Proteomic Analysis of Dorsal Root Ganglia in a Mouse Model of Paclitaxel-Induced Neuropathic Pain.

Paclitaxel is a chemotherapy drug widely used for the treatment of various cancers based on its ability to potently stabilize cellular microtubules and block division in cancer cells. Paclitaxel-based treatment, however, accumulates in peripheral system sensory neurons and leads to a high incidence rate (over 60%) of chemotherapy induced peripheral neuropathy. Using an established preclinical model of paclitaxel-induced peripheral neuropathy (PIPN), we examined proteomic changes in dorsal root ganglia (DRG) of adult male mice that were treated with paclitaxel (8 mg/kg, at 4 injections every other day) relative to vehicle-treated mice. High throughput proteomics based on liquid chromatography electrospray ionization mass spectrometry identified 165 significantly altered proteins in lumbar DRG. Gene ontology enrichment and bioinformatic analysis revealed an effect of paclitaxel on pathways for mitochondrial regulation, axonal function, and inflammatory purinergic signaling as well as microtubule activity. These findings provide insight into molecular mechanisms that can contribute to PIPN in patients.

Cost of care for subjective tinnitus in relation to patient satisfaction.

OBJECTIVE: A consistent management algorithm for subjective tinnitus remains to be elucidated. Chronic tinnitus yields approximately US$2110 in annual health care costs per patient. However, it is unclear whether spending more in the management of tinnitus equates with greater patient satisfaction. Thus, the aim of this study is to correlate patient satisfaction with patient demographics, provider recommendations, and total health care-related expenditures. STUDY DESIGN: A retrospective chart review and a patient satisfaction questionnaire. SETTING: All data were collected from a large Midwestern hospital. SUBJECTS AND METHODS: Patients were included who presented to the tinnitus clinic during the year 2011 and were between the ages of 18 and 89 years. They were excluded with diagnoses of Ménière's disease, pulsatile tinnitus, acoustic neuromas, or autoimmune inner ear diseases. The retrospective data and satisfaction surveys were entered by 3 of the authors. Responses were based on Likert scales. RESULTS: Of the 692 patients included, 230 completed and returned the satisfaction questionnaire (33.2% response rate), yielding an overall mean of $662.60 charges. The frequency of intervention recommendations per patients ranged from 0 to 13, with a median of 4. Spearman's correlations did not result in significant correlations between patient satisfaction and number of clinic visits (P=.499) or associated charges (P=.453). CONCLUSION: Given that the variability among provider recommendations, the high overall mean of tinnitus-related charges, and patient satisfaction was not related to costs, further research is needed examining patient preference in the treatment of tinnitus.

Diagnosis of catheter-related bloodstream infection.

Catheter-related bloodstream infection is a potentially serious condition with a mortality rate of 12% to 25%. Catheter-related bacteremia is difficult to diagnose, and clinical manifestations of the condition have proved to be unspecific and often inconclusive. Microbiologic techniques to diagnose catheter-related bloodstream infection have been developed, some of which require catheter removal whereas others do not. Differential time to positivity has demonstrated marked accuracy and practicality as it allows the catheter to remain in place. Many other methods, such as skin or hub cultures, show less remarkable results, and some, such as intraluminal brushing, may produce adverse effects. Once a catheter-related bloodstream infection is diagnosed, it is classified as either complicated or uncomplicated and treated accordingly.