Σάββατο, 27 Αυγούστου 2016

Innovative use of a guideliner catheter to assist in snare retrieval of an entrapped kinked guide catheter during transradial coronary intervention

Rescue techniques that enable removal of severe intravascular catheter kinking are always worthwhile. We herein demonstrate the novel employment of a GuideLiner support catheter to assist in the removal of a kinked and entrapped guide catheter within the radial artery during coronary intervention. © 2016 Wiley Periodicals, Inc.



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Early or late intervention in patients with transient ST-segment elevation acute coronary syndrome: Subgroup analysis of the ELISA-3 trial

Objectives

To investigate incidence and patient characteristics of transient ST-segment elevation (TSTE) ACS and to compare outcome of early versus late invasive treatment.

Background

Optimal timing of treatment in TSTE–ACS patients is not outlined in current guidelines and no prospective randomized trials have been done so far.

Methods

Post hoc subgroup analysis of patients with TSTE randomized in the ELISA 3 trial. This study compared early (<12 h) versus late (>48 h) angiography and revascularization in 542 patients with high-risk NSTE-ACS. Primary endpoint was incidence of death, reinfarction, or recurrent ischemia at 30 days follow-up.

Results

TSTE was present in 129 patients (24.2%) and associated with male gender, smoking and younger age. The primary endpoint occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR = 0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7 and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of patients with TSTE, incidence of the primary endpoint was 5.8% in the early and 12.7% in the late treatment group (RR = 0.455, P = 0.213), driven by reduction in recurrent ischemia. Enzymatic infarct size, bleeding and incidence of death or recurrent MI at 2 years follow-up was comparable between the treatment groups.

Conclusions

In high-risk patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in patients with high-risk NSTE-ACS, immediate angiography and revascularization in these patients is feasible but not superior to later treatment. Prospective randomized trials are needed to provide more evidence in the optimal timing of treatment in patients with TSTE-ACS. © 2016 Wiley Periodicals, Inc.



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The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

Objectives

We assessed whether post-operative delirium is associated with healthcare utilization and overall survival after trans-catheter aortic valve replacement.

Background

Delirium, a common syndrome among hospitalized older adults, is associated with increased morbidity and mortality.

Methods

We reviewed 294 transcatheter aortic valve replacement cases between June 2008 and February 2015 at a tertiary care academic medical center. Post-operative delirium was identified by confusion assessment method screening and clinician diagnosis.

Results

Delirium was identified in 61 patients (21%). Non-femoral access for trans-catheter aortic valve replacement was more common in delirious patients than in non-delirious patients (41% vs. 27%, P = 0.04). Delirious patients had diminished overall survival after trans-catheter aortic valve replacement compared to non-delirious patients (1-year survival 59% vs. 84%, log-rank P = 0.002). After adjusting for age, Society of Thoracic Surgeons predicted 30-day mortality, and access type; delirium remained independently associated with diminished overall survival (hazard ratio 2.01, 95% confidence interval 1.21–3.33, P = 0.007). The delirium group had longer mean hospital stay (13.3 ± 9.5 days vs. 6.7 ± 3.8 days, P < 0.001) and a higher rate of discharge to a rehabilitation facility (61% vs. 27%, P < 0.001), but there was no difference in 30-day hospital re-admission rates or 30-day mortality based on delirium status.

Conclusions

Delirium occurs in one out of five patients after trans-catheter aortic valve replacement and is associated with diminished survival and increased healthcare utilization. Further studies are needed to clarify whether strategies aimed at reducing delirium after trans-catheter aortic valve replacement may improve outcomes in this high-risk subset. © 2016 Wiley Periodicals, Inc.



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Relative prosthesis-patient mismatch after transcatheter aortic valve replacement: The impact of morbid obesity

Prosthesis-patient mismatch (PPM) is defined as a small effective orifice area (EOA) of a normally functioning prosthetic valve in relation to patient body size. Even moderate impediment to forward flow has been associated with an increase in all-cause mortality. We report an unusual cause of PPM where a transcatheter implantation of a large EOA valve in an aortic position results in relative PPM in a patient with morbid obesity. © 2016 Wiley Periodicals, Inc.



