whereas there was no significant difference between 3-month values (P = 0.06). Conclusions Three month follow-up showed thinning in SFCT measurements in patients with persistent DME unresponsive to IVR who were applied IVD or IVA treatment.Background Patients are increasingly turning to the internet for health education. Due to the complex pathophysiology, clinic-diagnostic profile, and management spectrum of pituitary tumors, an evaluation of the readability of printed online education materials (POEMs) regarding this entity is warranted. Objective (1) To apply established readability assessment tools to internet search results on the topic of pituitary tumors. (2) To identify sources of complexity in order to guide the creation POEMs that are in line with the reading level of the target audience. Methodology After independent, neutral internet search for the phrase "pituitary tumor," the first 100 results were subjected to inclusion criteria matching. Analysis was performed using 5 readability assessment tools including Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Score (GFS), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Results A total of 82 websites met inclusion criteria. All websites were found to be at a higher reading level (P less then .01) than the United States Department of Health and Human Services (USDHHS) recommended sixth-grade level. Mean readability scores were as follows FRE, 38.79; FKGL, 11.27; GFS, 12.83; CLI, 17.31; SMOG, 12.12. Intergroup comparison between FKGL, GFS, CLI, and SMOG yielded that CLI was significantly higher (P less then .03). No significant differences in readability were noted between academic and other websites. Conclusion There is a significant misalignment between the reading level of patients and the readability of pituitary tumor POEMs. This may lead patients to misconceive their diagnoses, management options, and prognosis.Significance The vascular extracellular matrix (ECM) not only provides mechanical stability but also manipulates vascular cell behaviors, which are crucial for vascular function and homeostasis. ECM remodeling, which alters vascular wall mechanical properties and exposes vascular cells to bioactive molecules, is involved in the development and progression of hypertension. Recent Advances This brief review summarized the dynamic changes in ECM components and their modification and degradation during hypertension and after antihypertensive treatment. We also discussed how alterations in the ECM amount, assembly, mechanical properties, and degradation fragment generation provide input into the pathological process of hypertension. Critical Issues Although the relevance between ECM remodeling and hypertension has been recognized, the underlying mechanism by which ECM remodeling initiates the development of hypertension remains unclear. Therefore, the modulation of ECM remodeling on arterial stiffness and hypertension in genetically modified rodent models is summarized in this review. The circulating biomarkers based on ECM metabolism and therapeutic strategies targeting ECM disorders in hypertension are also introduced. Future Directions Further research will provide more comprehensive understanding of ECM remodeling in hypertension by the application of matridomic and degradomic approaches. https://www.selleckchem.com/products/LY335979.html The better understanding of mechanisms underlying vascular ECM remodeling may provide novel potential therapeutic strategies for preventing and treating hypertension.Oxidative stress may play a crucial role in cardiac and vascular abnormalities in different types of cardiovascular diseases. In the present study, we explored the mechanism underlying oxidative stress-mediated cardiomyocyte apoptosis with a focus on the Akt-p53 signaling pathway. In vitro, cardiomyocyte was cultured with different concentrations of hydrogen peroxide. Then, cardiomyocyte viability, apoptosis rate and signaling pathway were analyzed through ELISA, immunofluorescence, qPCR and western blots. The results indicated that oxidative stress caused cardiomyocyte apoptosis in a dose-dependent manner. Mechanistically, oxidative stress inhibited cardiomyocyte glucose metabolism and promoted lactic acid accumulation. Besides, oxidative stress triggered calcium overload in cardiomyocyte. Finally, we found that oxidative stress inhibited the activity of Akt pathway while activated p53 signaling pathway. Genetic knockdown of p53 abolished oxidative stress-mediated cardiomyocyte injury and death through regulating the expressions and activities of caspase-3 and Bax. Altogether, our results illustrate that oxidative stress is associated with cardiomyocyte apoptosis through a mechanism involving dysregulated Akt/p53 signaling pathway.Primary effusion lymphoma is a rare, clinically aggressive large B-cell neoplasm universally associated with human herpesvirus 8 that occurs in the setting of immune compromise. It is classically described as a lymphomatous effusion occurring within body cavities. Recently, however, solid tumor masses, and rarely an intravascular form, have been described. We report a case of a cutaneous intravascular primary effusion lymphoma occurring within ectatic vascular spaces of a Kaposi sarcoma skin lesion in a human immunodeficiency virus-positive adult. Human herpesvirus 8 immunohistochemistry was positive in the nuclei of the Kaposi sarcoma spindled cells as well as within large intravascular plasmacytoid cells. This unusual case highlights the importance of careful assessment of the nature of human herpesvirus 8-positive staining cells in an otherwise typical Kaposi sarcoma. A careful search for dual pathology in immune-compromised patients as well as the importance of histologic assessment of skin lesions in human immunodeficiency virus-positive patients is also highlighted.

