3D Printed Cell Culture Chamber for Testing the Effect of Pump-Based Chronic Drug Delivery on Inner Ear Tissue.

Cochlear hair cell damage and spiral ganglion neuron (SGN) degeneration are the main causes of sensory neural hearing loss. Cochlear implants (CIs) can replace the function of the hair cells and stimulate the SGNs electrically. The condition of the SGNs and their spatial distance to the CI are key factors for CI-functionality. For a better performance, a high number of neurons and a closer contact to the electrode are intended. Neurotrophic factors are able to enhance SGN survival and neurite outgrowth, and thereby might optimize the electrode-nerve interaction. This would require chronic factor treatment, which is not yet established for the inner ear. Investigations on chronic drug delivery to SGNs could benefit from an appropriate in vitro model. Thus, an inner ear inspired Neurite Outgrowth Chamber (NOC), which allows the incorporation of a mini-osmotic pump for long-term drug delivery, was designed and three-dimensionally printed. The NOC's function was validated using spiral ganglion explants treated with ciliary neurotrophic factor, neurotrophin-3, or control fluid released via pumps over two weeks. The NOC proved to be suitable for explant cultivation and observation of pump-based drug delivery over the examined period, with neurotrophin-3 significantly increasing neurite outgrowth compared to the other groups.

Management of breast abscesses in nonlactating women.

Breast abscess in nonlactating women is a rare clinic-pathological entity. A retrospective analysis of all cases of breast abscesses in nonlactating women in a community teaching hospital from 2000 to 2006 was performed. We analyzed their clinical characteristics, prevalence of diabetes mellitus (DM), surgical and medical management, and clinical outcome. We identified 116 breast abscesses in 98 nonlactating women; 89 per cent of patients were black. At presentation, 63 patients (64%) had a known history of DM and eight patients (8%) had newly diagnosed DM. Patients with DM had an increased length of hospital stay than nondiabetic women (P < 0.01). Most patients (70%) were treated with incision and drainage and antibiotics with a mean time of abscess resolution of 47 +/- 54 days. There was no correlation with breast abscess and smoking history. Glycemic control was suboptimal with 46 per cent of subjects receiving insulin therapy during the hospital stay. We found a high prevalence of DM (72%) in nonlactating women presenting with breast abscess. Diabetic women had a longer hospital stay and longer duration of the abscess compared with the patients without diabetes. Diabetes screening in nonlactating women with breast abscess and intensified glycemic control might improve clinical outcome.

Breast abscesses in nonlactating women with diabetes: clinical features and outcome.

BACKGROUND: The association between diabetes and breast abscess in nonlactating women has not been previously reported in the literature. METHODS: Retrospective analysis of all cases of breast abscess in nonlactating women in a community teaching hospital from 2000 to 2006. We analyzed their clinical characteristics, prevalence of diabetes mellitus (DM), management, and clinical outcome. RESULTS: We identified 116 breast abscesses in 98 nonlactating women [age 48 +/- 14, (mean +/- SD), 89% African Americans]. At presentation, 63 patients (64%) had a known history of DM (duration: 8.5 +/- 5 years) and 8 patients (8%) had newly diagnosed DM. Among the remaining 27 women, 7 (26%) developed DM within 5 years of follow-up. The odds ratio of having diabetes in nonlactating women with breast abscess relative to those without breast abscess was estimated as 14.24 (95% confidence interval, 6.72-30.17). Most patients (89%) had a single abscess. Patients with DM had increased length of hospital stay (P < 0.01) and a more severe clinical course during follow-up. Most patients (70%) were treated with incision and drainage and antibiotics. Glycemic control was suboptimal with only 46% of subjects receiving insulin therapy during the hospital stay. CONCLUSIONS: Our study indicates a strong association between DM and breast abscess in nonlactating women. The high prevalence of DM (72%) and their more severe clinical course suggest that breast abscesses in nonlactating women should be considered among the "typical" infections associated with DM. Increased awareness and intensified glycemic control might improve clinical outcome in nonlactating women with breast abscesses.

Clenbuterol-contaminated heroin: cardiovascular and metabolic effects. A case series and review.

We report a series of six cases, admitted over a single weekend, following nasal inhalation of street drugs and exhibiting markedly atypical presentations. Clenbuterol, a beta2 adrenoceptor agonist, was identified as a contaminant. Increased awareness of the effects of specific adulterants is essential to the adequate management of these patients.

Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery.

OBJECTIVE: Hospital hyperglycemia, in individuals with and without diabetes, has been identified as a marker of poor clinical outcome in cardiac surgery patients. However, the impact of perioperative hyperglycemia on clinical outcome in general and noncardiac surgery patients is not known. RESEARCH DESIGN AND METHODS: This was an observational study with the aim of determining the relationship between pre- and postsurgery blood glucose levels and hospital length of stay (LOS), complications, and mortality in 3,184 noncardiac surgery patients consecutively admitted to Emory University Hospital (Atlanta, GA) between 1 January 2007 and 30 June 2007. RESULTS: The overall 30-day mortality was 2.3%, with nonsurvivors having significantly higher blood glucose levels before and after surgery (both P < 0.01) than survivors. Perioperative hyperglycemia was associated with increased hospital and intensive care unit LOS (P < 0.001) as well as higher numbers of postoperative cases of pneumonia (P < 0.001), systemic blood infection (P < 0.001), urinary tract infection (P < 0.001), acute renal failure (P = 0.005), and acute myocardial infarction (P = 0.005). In multivariate analysis (adjusted for age, sex, race, and surgery severity), the risk of death increased in proportion to perioperative glucose levels; however, this association was significant only for patients without a history of diabetes (P = 0.008) compared with patients with known diabetes (P = 0.748). CONCLUSIONS: Perioperative hyperglycemia is associated with increased LOS, hospital complications, and mortality after noncardiac general surgery. Randomized controlled trials are needed to determine whether perioperative diabetes management improves clinical outcome in noncardiac surgery patients.