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First prospective multicenter experience with the 7 French Glidesheath slender for complex transradial coronary interventions

Purpose

To assess the feasibility and safety of the 7 French (Fr) Glidesheath Slender for complex transradial (TR) percutaneous coronary interventions (PCI).

Background

The TR approach is increasingly used worldwide for coronary and peripheral vascular interventions. However, the small size of the radial artery remains an important limitation for the use of large-bore guiding catheters (>6 Fr), restricting thereby the treatment of highly complex lesions through the TR approach. The 7 Fr Glidesheath slender (Terumo, Tokyo, Japan) is a new dedicated radial sheath with a thinner wall and hydrophilic coating. It combines an inner diameter compatible with any 7 Fr guiding catheter and an outer diameter smaller than current 7 Fr sheaths.

Methods

Prospective multicenter registry of complex TR PCI cases using the 7 Fr Glidesheath Slender to determine the procedural success, rates of vascular complications, radial spasm, and radial artery occlusion (RAO).

Results

A total of 60 patients were included. Procedural success was 97% with only one access-site crossover. The use of a 7 Fr guiding catheter was indicated for the treatment of highly complex coronary lesions including distal left main (LM) disease (n = 20), complex non-LM bifurcation lesions (n = 16), chronic total occlusion (n = 15), and severely calcified vessels requiring rotational atherectomy (n = 10). There were three vascular access-site complications (4.7%) including two moderate (type II) local hematoma and one uncomplicated guiding catheter-induced brachial artery dissection. None of the patients experienced major bleeding. The occurrence of radial spasm was reported in seven patients (11%). Doppler ultrasound imaging of the radial artery at 1 month was available in 62 of 64 radial access with three cases of RAO (4.8%).

Conclusions

Use of the 7 Fr Glidesheath slender for complex coronary interventions is feasible and associated with a high rate of procedural success and a low rate of vascular complications. These favorable results need be confirmed in larger multicenter studies. © 2016 Wiley Periodicals, Inc.



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Left atrial appendage closure: A single center experience and comparison of two contemporary devices

Objectives

To compare indications and clinical outcomes of two contemporary left atrial appendage (LAA) percutaneous closure systems in a “real-world” population.

Background

Percutaneous LAA occlusion is an emerging therapeutic option for stroke prevention in atrial fibrillation. Some questions however remain unanswered, such as the applicability of results of randomized trials to current clinical practice. Moreover, currently available devices have never been directly compared.

Methods

We retrospectively analyzed consecutive patients who underwent LAA closure at San Raffaele Hospital, Milan, Italy between 2009 and 2015. Clinical indications and device selection were left to operators' decision; routine clinical and transesophageal echocardiography (TEE) follow-up was performed.

Results

One-hundred and sixty-five patients were included in the study, of which 99 were treated with the Amplatzer Cardiac Plug (ACP) and 66 with the Watchman system. During the follow-up period (median 15 months, interquartile range 6–26 months) five patients died. The incidence of ischemic events was low, with one patient suffering a transient ischemic attack and no episodes recorded of definitive strokes. Twenty-six leaks ≥1 mm were detected (23%); leaks were less common with the ACP and with periprocedural three-dimensional TEE evaluation, but were not found to correlate with clinical events. Clinical outcomes were comparable between the two devices.

Conclusions

Our data show excellent safety and efficacy of LAA closure, irrespectively of the device utilized, in a population at high ischemic and hemorrhagic risk. The use of ACP and 3D-TEE minimized the incidence of residual leaks; however, the clinical relevance of small peri-device flow warrants further investigation. © 2016 Wiley Periodicals, Inc.



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Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial

Objective

We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations.

Background

In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized.

Methods

Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations.

Results

The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin.

Conclusion

Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.



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Intravascular ultrasound-derived morphological predictors of myocardial ischemia assessed by stress myocardial perfusion computed tomography

Background

Although ischemia-guided revascularization improves clinical outcomes, morphological determinants of clinically relevant myocardial ischemia have not been studied. To identify intravascular ultrasound (IVUS)-derived anatomical parameters for predicting myocardial perfusion defect and its extent.