The E-cigarette market continues to expand at an alarming rate with thousands of flavours available for purchase and continuously evolving devices. Now that it is a multi-billion dollar industry and one without stringent regulation, there is rising concern over the safety of vaping products. Since June 2019, over 2800 cases of E-cigarette-associated acute lung toxicity have been reported in the USA, over 60 of which resulted in death. Many argue that E-cigarettes offer a safer alternative to smoking, but we are evidently far from fully understanding the potential hazards that they pose to respiratory health. Although the risk of an outbreak in the UK has been considered low due to tighter E-cigarette regulations, we cannot fully eliminate the possibility of similar events occurring in the future. With evidence frequently emerging of the harmful effects of E-cigarettes to pulmonary health, there is an urgent need to define the long-term implications of vaping. Studies show that E-cigarette exposure can disrupt pulmonary homeostasis, with reports of gas exchange disturbance, reduced lung function, increased airway inflammation and oxidative stress, downregulation of immunity, and increased risk of respiratory infection. In this review, the latest research on the effect of E-cigarette use on respiratory health will be presented.Aims The 2019 update to the US consensus guideline for vancomycin therapeutic monitoring advocates using Bayesian-guided personalised dosing to maximise efficacy and minimise toxicity of vancomycin. We conducted an observational cohort study of the implementation of bed-side Bayesian-guided vancomycin dosing in vascular surgery patients. Methods Over a 9-month prospective study period, vascular surgery patients were dosed vancomycin using Bayesian-guided dosing decision tool (DoseMeRx) and compared retrospectively with a control group admitted to the same ward in the 14 months prior to the study and dosed using a standard algorithmic approach. Primary endpoints were proportion of patients achieving mean area under the curve in 24 hours (AUC24 ) in the acceptable range 350-450 mg/L• h and percentage time in acceptable range (%TTR). Secondary endpoints focused on clinical outcomes including incidence of acute kidney injury. Results A significantly higher proportion of DoseMeRx patients achieved mean AUC24 values in the acceptable range compared to the control group; 71/104 (68.3%) vs 58/139 (41.7%), P less then .005. The median %TTR was also greater in DoseMeRx patients compared to the control group (57.1 vs 30.0%, P less then .00001). Patients in the DoseMeRx group missed an average of 0.23 doses per course compared to 1.04 doses in the control group (P less then .00001). No difference was observed in secondary (clinical) outcomes between the 2 groups. Conclusion Bedside Bayesian-guided personalised dosing of vancomycin increases the proportion of patients achieving target AUC24 and the %TTR.Antiangiogenesis is a promising approach to cancer therapy but is limited by the lack of tumor-homing capability of the current antiangiogenic agents. Angiogenin, a protein overexpressed and secreted by tumors to trigger angiogenesis for their growth, has never been explored as an antiangiogenic target in cancer therapy. https://www.selleckchem.com/products/stattic.html Here it is shown that filamentous fd phage, as a biomolecular biocompatible nanofiber, can be engineered to become capable of first homing to orthotopic breast tumors and then capturing angiogenin to prevent tumor angiogenesis, resulting in targeted cancer therapy without side effects. The phage is genetically engineered to display many copies of an identified angiogenin-binding peptide on its side wall and multiple copies of a breast-tumor-homing peptide at its tip. Since the tumor-homing peptide can be discovered and customized virtually toward any specific cancer by phage display, the angiogenin-binding phages are thus universal "plug-and-play" tumor-homing cancer therapeutics.Background Treatment of patients with head and neck cancer can result in disrupted mastication. To measure masticatory performance in people with compromised mastication, the mixing ability test (MAT) was developed. Objective In this study, the reliability of the MAT was evaluated in patients with head and neck cancer and healthy controls. Methods Thirty-four patients with head and neck cancer and 42 healthy controls performed the MAT twice on the same day. To assess reliability, the intra-class correlation coefficient (ICC2,1 ), standard error of measurement (SEM), smallest detectable change (SDC) and limits of agreement (LoA) were calculated. Results A good (ICC = 0.886) and moderate correlation (ICC = 0.525) were found for patients and healthy controls, respectively. Patients had a worse mixing ability (mean = 19.12, SD = 4.56) in comparison with healthy controls (mean = 16.42, SD = 2.04). The SEM was 0.76 in patients and 1.45 in healthy controls, with a SDC of 2.12 and 4.02, respectively. The LoA was -4.46 to 4.42 in patients and -3.65 to 4.59 in healthy controls. Conclusion The MAT has a good reliability in patients with head and neck cancer and a moderate reliability in healthy controls.FoxA2 is an essential transcription factor for liver organogenesis and homeostasis. Although reduced expression of FoxA2 has been associated with chronic liver diseases, hepatic progenitor cells (HPCs) that are activated in these circumstances express FoxA2. However, the functional effects and underlying mechanism of FoxA2 in HPCs are still unknown. As revealed by immunostaining, HPCs expressed FoxA2 in human cirrhotic livers and in the livers of choline-deficient diet supplemented with ethionine (CDE) rats. Knocking down FoxA2 in HPCs isolated from CDE rats significantly increased cell proliferation and aerobic glycolysis. Moreover, gene transcription, protein expression, and the enzyme activities of hexokinase 2 (HK2) were upregulated, and blocking HK2 activities via 2-deoxyglucose markedly reduced cell proliferation and aerobic glycolysis. Kyoto Encyclopedia of Genes and Genomes analysis revealed that FoxA2 knockdown enhanced the transcription of genes involved in the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway and triggered downstream Akt phosphorylation.

