Townsville University Hospital (TUH), formerly The Townsville Hospital (TTH), is a public tertiary care hospital on Angus Smirth Drive, Douglas, Townsville, Queensland, Australia. It is the largest facility within the Townsville Hospital and Health Service (HHS) geographic area. It provides healthcare across the entire North Queensland region, with patients from as far as Mount Isa and Cape York being airlifted or transported to the hospital on a daily basis. This is the third general hospital to be built in Townsville and is relatively new (completed 2001). The next main referral hospital is the Royal Brisbane and Women's Hospital, in Herston, Brisbane some 1,375 kilometres (854 mi) distant.
Importance:High-flow nasal oxygen therapy (HFNOT) is used for noninvasive respiratory support following cardiac surgery despite uncertainty about its clinical effectiveness or associated costs. Objective:To determine whether prophylactic HFNOT in patients at increased risk of respiratory complications following cardiac surgery has clinical benefits compared with standard oxygen therapy (SOT). Design, Setting, and Participants:This adaptive, parallel group, randomized clinical trial collected and analyzed data from 17 cardiac surgery centers in 3 countries between October 7, 2020, and June 19, 2024. Eligible participants included adults undergoing nonemergent cardiac surgery with any of the following risk factors for pulmonary complications: chronic obstructive pulmonary disease, asthma, lower respiratory tract infection in the last 4 weeks, a body mass index of 35 or greater, or currently or recently smoking for longer than 10 pack-years. Outcome assessors were blinded. A preplanned sample size re-estimation was conducted after 300 participants completed the 90-day follow-up. Intervention:Participants were randomized at a 1:1 ratio with concealed allocation to HFNOT or SOT administered for at least 16 hours immediately after postoperative extubation. Main Outcomes and Measures:The primary effectiveness outcome was days alive and at home (DAH) without increased support compared with baseline in the first 90 days (DAH90). Any day of increased support, including at home, would provide a value of 0 for that day. Secondary outcomes included DAH90 without considering the additional support component. Results:A total of 1280 patients were recruited (mean [SD] age, 62.9 [10.5] years; 892 [69.7%] men; 640 in each group), of whom 1224 (95.6%) had complete DAH90 data. The primary outcome of median DAH90 was 0 (IQR, 0-79) for the HFNOT group and 0 (IQR, 0-87) for the SOT group (median difference, 0 [95% CI, 0-0]; P = .75). Secondary clinical outcomes, including DAH90 without considering whether additional support was required, were similar between groups. Conclusions and Relevance:In this randomized clinical trial of HFNOT in patients at increased risk of postoperative pulmonary complications after nonemergent cardiac surgery, HFNOT did not improve DAH90 without increased support. These findings do not support the implementation of routine prophylactic HFNOT after cardiac surgery. Trial Registration:isrctn.org Identifier: ISRCTN14092678.
Cancer development is linked to dysregulated immune surveillance, chronic inflammation, and immunosuppressive signaling within the tumor microenvironment. Emerging evidence suggests that the anticancer effects of naturally occurring phytochemicals are not directly mediated by cytotoxicity but rather by altering key components of both innate and adaptive immunity. Over the last few years, significant progress has been made in understanding the interactions of specific classes of phytochemicals, including polyphenols, flavonoids, alkaloids, and terpenoids, with immune-linked signal transduction mechanisms involved in carcinogenesis. These include the suppression of pro- and anti-inflammatory mediators, the control of immune checkpoint-related pathways, the polarization of tumor-associated macrophages, the enhancement of cytotoxic T-cell and natural killer cell functions, and the suppression of angiogenic and metastatic signaling. Notably, many phytochemicals have demonstrated translational relevance, and some have advanced to later clinical trial phases. This narrative review highlights the recent preclinical, translational, and clinical evidence on the immunomodulatory effects of phytochemicals in cancer prevention and treatment. There is an accentuated focus on mechanistic convergence, the strength of the evidence, and translational potential, and the most frequently targeted immune pathways by phytochemicals are identified, with a highlight of the major challenges of integrating them into contemporary anticancer approaches.