Methods

A total of 103 patients (88 stable and 15 unstable angina) with 153 lesions (angiographic diameter stenosis of 30–80%) underwent stress myocardial perfusion computed tomography (CT) and IVUS pre-procedure. The volume of CT perfusion defect and %CT perfusion defect in the target vessel territories were measured.

Results

The CT perfusion defect was seen in 76 (50%) lesions. The independent determinants for the presence of CT perfusion defect were IVUS-minimal lumen area (MLA) (adjusted OR = 0.56, 95% CI = 0.38–0.82), plaque burden (adjusted OR = 1.07, 95% CI = 1.02–1.11) and involvement of left main or left anterior descending artery (adjusted OR = 4.13, 95% CI = 1.75–9.78, all P < 0.05). The CT perfusion defect was predicted by IVUS-MLA <2.28mm2 (sensitivity 74%, specificity 82%) and plaque burden >77% (sensitivity 79%, specificity 78%) as thresholds. The independent determinants for the volume of CT perfusion defect were the involvement of left main or left anterior descending artery (β = 16.43, standard errors = 4.387, P = 0.020) and a greater plaque burden (β = 0.56, standard errors = 0.163, P = 0.026).

Conclusions

IVUS-derived morphological parameters were useful to predict the presence of CT perfusion defect and the size of myocardial ischemia that were primarily determined by lesion severity and subtended myocardial territory. © 2016 Wiley Periodicals, Inc.



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Coronary artery stenting in a patient with progeria

Progeria syndrome is a very rare disease with early demise in the second decade due to cardiovascular disease. Most events are sudden and fatal, leaving no time for medical or interventional therapies; no such interventional therapy has been reported. We present a 13 years old boy who previously had suffered from dissection of both internal carotid arteries; he now presented with exercise-induced angina. Both CT-scan and angiography revealed severe stenotic lesions at the origin of the right coronary artery and left anterior descending artery, typical for dissection. Coronary artery stenting resolved the symptoms. © 2016 Wiley Periodicals, Inc.



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Dealing with time-varying recruitment and length in Hill-type muscle models

Publication date: Available online 27 August 2016
Source:Journal of Biomechanics
Author(s): Ahmed Hamouda, Laurence Kenney, David Howard
Hill-type muscle models are often used in muscle simulation studies and also in the design and virtual prototyping of functional electrical stimulation systems. These models have to behave in a sufficiently realistic manner when recruitment level and contractile element (CE) length change continuously. For this reason, most previous models have used instantaneous CE length in the muscle's force vs. length (F-L) relationship, but thereby neglect the instability problem on the descending limb (i.e. region of negative slope) of the F-L relationship. Ideally CE length at initial recruitment should be used but this requires a multiple-motor-unit muscle model to properly account for different motor-units having different initial lengths when recruited. None of the multiple-motor-unit models reported in the literature have used initial CE length in the muscle's F-L relationship, thereby also neglecting the descending limb instability problem. To address the problem of muscle modelling for continuously varying recruitment and length, and hence different values of initial CE length for different motor-units, a new multiple-motor-unit muscle model is presented which considers the muscle to comprise 1000 individual Hill-type virtual motor-units, which determine the total isometric force. Other parts of the model (F-V relationship and passive elements) are not dependent on the initial CE length and, therefore, they are implemented for the muscle as a whole rather than for the individual motor-units. The results demonstrate the potential errors introduced by using a single-motor-unit model and also the instantaneous CE length in the F-L relationship, both of which are common in FES control studies.



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The kinematics and kinetics of riding a racehorse: A quantitative comparison of a training simulator and real horses