Conclusions The expression levels of differentially expressed genes in biological function "Organismal Injury and Abnormalities" were displayed and validated. Our current study helps to obtain a better understanding of the biological processes of peripheral nerve regeneration, especially the regeneration process in the proximal nerve stumps, and thus may help to discover new therapeutic methods that can promote nerve regeneration. 2019 Annals of Translational Medicine. All rights reserved.Background Cleft palate results from the defective palatal fusion of the medial-edge epithelium after cells undergo epithelial-mesenchymal transition, a process that involves regulation by microRNAs (miRNAs). However, in palatal shelf fusion, miRNA regulation by long non-coding RNAs (lncRNAs) when acting as competing endogenous RNAs (ceRNAs) or miRNA sponges, remains unclear. Methods We systematically analyzed the correlation between lncRNAs, miRNAs, and mRNAs from RNA sequencing profiling in embryonic gestation day 14.5 (E14.5) mouse embryos from control (n=3) and all-trans retinoic acid (ATRA)-treated (n=3) mice. We then constructed a lncRNA-associated ceRNA network. The expression profiles of mRNA, lncRNA, and miRNA were verified by quantitative polymerase chain reaction (qPCR). https://www.selleckchem.com/products/Imatinib-Mesylate.html Results In total, 18 aberrantly expressed miRNAs, 861 mRNAs, and 583 lncRNAs were identified from palate samples of control and ATRA-treated samples. Bioinformatics data and integrative analysis identified 69 lncRNAs, 18 miRNAs, and 78 mRNAs that were aberrantly expressed, and a ceRNA network was then constructed. Finally, we identified a NONMMUT004850.2/NONMMUT024276.2-miR-741-3p/miR-465b-5p-Prkar1α ceRNA network associated with palatal shelf fusion at E14.5. The qPCR results showed that NONMMUT004850.2 (P=5E-05), NONMMUT024276.2 (P=0.0012), and Prkar1α (P=3E-05) were up-regulated, whereas miR-741-3p (P=0.006) and miR-465b-5p (P=1E-04) were down-regulated in ATRA-treated mice compared to the control samples. The qPCR results were in concordance with the RNA sequencing profiling. Conclusions Our study demonstrated that NONMMUT004850.2/NONMMUT024276.2-miR-741-3p/miR-465b-5p-Prkar1α could potentially serve as an important regulatory mechanism of palatal fusion in the development of the cleft palate. 2019 Annals of Translational Medicine. All rights reserved.Background Thymectomy is widely used to for the treatment of thymomas, thymic cysts, thymic adenocarcinomas, and other thymic diseases. The development of video-assisted thoracoscopic surgery (VATS) thymectomy by our team offers the advantages of a glasses-free 3D thoracoscopic system for pulmonary surgery. The aim of the present retrospective study was to compare the advantages and short-term outcomes of glasses-free 3D VATS vs. 2D VATS for the treatment of thymic diseases. Methods The medical records of patients who underwent traditional 2D and glasses-free 3D video-assisted thoracoscopic thymectomy at the First Affiliated Hospital of Guangzhou Medical University from May 2015 to December 2018 were retrospectively reviewed, while focusing on the collection, evaluation, and comparison of clinical data and perioperative manifestations. Results A total of 152 patients were included, of which 71 patients underwent glasses-free 3D VATS and 81 underwent 2D VATS. There were no significant differences in demographinnals of Translational Medicine. All rights reserved.Background This study investigated the prevalence of insulin refusal and compared the level of psychological insulin resistance (PIR) with the intention to accept insulin therapy among Korean patients with type 2 diabetes. Methods Type 2 diabetes patients (n=1,209) were recruited from inner city outpatient diabetes clinics in 2016. Patient demographic, insulin recommendation, diabetes treatment type, intention to receive insulin therapy, and PIR information was collected using self-reports. The patients were divided into three groups those who refused insulin therapy (n=184), those who accepted insulin therapy (n=331), and those not recommended for insulin therapy (n=694). Descriptive statistics were used to calculate the prevalence of insulin refusal; t-tests and analyses of variance were used to compare demographics with PIR. Results The insulin refusal rate was 35.7%. The duration of diabetes, numbers of diabetes-related complications, and glycated hemoglobin levels were significantly lower in the group not recommended for insulin therapy than refused and accepted insulin groups. The level of PIR in insulin refusal group was significantly lower among patients agreeing to receive insulin therapy within 3 months than among those refusing insulin therapy. Conclusions The prevalence of insulin refusal in Korea is not low, and people who refuse insulin therapy have high levels of PIR. Strategies to reduce PIR levels are needed. 2019 Annals of Translational Medicine. All rights reserved.Background The purpose of this study was to investigate the association between HPV 16 status and survival outcomes in patients with non-oropharyngeal squamous carcinoma (non-OPSCC). Methods Patients with non-OPSCC diagnosed between 2006 and 2016 were included in this study. The presence of HPV 16 DNA was confirmed by quantitative real-time polymerase chain reaction. Survival analysis was performed using Kaplan-Meier estimates, the Cox proportional hazards model, and propensity score matching (PSM). Results Overall, 1,539 patients with adequate specimens were identified, of whom 131 (8.51%) were positive for HPV 16. Compared to HPV 16-negative patients, the adjusted hazard ratios (aHR) for HPV 16-positive non-OPSCC patients were 0.77 and 0.81 for disease-specific survival (DSS) and overall survival (OS), respectively. Additionally, the larynx was the only subsite in which DSS was significantly improved. After PSM, cohorts consisted of 129 patients in the HPV 16-positive group and 129 in the HPV 16-negative group. HPV 16-positive non-OPSCC patients had favorable survival outcomes, however, these outcomes were not significantly different compared to HPV 16-negative patients. Stratified analysis performed according to primary site showed that only in the larynx was HPV 16-positive status a significant factor for predicting favorable DSS. Conclusions Our findings indicate that HPV 16-positive non-OPSCC patients did not have significantly better survival outcomes compared to HPV 16-negative patients. 2019 Annals of Translational Medicine. All rights reserved.