Objective We aimed to determine the incidence of new onset atrial fibrillation (NOAF) in a cohort of intensive care unit (ICU) patients and, further, identify commonly utilised pharmacological strategies for its management in patients with and without sepsis. Design A multicentre, retrospective observational study was conducted. Setting Twelve ICUs in Queensland, Australia. Participants Adult patients, excluding those with cardiothoracic surgical diagnoses, admitted to a participating ICU from 2015 to 2021. Main outcome measures Main outcome measures included the incidence of NOAF in ICU, association of NOAF with illness severity and outcomes, cardiac rhythm at ICU discharge, and incidence of pharmacological intervention for NOAF in the ICU. Results NOAF occurred in 8.4 % of included ICU admissions, and was associated with higher illness severity, length of stay, and mortality. The majority of patients who experienced NOAF and survived their ICU stay were discharged from the ICU in a sinus rhythm (68.6 %). Patients with sepsis-associated NOAF were more likely to be in a sinus rhythm at ICU discharge than patients with NOAF without sepsis (72.2 vs 65.7 %). Amiodarone was frequently (50.4 %) prescribed to patients both with (56.5 %) and without (45.3 %) sepsis. Conclusion NOAF was common amongst patients admitted to the ICU, and amiodarone is commonly prescribed. Future studies are required to determine the optimal short- and long-term management strategies for NOAF complicating critical illness.
INTRODUCTION:Parents and caregivers play a critical role in the care of their child peri-operatively. Our team undertook previous research with parents/carers, which identified Australian parents' top 10 research priorities for paediatric anaesthesia and peri-operative medicine. While this was an important exercise, it focused on parent-reported experiences rather than the priorities of the children themselves; however, the experiences and concerns of parents/carers may not always reflect those of their child. It has been shown previously how integral it is to listen to each child's own voice to improve and create a more adaptive and safer peri-operative environment. METHODS:This research prioritisation study was developed for children and used a modified James Lind Alliance method that involved surveys, a youth community conversation and a final consensus-based prioritisation meeting, all of which were conducted online. RESULTS:Participants were children and young people aged 6-18 y living in Australia. In total, we engaged 356 children and young people. We identified the top research priorities for Australian children and young people for paediatric anaesthesia and peri-operative medicine through a rigorous process of consensus. The final top 10 priorities were agreed by consensus after a multi-step process and included how to: reduce anxiety (including needle phobia); make anaesthesia safer; avoid postoperative complications (e.g. pain, sickness, agitation); and improve communication between children and doctors. DISCUSSION:The resulting priorities differed from those conducted in Australia for adult peri-operative medicine and from the parent/carer and clinician priorities identified previously for paediatric anaesthesia care. These research priorities can help guide future paediatric anaesthesia and peri-operative medicine research directions.
House dust mites (HDM) are a major perennial allergen source and a significant cause of allergic diseases worldwide. However, inhalation exposure to HDMs in the paranasal cavities remains unclear. This study describes and quantifies HDM deposition and potential allergic impact in the paranasal cavities for patients who underwent functional endoscopic sinus surgery (FESS). HDM deposition in postoperative nasal models was numerically investigated based on the largest patient cohort with 8 post-FESS nasal airway subjects. The effects of body position on allergen deposition were investigated. HDM with a smaller diameter was deposited dispersively in the paranasal cavities, and compared with healthy adults, there were rare fecal pellet deposits in the post-FESS of the paranasal sinuses, except for the frontal sinus. The large particles were mainly deposited in the nasal septum, and a few were deposited in the sinuses. In a lying position, more HDM is deposited outside the paranasal cavities. Under exercising conditions, the deposition rates in the nasal cavity and ethmoid sinus increased, while those in the frontal sinus decreased. HDM fecal pellets could enter all sinuses following FESS, and the smaller were deposited dispersively in the paranasal cavities, which may contribute to allergic respiratory disease. In addition to the respiratory flow rate and particle size, body position is also a notable factor in HDM deposition. The digital post-FESS nasal subject database with HDM fecal pellet deposition data can offer a valuable reference for the treatment and prevention of recurrence following endoscopic sinus surgery.