Publication date: Available online 26 August 2016
Source:Journal of Biomechanics
Author(s): A.M. Walker, C. Applegate, T. Pfau, E.L. Sparkes, A.M. Wilson, T.H. Witte
Movement of a racehorse simulator differs to that of a real horse, but the effects of these differences on jockey technique have not been evaluated. We quantified and compared the kinematics and kinetics of jockeys during gallop riding on a simulator and real horses. Inertial measurement units were attached mid-shaft to the long bones of six jockeys and the sacrum of the horse or simulator. Instrumented stirrups were used to measure force. Data were collected during galloping on a synthetic gallop or while riding a racehorse simulator. Jockey kinematics varied more on a real horse compared to the simulator. Greater than double the peak stirrup force was recorded during gallop on real horses compared to the simulator. On the simulator stirrup forces were symmetrical, whereas on a real horse peak forces were higher on the lead limb side. Asymmetric forces and lateral movement of the horse and jockey occurs towards the side of the lead leg, likely a result of horse trunk roll. Jockeys maintained a more upright trunk position on a real horse compared to simulator, with no change in pitch. The feet move in phase with the horse and simulator exhibiting similar magnitude displacements in all directions. In contrast the pelvis was in phase with the horse and simulator in the dorso-ventral and medio-lateral axes while a phase shift of 180 degrees was seen in the cranio-caudal direction indicating an inverted pendulum action of the jockey.



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Prophylactic Knee Bracing Alters Lower-Limb Muscle Forces During A Double-Leg Drop Landing

Publication date: Available online 27 August 2016
Source:Journal of Biomechanics
Author(s): Katie A. Ewing, Justin W. Fernandez, Rezaul K. Begg, Mary P. Galea, Peter VS Lee
Anterior cruciate ligament (ACL) injury can be a painful, debilitating and costly consequence of participating in sporting activities. Prophylactic knee bracing aims to reduce the number and severity of ACL injury, which commonly occurs during landing maneuvers and is more prevalent in female athletes, but a consensus on the effectiveness of prophylactic knee braces has not been established. The lower-limb muscles are believed to play an important role in stabilizing the knee joint. The purpose of this study was to investigate the changes in lower-limb muscle function with prophylactic knee bracing in male and female athletes during landing. Fifteen recreational athletes performed double-leg drop landing tasks from 0.30m and 0.60m with and without a prophylactic knee brace. Motion analysis data were used to create subject-specific musculoskeletal models in OpenSim. Static optimization was performed to calculate the lower-limb muscle forces. A linear mixed model determined that the hamstrings and vasti muscles produced significantly greater flexion and extension torques, respectively, and greater peak muscle forces with bracing. No differences in the timings of peak muscle forces were observed. These findings suggest that prophylactic knee bracing may help to provide stability to the knee joint by increasing the active stiffness of the hamstrings and vasti muscles later in the landing phase rather than by altering the timing of muscle forces. Further studies are necessary to quantify whether prophylactic knee bracing can reduce the load placed on the ACL during intense dynamic movements.



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Turning a Refrigerator into a Solar Powered Race Car

The Icebox Derby helps young women explore their passions for STEM careers—and I loved it

-- Read more on ScientificAmerican.com
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Survival, recurrence and toxicity of HNSCC in comparison of a radiotherapy combination with cisplatin versus cetuximab: a meta-analysis

Cisplatin-based treatment has been considered the standard treatment regimen of HNSCC. Cetuximab is an emerging target therapy that has potential therapeutic benefits over cisplatin. Nevertheless, curative eff...

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Worse outcome in breast cancer with higher tumor-infiltrating FOXP3+ Tregs : a systematic review and meta-analysis

Forkhead box P3(FOXP3) is known as the optimum maker for regulatory T cells(Tregs), which are conventionally thought to induce immune tolerance to disturb the antitumor immunity. However, the research on the p...

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Changes in the in vitro activity of platinum drugs when administered in two aliquots

The management of ovarian cancer remains a challenge. Because of the lack of early symptoms, it is often diagnosed at a late stage when it is likely to have metastasized beyond ovaries. Currently, platinum bas...

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Belotecan/cisplatin versus etoposide/cisplatin in previously untreated patients with extensive-stage small cell lung carcinoma: a multi-center randomized phase III trial

No novel chemotherapeutic combinations have demonstrated superior efficacy to etoposide/cisplatin (EP), a standard treatment regimen for extensive-stage small cell lung carcinoma (ES-SCLC) over the past decade...