Purpose To investigate the recurrence rate of Helicobacter pylori infection after eradication in Jiangjin District, Chongqing, China, and to analyze the related causes. Methods Outpatients who were eradicated of H. pylori infection with standard therapy between August 2014 and August 2017 were included in this study. The recurrence rate was investigated 1 year later. Data regarding gender, smoking, alcohol intake, frequency of eating out, and treatment strategy were recorded, and their relationships with the recurrence rate were analyzed. Multivariate logistic regression analysis was performed to determine the independent risk factors for H. pylori infection recurrence. Results In total, 400 patients (225 males and 175 females) were included in this study. Of them, the recurrence rate of H. pylori infection was 4.75% (19/400), with 5.33% (12/225) in males and 4.57% (7/175) in females, showing no gender difference. The recurrence rate was 7.03% (9/128) in smokers and 3.68% (10/272) in nonsmokers, while it was 6.45% (12/186) in those who drink alcohol and 3.27% (7/214) in those who do not drink alcohol, showing no significant differences. The higher the frequency of eating out, the higher the recurrence rate of H. pylori infection (P = 0.001). There was a statistically significant difference in the recurrence rate between patients receiving treatment alone and patients whose family members also received treatment (6.08% vs. 0.96%, P = 0.035). Drinking and dining out were independent risk factors for H. pylori infection recurrence (P = 0.014 for drinkers and P = 0.015 and P = 0.003 for those who sometimes and often dine out, respectively). Conclusions The overall recurrence rate after H. pylori eradication by standard therapy in Jiangjin District is 4.75%. Reducing the frequency of eating out and family members receiving treatment may reduce the recurrence of H. pylori infection. Copyright © 2020 Gang Zhou.[This corrects the article DOI 10.1155/2018/2968252.]. Copyright © 2020 Liang Sun et al.Results Acute ischemia of the bowel mesentery was diagnosed in 41 patients (27 women and 14 men; mean age, 65.4 years). All patients underwent laparotomy. For 13 (31.71%) patients, surgery was performed within the first 24 hours of the clinical symptom onset. Mesenteric artery embolectomy without intestine resection was performed for 7 (17.07%) patients. Partial intestine resection due to necrosis was performed for 21 (51.22%) patients. Exploratory laparotomy without a therapeutic procedure was performed for 13 (31.71%) patients. Fifteen (36.59%) patients were discharged home in good general condition. Twenty-six (63.41%) patients died. The time from the clinical symptom onset until intervention exceeded 24 hours for all patients who died. Surgery within the first 24 hours reduced mortality associated with acute mesenteric ischemia (P = 0.001). Female sex, age older than 65 years, obesity (body mass index > 30), diabetes, chronic kidney disease, and smoking were adverse prognostic factors for increased mortality for patients with acute bowel ischemia. Conclusion The time from clinical symptoms to acute mesenteric ischemia treatment was the main prognostic factor and helped determine appropriate management. Early diagnosis and rapid intervention improved treatment outcomes and survival. Copyright © 2020 Mateusz Jagielski et al.Objective To investigate the efficacy and safety of the combination use of tegafur and apatinib as a first-line therapy strategy in advanced gastric cancer (GC). Methods The present study included a total of 62 advanced GC patients. The patients were randomized into the combined group (treated with both tegafur and apatinib) and the control group (treated with only tegafur). Treatment efficacy, KPS score, nutrition condition, and progression-free survival time (PFS) were recorded. Results Both the response and disease control rates were significantly higher in the combined group. The PFS time was remarkably higher and the KPS score was significantly reduced in the combined group after treatment. After treatment, both groups showed significantly increased nutrition risk, but the rates of patients with nutrition risk or innutrition were remarkably higher in the combined group. The ADR rates were also significantly higher in the combined group. Conclusion The combination use could achieve good efficacy and prolong patients' PFS time; however, apatinib also reduced the patients' quality of life and enhanced the nutrition risk and adverse drug reactions. Copyright © 2020 Chaofeng Li et al.Objective To investigate the safety and feasibility of endoscopic nasogallbladder drainage (ENGBD) combined with laparoscopic surgery for Mirizzi syndrome type I with acute cholecystitis. Methods An analysis of 4 patients with type I Mirizzi syndrome with acute cholecystitis admitted to the First Hospital of Jilin University. Results The patients underwent ENGBD, and laparoscopic surgery was evaluated postoperatively. https://www.selleckchem.com/products/Imatinib-Mesylate.html All four patients successfully recovered from this combined surgical approach. Conclusion The combination of ENGBD and laparoscopic surgery is safe and feasible for the treatment of patients with type I Mirizzi syndrome accompanied by acute cholecystitis. This approach may reduce the traumatic stress on patients and is worthy of widespread implementation. Copyright © 2020 Wei Han et al.Aim To develop and validate a simple-to-use nomogram for prediction of 3-/5-year survival in patients with N0M0 hepatocellular carcinoma after curative liver resection. Patients and Methods. Patients diagnosed HCC with hepatic resection in the Surveillance, Epidemiology, and End Results (SEER) database were included to identify prognostic factors of overall survival. Multivariate Cox regression were used to create a nomogram. Results We identified 4856 HCC with hepatic resection from the SEER database. A nomogram to predict long-term survival with a C-index 0.667 (95% CI, 0.653 to 0.681) is more efficient than TNM staging with a lower C-index 0.613 (95% CI, 0.597 to 0.629). The C-index was confirmed to be 0.663 (95% CI, 0.640 to 0.686) through validation, suggesting a good discrimination and a good prediction capability. Conclusions The nomogram is a simple and effective screening tool for assessing the prognosis of HCC with hepatic resection and assists with the planning of individual postoperative surveillance protocols.

