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( Rene Rodriguez Gutierrez ),( Roberto Monreal Robles ),( Maria Azucena Zapata Rivera ),( Karla V Rodriguez Velver ),( Fernando Jj Lavallegonzalez ),( Jose Gerardo Gonzalez Gonzalez ),( Jesus Zacarias 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background and Description: The association of chronic tophaceous gout with severe hypercalcemia is extremely rare and has been usually associated with calcitriol secretion. PTHrP has never been described as the responsible cause. A 42-year old man with a long stand history of chronic gout initiated a week before admission with polyuria, polypsia and progressive altered mental status. Neurological examination revealed only lethargy. Characteristic, multiple, non-tender tophi were obvious at inspection (Figures 1-3). Initial laboratory work up revealed a uric acid of 14.0 mg/dl, calcium of 14.5 mg/dl, phosphorous of 6.3 mg/dl, creatinine of 5.4 mg/dl, blood nitrogen urea of 56, a MDRD GFR of 16 ml/min. Diagnostic and Therapeutic Approach: PTH was suppressed (< 3.0 pg/ml), 25-dihydroxyvitamin D was normal, PTHrP was elevated 45.0 pg/ml, and calcitriol normal (19.6 pg/ml). Radiographs revealed bone erosions (Figure 1-3). Bone scan and a PET-CT were negative for metastasis and malignancy. Treatment was initiated with calcitonin, hydration and prednisone. PTH, 25-dihydroxyvitamin D, PTHrP, and calcitriol returned to normal values. At 6 months follow-up he referred no pain, tophi had improved and calcium levels were within normal range. Discussion and Conclusion: A systemic research on PubMed, Medline, Embase and MedConsult with the search criteria: “Tophaceous gout”, hypercalcemia”, “calcitriol”, “PTHrP”, was made. The proposed mechanism has being an enhanced 1a-hydroxylation of vitamin D in a proliferative chronic synovitis. In this case calcitriol levels were normal. PTHrP had never been, until now, described as the responsible cause of hypercalcemia in gout. In our case baseline PTHrP and calcium values were elevated and after medical treatment both returned to normal values. Immobilization is another well-known cause of mild calcium elevations. It is likely that in this case this was an exacerbating rather than the primary factor.
BoxBroker: A Policy-Driven Framework for Optimizing Storage Service Federation
( Rene Heinsen ),( Cindy Lopez ),( Eui-Nam Huh ) 한국인터넷정보학회 2018 KSII Transactions on Internet and Information Syst Vol.12 No.1
Storage services integration can be done for achieving high availability, improving data access performance and scalability while preventing vendor lock-in. However, multiple services environment management and interoperability have become a critical issue as a result of service architectures and communication interfaces heterogeneity. Storage federation model provides the integration of multiple heterogeneous and self-sufficient storage systems with a single control point and automated decision making about data distribution. In order to integrate diverse heterogeneous storage services into a single storage pool, we are proposing a storage service federation framework named BoxBroker. Moreover, an automated decision model based on a policy-driven data distribution algorithm and a service evaluation method is proposed enabling BoxBroker to make optimal decisions. Finally, a demonstration of our proposal capabilities is presented and discussed.
Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion
Renee Ren,Calista Dominy,Brian Bueno,Sara Pasik,Jonathan Markowitz,Brandon Yeshoua,Brian Cho,Varun Arvind,Aly A. Valliani,Jun Kim,Samuel Cho 대한척추신경외과학회 2023 Neurospine Vol.20 No.1
Objective: The “weekend effect” occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF. Methods: All ECSF patients > 18 years were retrospectively identified from the 2016–2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates. Results: Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism. Conclusion: Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.