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Supporting long-term follow-up of young adult survivors of childhood cancer: Correlates of healthcare self-efficacy

Abstract

Background

Healthcare self-efficacy (HCSE), the perceived confidence to manage one's health care, has been identified as a critical component in the transition process from pediatric to adult-oriented care for childhood cancer survivors (CCSs). HCSE is amenable to intervention and associated with long-term follow-up care among CCSs. However, factors associated with HCSE have not been fully explored among CCSs.

Procedure

We identified correlates of HCSE among a sample of CCSs (n = 193). Descriptive statistics and linear regression methods were used in this cross-sectional analysis.

Results

In univariate analyses, higher physical and psychosocial quality of life, posttraumatic growth, and religious/spiritual importance were associated with higher HCSE. Attendance at a survivorship clinic, having a regular source of care (both noncancer and oncologist), and any type of health insurance were also associated with HCSE. Hispanic ethnicity was negatively associated with HCSE relative to non-Hispanics. In a multivariable model, psychosocial quality of life, religious/spiritual importance, survivorship clinic attendance, having a regular oncologist, and Hispanic ethnicity remained significantly associated with HCSE.

Conclusions

CCSs who reported greater well-being, who rated religion and spirituality of high importance, and who accessed specialized cancer services expressed greater HCSE. Hispanic CCSs, however, reported less HCSE than non-Hispanics. Interventions that attend to the quality of life and spiritual needs of CCSs have potential to build HCSE to support the healthcare transition process. Because Hispanic CCSs may be at risk of lower perceived confidence to navigate their health care, culturally competent, efficacy-enhancing interventions are needed for this population.



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Short-term recovery of chemotherapy-induced peripheral neuropathy after treatment for pediatric non-CNS cancer

Abstract

Purpose

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent side effect of pediatric cancer treatment. The presentation of CIPN, trajectory and completeness of recovery over the first 6 months postchemotherapy, and the influence of patient and treatment characteristics on recovery are described.

Patients and Methods

Sixty-seven children and adolescents treated for non-CNS cancers were evaluated for CIPN using the pediatric modified total neuropathy score (ped-mTNS) while on treatment and 3 and 6 months postchemotherapy. Differences between diagnostic groups and treatment type were evaluated as well as change in scores over time. Risk factors for on-treatment and persistent CIPN at 6 months were identified.

Results

Overall, ped-mTNSs were in the abnormal range for 86.5% during treatment and scores decreased over time (initial 9.3 ± 0.6, 6 months 4.3 ± 0.4; F = 38.14, P < 0.001). By 6 months posttreatment, mean scores and percentage of children with abnormal scores were reduced to 2.4 ± 0.3 and 11.5%, respectively, in the ALL group, but remained higher at 5.7 ± 0.7 and 57%, respectively, for lymphoma, and 5.2 ± 1.0 and 60%, respectively, for other solid tumors. At 6 months posttreatment, light touch deficits and foot strength deficits remained in 19.4 and 59.7%, respectively, compared with only 4.9 and 9.8% of the control population. Subjects who were older at exposure, female, or who received etoposide in addition to vincristine were at higher risk for on-treatment CIPN. On-treatment sensory abnormalities were associated with increased risk of persistent CIPN.

Conclusion

While CIPN improves in most pediatric patients, significant numbers, especially those treated for lymphoma or other solid tumors, have remaining neuropathic signs and symptoms 6 months posttreatment.



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The Neurological Predictor Scale: A predictive tool for long-term core cognitive outcomes in survivors of childhood brain tumors

Abstract

Objective

Prior research has demonstrated the reliability and validity of the Neurological Predictor Scale (NPS) in relation to intelligence and adaptive functioning in survivors of pediatric brain tumors. To extend these findings, this study examined the relationship between the NPS and core neurocognitive skills hypothesized to underlie broad outcome measures of IQ and adaptive functioning.

Method

Sixty-one adulthood survivors of childhood brain cancers (Mage = 24 years, SD = 6) on average 16 years after diagnosis completed neuropsychological assessments examining attention (Wechsler Memory Scale Digit Span Forward), processing speed (Symbol Digit Modalities Test), and working memory (Auditory Consonant Trigrams). The medical information necessary to compute the NPS was extracted from a thorough medical record review.