0% of patients did not have worsening of bone density, while 21.0% had new osteopenia or osteoporosis; many patients were prescribed treatment for bone loss. Older age, increased duration of anti-epileptic drug (AED) usage, and low body mass index (BMI) were risk factors for abnormal BMDs. Based on the first DXA scan, the FRAX calculator estimated that none of the patients in this study had a 10-year risk of more than 20% for developing major osteoporotic fracture (hip, spine, wrist, or humeral fracture). However, in this population, 11 patients (13.6%) sustained a major osteoporotic fracture after their first DXA scan. Significance Despite being routinely screened and frequently treated for bone mineral density loss and fracture prevention, many patients with epilepsy suffered new major osteoporotic fractures. This observation is especially important as persons with epilepsy are at high risk for falls and traumas.Objective To investigate feasibility, safety, and tolerability of long-term (48 weeks) add-on treatment with triheptanoin (UX007), the triglyceride of heptanoate, in adults with drug-resistant epilepsy. Methods This extension study was offered to adult participants with drug-resistant epilepsy who completed a 12-week randomized controlled trial of add-on medium-chain triglycerides (MCT) vs triheptanoin. Participants were asked to titrate triheptanoin to their maximum tolerated dose over 3 weeks, followed by 48-week maintenance before tapering or treatment extension. The primary aims were to assess retention and safety of the triheptanoin treatment, and secondary aims to assess the tolerated doses and changes in seizure frequency. Results Eleven adults were enrolled and ten people were analyzed (because one patient was diagnosed as having nonepileptic seizures while on the study). Two adults finished the study and extended their treatment. Eight participants withdrew from the study, due to lack of efficacy (n N12615000406505.Objective The importance of school teachers' knowledge of and attitudes toward epilepsy and the communication between educational and medical systems is widely appreciated, but exploration of these factors in Japan has been extremely limited. In order to identify issues in support systems for students with epilepsy and bridge the gaps in communication between schools and medical institutions in Japan, we performed a nationwide questionnaire survey of nurse teachers (nurses in charge of health education/care at schools). Methods We mailed a questionnaire to 900 nurse teachers all over Japan. It included six items on general epilepsy knowledge and 15 items on information about each student with epilepsy in their schools. We used a modified grounded theory approach (M-GTA) to analyze open-ended questions. Results We received responses from 640 (71.1%) nurse teachers. In their schools, there were 237 253 students, of whom 1565 had epilepsy. Most nurse teachers (84.7%) understood that epilepsy is a neurological diObjective The epileptic baboon provides an animal model for juvenile myoclonic epilepsy (JME), demonstrating spontaneous generalized tonic-clonic seizures (GTCS) in addition to generalized myoclonic, absence and multifocal seizures. While photoconvulsive responses have been described in this model, spontaneous GTCS have not been characterized. Methods In this study, we characterized 46 seizures in 7 epileptic baboons (5 females, 12 ± 3 years old) by video recording. While housed in single cages, the baboons were monitored for a median of 2 (range 1-10) weeks, with high-resolution, infrared-capable camera systems. Each GTCS was evaluated for evidence of preconvulsive ictal symptoms, focal convulsive behaviors, duration of the preconvulsive and convulsive periods, postictal immobility, and recovery of an upright posture. The circadian pattern of GTCS was also for each baboon. Results More than half of GTCS occurred in sleep, beginning from an upright position in all but one tethered baboon. Focal semiological findings were noted in 19 (41%) GTCS, and these included preconvulsive focal ictal motor behaviors as well as lateralized motor activity during the convulsions. The convulsive portion lasted 47 ± 10 seconds, whereas the entire seizure lasted 54 ± 21 seconds. Postictally, the baboons remained immobile for a median latency of 40 (range 14-347) seconds, recovering an upright posture after 173 (range 71-1980) seconds. GTCS demonstrated circadian patterns in all but one baboon, with 34 (74%) all seizures occurring between 1-9 am. Significance GTCS in the baboon revealed intersubject variability, but semiology remained stereotyped in a given baboon. Similar to GTCS in people with JME, focal symptoms were also observed in epileptic baboons. The postictal recovery period, characterized by postictal immobility and myoclonus as well as time to recumbency, also varied among baboons.Objective Organophosphates (OPs) such as diisopropylfluorophosphate (DFP) and soman are lethal chemical agents that can produce seizures, refractory status epilepticus (SE), and brain damage. There are few optimal treatments for late or refractory SE. Phenobarbital is a second-line drug for SE, usually after lorazepam, diazepam, or midazolam have failed to stop SE. Practically, 40 minutes or less is often necessary for first responders to arrive and assist in a chemical incident. However, it remains unclear whether administration of phenobarbital 40 minutes after OP intoxication is still effective. Here, we investigated the efficacy of phenobarbital treatment at 40 minutes postexposure to OP intoxication. Methods Acute refractory SE was induced in rats by DFP injection as per a standard paradigm. After 40 minutes, subjects were given phenobarbital intramuscularly (30-100 mg/kg) and progression of seizure activity was monitored by video-EEG recording. The extent of brain damage was assessed 3 days after DFP inmay preclude its use as medical countermeasure in mass casualty situations.Objective The global burden of pediatric epilepsy is disproportionately concentrated in low- and middle-income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Épilepsie de Port-au-Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti. Methods A 10-year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data-driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest. Results Of the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. https://www.selleckchem.com/products/xmu-mp-1.html Very few children (7%) underwent cranial imaging. Although many patients were lost to follow-up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%).