Results

The NPS score significantly predicted processing speed (R2 = 0.28, P < 0.05) and working memory (R2 = 0.15, P < .05) outcomes over and above each individual risk factor. NPS was significantly associated with attention outcomes after covarying for age (R2 = 0.13, P < 0.05) over and above each risk factor except presence of hormone deficiency, hydrocephalus, and chemotherapy. These three variables were not significantly associated with attention outcomes in this sample.

Conclusions

Our findings suggest that survivors with more treatments and neurological sequelae experience greater deficits in working memory, processing speed, and attention. Further, the NPS affords the ability to predict how cumulative neurological factors impact core cognitive outcomes many years after initial diagnosis.



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Incidence of second cancers after radiotherapy and systemic chemotherapy in heritable retinoblastoma survivors: A report from the German reference center

Abstract

Background

Survivors of heritable retinoblastoma carry a high risk to develop second cancers. Eye-preserving radiotherapy raises this risk, while the impact of chemotherapy remains less defined.

Procedure

This population-based study characterizes the impact of all treatment modalities on second cancers incidence and type after retinoblastoma treatment in Germany. Data on second cancer incidence in 648 patients with heritable retinoblastoma treated between 1940 and 2008 at the German national reference center for retinoblastoma were analyzed to identify associations with treatment.

Results

The cumulative incidence ratio (per 1,000 person years) of second cancers was 8.6 (95% confidence interval 7.0–10.4). Second cancer incidence was influenced by type of retinoblastoma treatment but not by the year of diagnosis or by sex. Radiotherapy and systemic chemotherapy increased the incidence of second cancers (by 3.0- and 1.8-fold, respectively). While radiotherapy was specifically associated with second cancers arising within the periorbital region in the previously irradiated field, chemotherapy was the strongest risk factor for second cancers in other localizations. Soft tissue sarcomas and osteosarcomas were the most prevalent second cancers (standardized incidence ratio 179.35 compared to the German population).

Conclusions

Second cancers remain a major concern in heritable retinoblastoma survivors. Consistent with previous reports, radiotherapy increased second cancer incidence and influenced type and localization. However, chemotherapy was the strongest risk factor for second malignancies outside the periorbital region. Our results provide screening priorities during life-long oncological follow-up based on the curative therapy the patient has received and emphasize the need for less-detrimental therapies for children with heritable retinoblastoma.



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Sclerosing cholangitis and intracranial lymphoma in a child with classical Wiskott–Aldrich syndrome

Abstract

Patients with Wiskott–Aldrich syndrome (WAS) are predisposed to malignancy and autoimmunity in addition to infections. We report a male child with WAS, who had presented with recurrent pneumonia, eczema, thrombocytopenia, autoimmune hemolytic anemia, and vasculitic skin lesions. Genetic analysis revealed a classical genotype WAS 155C>T; R41X. At 2 years of follow-up, he developed persistent headache and progressive hepatomegaly. Brain imaging showed a mass in the right frontal region, which on histopathology was shown to be high-grade non-Hodgkin lymphoma. Magnetic resonance cholangiopancreatography showed features of sclerosing cholangitis. This report extends the clinical spectrum and highlights unusual manifestations of sclerosing cholangitis and intracranial lymphoma in a patient with WAS.



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Proton-pump inhibitor omeprazole attenuates hyperoxia induced lung injury

The administration of supplemental oxygen to treat ventilatory insufficiency may lead to the formation of reactive oxygen species and subsequent tissue damage. Cytochrome P4501A1 (CYP1A1) can modulate hyperoxi...

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Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II)

Mesenchymal stromal cells are a promising option to treat knee osteoarthritis. Their safety and usefulness must be confirmed and the optimal dose established. We tested increasing doses of bone marrow mesenchy...