The lung surfactant proteins are recognized as critical not only for their role in lowering lung surface tension but also in innate host defense. Reports have shown that some asthmatic patients have decreased levels of one member of this protein family in particular, surfactant protein-A (SP-A). Our studies set out to determine the contribution of SP-A to the response of a key effector cytokine in asthma, IL-13. Our studies employ both animal models sufficient and deficient in SP-A challenged with IL-13 and primary epithelial cells from participants with asthma that are exogenously treated with SP-A in the context of IL-13 challenge. The inflammatory response and mucin production were assessed in both model systems. As compared with WT mice, we show that the activity of IL-13 is dramatically augmented in SP-A-/- mice, which have significantly increased neutrophil and eosinophil recruitment, mucin production and asthma-associated cytokines in the bronchoalveolar lavage fluid. In parallel, we show asthma-associated factors are attenuated in human cells from asthma subjects when exogenous SP-A is added during IL-13 challenge. Although many of these phenotypes have previously been associated with STAT6 signaling, SP-A inhibited IL-13-induced STAT3 phosphorylation in mice and in human epithelial cells while having little effect on STAT6 phosphorylation. In addition, when either STAT3 or IL-6 were inhibited in mice, the phenotypes observed in SP-A-/- mice were significantly attenuated. These studies suggest a novel mechanism for SP-A in asthma as a modulator of IL-13-induced inflammation via mediating downstream IL-6/STAT3 signaling. Copyright © 2020 by The American Association of Immunologists, Inc.Leishmania major causes cutaneous leishmaniasis. An antileishmanial vaccine for humans is unavailable. In this study, we report development of two attenuated L. major strains-5ASKH-HP and LV39-HP-by continuous culture (high passage) of the corresponding virulent strains (low passage). Both avirulent strains showed similar changes in proteome profiles when analyzed by surface-enhanced laser desorption ionization mass spectrometry. Liquid chromatography-mass spectrometry and microarray characterization of 5ASKH strains revealed substantially altered gene and protein expression profiles, respectively. Both virulent and avirulent L. major strains grew comparably in culture, but the avirulent strain survived significantly less in BALB/c-derived peritoneal macrophages. Both attenuated strains failed to infect BALB/c mice and elicited IFN-γ, but not IL-4 and IL-10, responses. 5ASKH-HP parasites failed to induce significant infection even in severely immunocompromised- SCID or inducible NO synthase-, CD40-, or IL-12-deficient mice, indicating attenuation. The avirulent strain induced less IL-10, but higher IL-12, in macrophages. The avirulent strain failed to reduce CD40 relocation to the detergent-resistant membrane domain and to inhibit CD40-induced phosphorylation of the kinases Lyn and protein kinase C-β and MAPKs MKK-3/6 and p38MAPK or to upregulate MEK-1/2 and ERK-1/2 in BALB/c-derived peritoneal macrophages. The virulent and the avirulent strains reciprocally modulated CD40-induced Ras-mediated signaling through PI-3K and Raf-1. Avirulent 5ASKH-primed BALB/c mice were protected against virulent L. major challenge infection. The loss of virulence accompanied by substantially altered proteome profiles and the elicitation of host-protective immune responses indicate plausibly irreversible attenuation of the L. major strain and its potential use as a vaccine strain. Copyright © 2020 by The American Association of Immunologists, Inc.The ability to precisely design large proteins with diverse shapes would enable applications ranging from the design of protein binders that wrap around their target to the positioning of multiple functional sites in specified orientations. We describe a protein backbone design method for generating a wide range of rigid fusions between helix-containing proteins and use it to design 75,000 structurally unique junctions between monomeric and homo-oligomeric de novo designed and ankyrin repeat proteins (RPs). Of the junction designs that were experimentally characterized, 82% have circular dichroism and solution small-angle X-ray scattering profiles consistent with the design models and are stable at 95 °C. Crystal structures of four designed junctions were in close agreement with the design models with rmsds ranging from 0.9 to 1.6 Å. Electron microscopic images of extended tetrameric structures and ∼10-nm-diameter "L" and "V" shapes generated using the junctions are close to the design models, demonstrating the control the rigid junctions provide for protein shape sculpting over multiple nanometer length scales. Copyright © 2020 the Author(s). Published by PNAS.The disposable soma theory is a central tenet of the biology of aging where germline immortality comes at the cost of an aging soma [T. B. L. Kirkwood, Nature 270, 301-304 (1977); T. B. L. Kirkwood, Proc. https://www.selleckchem.com/products/mln2480.html R. Soc. Lond. B Biol. Sci. 205, 531-546 (1979); T. B. L. Kirkwood, S. N. Austad, Nature 408, 233-238 (2000)]. Limited resources and a possible trade-off between the repair and maintenance of the germ cells and growth and maintenance of the soma may explain the deterioration of the soma over time. Here we show that germline removal allows accelerated somatic healing under stress. We tested "the expensive germ line" hypothesis by generating germline-free zebrafish Danio rerio and testing the effect of the presence and absence of the germ line on somatic repair under benign and stressful conditions. We exposed male fish to sublethal low-dose ionizing radiation, a genotoxic stress affecting the soma and the germ line, and tested how fast the soma recovered following partial fin ablation. We found that somatic recovery from ablation occurred substantially faster in irradiated germline-free fish than in the control germline-carrying fish where somatic recovery was stunned. The germ line did show signs of postirradiation recovery in germline-carrying fish in several traits related to offspring number and fitness. These results support the theoretical conjecture that germline maintenance is costly and directly trades off with somatic maintenance. Copyright © 2020 the Author(s). Published by PNAS.

Presence of CB alteration correlated with greater central macular thickness (p = 0.0020), horizontal extent of edema (p = 0.0042), and worse baseline visual acuity (p = 0.0195). Type 2 CB alterations were associated with worse logMAR vision compared with type 1 at baseline and final examinations (p = 0.0002, p = 0.0470). CONCLUSIONS CB alterations were noted in the majority of eyes with CME from CRVO, uveitis, and IG. The association observed between CB alterations and central macular thickness suggests that these alterations may develop as a result of mechanical stress of Müller cells on the CB. Published by Elsevier Inc.Atrial fibrillation (AF) is an increasingly prevalent arrhythmia; its pathophysiology and progression are well studied. Stroke and bleeding risk models have been created and validated. Decision tools for stroke prophylaxis are evolving, with better options at hand. Utilization of various diagnostic tools offer insight into AF burden and thromboembolic risk. Rate control, rhythm control, and stroke prophylaxis are the cornerstones of AF therapy. Although antiarrhythmic drugs are useful, AF ablation has become a primary therapeutic strategy. Pulmonary vein isolation is the cornerstone of AF ablation, and methods to improve ablation safety and efficacy continue to progress. Ablation of nonpulmonary vein sites is increasingly being recognized as an important strategy for treating nonparoxysmal AF. Several new ablation techniques and technologies and stroke prophylaxis are being explored. This is a contemporary review on the prevalence, pathophysiology, risk prediction, prophylaxis, treatment options, new insights for optimizing treatment outcomes, and emerging concepts of AF. BACKGROUND Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT). OBJECTIVES The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality. METHODS From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates. RESULTS There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therap; p = 0.011). A left ventricular ejection fraction ≥35% (HR 0.46; 95% CI 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR 0.42; 95% CI 0.20 to 0.88; p = 0.021) were independently associated with less MACE. CONCLUSIONS The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality. BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) may reflect early prognosis in patients with valvular heart disease (VHD). https://www.selleckchem.com/products/gw-4064.html OBJECTIVES The aim of this study was to examine the association between NT-proBNP and mortality in elderly patients with VHD. METHODS A total of 5,983 elderly patients (age ≥60 years) with moderate or severe VHD underwent echocardiography and NT-proBNP measurement. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, and multivalvular heart disease. NT-proBNP ratio was defined as measured NT-proBNP relative to the maximal normal values specific to age and sex. Disease-specific thresholds were defined on the basis of penalized splines and maximally selected rank statistics. RESULTS The cohort had a mean age of 71.1 ± 7.6 years. At 1-year follow-up, 561 deaths (9.4%) had occurred. In penalized splines, relative hazards showed a monotonic increase with greater NT-proBNP ratio for death with different VHDragmatic and versatile biomarker in elderly patients. BACKGROUND Studies examining sex-related outcomes following percutaneous coronary intervention (PCI) have reported conflicting results. OBJECTIVES The purpose of this study was to examine the sex-related risk of 5-year cardiovascular outcomes after PCI. METHODS The authors pooled patient-level data from 21 randomized PCI trials and assessed the association between sex and major adverse cardiac events (MACE) (cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]) as well as its individual components at 5 years. RESULTS Among 32,877 patients, 9,141 (27.8%) were women. Women were older and had higher body mass index, more frequent hypertension and diabetes, and less frequent history of surgical or percutaneous revascularization compared with men. By angiographic core laboratory analysis, lesions in women had smaller reference vessel diameter and shorter lesion length. At 5 years, women had a higher unadjusted rate of MACE (18.9% vs. 17.7%; p = 0.003), all-cause death (10.4% vs. 8.7%; p = 0.0008), cardiac death (4.9% vs. 4.0%; p = 0.003) and ID-TLR (10.9% vs. 10.2%; p = 0.02) compared with men. By multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR] 1.14; 95% confidence interval [CI] 1.01 to 1.30; p = 0.04) and ID-TLR (HR 1.23; 95% CI 1.05 to 1.44; p = 0.009) but not all-cause death (HR 0.91; 95% CI 0.75 to 1.09; p = 0.30) or cardiac death (HR 0.97; 95% CI 0.73 to 1.29; p = 0.85). CONCLUSIONS In the present large-scale, individual patient data pooled analysis of contemporary PCI trials, women had a higher risk of MACE and ID-TLR compared with men at 5 years following PCI. BACKGROUND Atherosclerosis progression predicts cardiovascular events; however, progression of multiterritorial subclinical atherosclerosis is incompletely understood. OBJECTIVES This study sought to study short-term progression of atherosclerosis using different noninvasive imaging techniques and their relationship with cardiovascular risk. METHODS The study included 3,514 PESA (Progression of Early Subclinical Atherosclerosis) study participants (45.7 ± 4.2 years of age; 63% men). Participants underwent 2-dimensional vascular ultrasound (2DVUS) of abdominal aorta, carotid, iliac, and femoral territories to determine a plaque number score; 3DVUS to quantify carotid and femoral plaque volume; and coronary artery calcium score (CACS) at baseline and 2.8 years later. The authors calculated the rate of new disease incidence and changes in disease extent. Logistic regression models were used to evaluate associations of progression rates with baseline cardiovascular risk factors and estimated 10-year risk. RESULTS Imaging detected short-term (3-year) atherosclerosis progression in 41.

Societies experiencing rapid demographic transition may expect to face challenges such as accelerated population aging and increasing care-related needs. Decentralization of welfare states and resultant fragmentation of services is gaining increasing attention. In this study, we offer suggestions of how developing countries might move from fragmentation to integration of social and health care services. Using the Health Survey of Turkey (HST-2012) data with 15,000 households of populations' age 15 and older, we explore challenges to integrating social and health care service strategies in Turkey. Findings include inequities in material and service accessibility between rural and urban settings. Increasing numbers of older widowed women, especially in rural environments, will require direct income assistance over the coming decades. Additional findings include the need for primary and preventative health care services for middle age groups and strategies to address both unemployment among younger generations and barriers to work force participation for women. In conclusion, among rapid transition societies, it will take time to resolve decentralization-related regional inequalities in social and health services. Therefore, information and communications technologies (ICT) should be employed from an intersectionality perspective to more quickly bridge the services integration - regional inequalities gap in Turkey and possibly other societies in transition.This study investigates the transition to retirement of male academics. It applies approaches drawn from Cumulative Advantage and Disadvantage (CAD) principles to expand Continuity theory by examining evidence for continuity and inequalities in the lifestyles of the respondents. Biographical-Narrative interviews with 20 retired academics in Brazil and the United Kingdom were conducted and analysed using Thematic Analysis. An exploration of the same occupational group in different cultural and social contexts was carried out to capture a diversity of CAD influences on retirement outcomes. The experience of continuity was individualised to each participant due to their unique combination of advantages, and their subjective interpretation of their experiences. https://www.selleckchem.com/products/loxo-195.html Cumulative processes identified in this study related to (1) occupational roles played in their career; and (2) organisational level policies and practices for retirement. At the level of individual retired men, cultural and social context factors were not perceived as influential in the achievement of continuity in retirement. Continuity theory is still supported, but alone offers limited explanations of the diversity of experiences in the transition to retirement of male academics. A consideration of the role of cumulative processes and systemic dynamics, including how individuals respond to their experiences in retirement, shows how these different factors interact and affect retirement and ageing. Further studies should investigate the processes identified with other occupations, as well as women and minority groups.Social isolation relates to a lack of social contacts and interactions with family members, friends or the wider community, and results in diminished health and well-being. And yet many interventions aimed at enhanced social participation are not effective because they do not match the needs of the socially isolated older adults themselves. Little is known about the experiences of socially isolated older adults and their need for help and support. In this paper, we use concepts from Giddens' structuration theory to understand the strategies they use to deal with social isolation in everyday life. We report on findings from in-depth interviews with 25 community-dwelling socially isolated older adults (aged 63-86). Most of them were interviewed two or three times with in-between periods of one to three years. The study shows that they see few possibilities for changing their situation. They consider their social skills as inadequate and choose a mode of behavior that they habitually follow and which implies a certain degree of safety. At the same time, these strategies further lower their chances of social integration and intensify their isolation. These long-term patterns of socialization make social isolation a persistent problem that in many cases takes on a structural character. This mechanism makes social isolation difficult to break through. Most socially isolated older adults have no desire to tackle their isolation but hope to solve their problems by themselves for as long as possible. Practical help may contribute to their self-reliance.This paper outlines the case for applying Bourdieu's writing on 'forms of capital' to the explication of the social divisions of later life. Much of the writing about class in later life pivots on the distinction between working and non-working life. Broadening the focus towards a more Bourdieusian conceptualisation of forms of capital offers a greater potential to delineate and account for social stratification in later life than that accorded by either treating older retired people as a more or less homogenously marginal class or by applying class analyses to later life based on the relations of capital and labour. The paper begins with an outline of Bourdieu's account of the three main forms of capital and their symbolic representation. This is followed by consideration of the various critiques that have been made of Bourdieu's formulation of his capitals alongside various elaborations and re-formulations. Finally various potential avenues are explored to illustrate how forms of capital may be realised in later life and the role they may play in determining its social stratification. Examples range from the financial capital represented by home ownership to the investment in embodied cultural capital made by the various technologies of the self that characterise third age cultures.As the U.S. population continues to age and will require increasing levels of care, scholars continue to question what conventional methods of "custodial care" and rehabilitation accomplish for the individuals receiving them, relative to those providing them. To this end, critical discourse surrounding the spatial institutionalization of older adults argues that formal institutions of care and rehabilitation are simply alternative and synonymous forms of incarceration and imprisonment. Using semi-structured interviews with ten male residents of a Rhode Island nursing home and ten incarcerated males at the Rhode Island state prison's medium security unit, this work explores the following questions within the existing scholarship of the medical sociology of confinement and incarceration In what ways are experiences of confinement alike for older adults living in prisons and for those living in nursing homes, and what do these similarities/differences imply about aging, disabled, and economically unproductive bodies as "deviant" and subsequently "criminal" as the traditional definition of the carceral space expands? Participant responses across the nursing home and prison settings fit into three categories, including "home as historical/home as negation," "institution as escape," and "self as non-human/self as non-agent.