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GOLM1 Modulates EGFR/RTK Cell-Surface Recycling to Drive Hepatocellular Carcinoma Metastasis

Publication date: Available online 25 August 2016
Source:Cancer Cell
Author(s): Qing-Hai Ye, Wen-Wei Zhu, Ju-Bo Zhang, Yi Qin, Ming Lu, Guo-Ling Lin, Lei Guo, Bo Zhang, Zhen-Hai Lin, Stephanie Roessler, Marshonna Forgues, Hu-Liang Jia, Lu Lu, Xiao-Fei Zhang, Bao-Feng Lian, Lu Xie, Qiong-Zhu Dong, Zhao-You Tang, Xin Wei Wang, Lun-Xiu Qin
The mechanism of cancer metastasis remains poorly understood. Using gene profiling of hepatocellular carcinoma (HCC) tissues, we have identified GOLM1 as a leading gene relating to HCC metastasis. GOLM1 expression is correlated with early recurrence, metastasis, and poor survival of HCC patients. Both gain- and loss-of-function studies determine that GOLM1 acts as a key oncogene by promoting HCC growth and metastasis. It selectively interacts with epidermal growth factor receptor (EGFR) and serves as a specific cargo adaptor to assist EGFR/RTK anchoring on the trans-Golgi network (TGN) and recycling back to the plasma membrane, leading to prolonged activation of the downstream kinases. These findings reveal the functional role of GOLM1, a Golgi-related protein, in EGFR/RTK recycling and metastatic progression of HCC.

Graphical abstract

image

Teaser

Ye et al. identify GOLM1 as a key promoter of hepatocellular carcinoma (HCC) metastasis and determine its critical roles in the recycling, spatial redistribution, and signaling kinetics of EGFR/RTKs. In human HCC, GOLM1 expression is correlated with early recurrence, metastasis, and poor patient survival.


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Dexmedetomidine regulate the malignancy of breast cancer cells by activating α2-adrenoceptor/ERK signaling pathway

OBJECTIVE: Breast cancer is one of the most aggressive and pervasive cancers identified in females. Dexmedetomidine (Dex) is an efficient anesthetic used in surgery. Our study aimed to explore the role of Dex in the malignancy of breast cancer cells in vitro and in vivo. Further, we investigate the molecular mechanism involved in the function of Dex on breast cancer cells.

MATERIALS AND METHODS: The methyl thiazolyl tetrazolium (MTT) assay was applied to detect cell proliferation. The migration and invasion capacity of MDA-MB-231 cells was tested by wound healing assay and transwell assay. Western blot analysis was performed to quantify the protein expression levels of α2-adrenoceptor and ERK.

RESULTS: The proliferation, migration and invasion ability of MDA-MB-231 cells was gradually increased after treatment of Dex in a dose-dependent manner in vitro. In addition, Dex could significantly elevate the volume and weight of xenotransplant tumor in vivo. Furthermore, Dex up-regulated the protein level of a2-adrenoceptor and consistently enhanced the phosphorylation of ERK without changing the total level of it. Similarity, over-expression of a2-adrenoceptor via its agonist Clonidine could mimic the function of Dex on breast cancer.

CONCLUSIONS: These data suggest that Dex could promote the proliferation, migration and invasion of breast cancer cells through the activation of α2B-adrenoceptor /ERK signaling.

L'articolo Dexmedetomidine regulate the malignancy of breast cancer cells by activating α2-adrenoceptor/ERK signaling pathway sembra essere il primo su European Review.



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Porous tantalum seeded with bone marrow mesenchymal stem cells attenuates steroid-associated osteonecrosis

OBJECTIVE: Bone marrow mesenchymal stem cells (BMMSCs) have been widely applied in osteonecrosis. However, lack of biomechanical support limited application of BMMSCs. And porous tantalum (PTA) has been identified as a cell-friendly scaffold for bone regeneration. Herein, we aimed to investigate the efficacy of PTA seeded with BMMSCs in the treatment of osteonecrosis.

MATERIALS AND METHODS: After the production of PTA seeded with BMMSCs, MTT and GFP were performed to identify the proliferation and adhesion of BMMSCs respectively, which was further examined by scanning electron microscopy (SEM). And real-time PCR was also used to determine mRNA level of osteogenic markers, including Alp, OCN, OPN, Col I and Runx-2 in BMMSCs. Nineteen adult rabbits were applied for building steroid-associated osteonecrosis (SAON) models. Bone formation rate (BFR) and mineral apposition rate (MAR) were determined. And Goldner Trichrome Staining was used in these SAON models, which further confirmed the efficacy of PTA seeded with BMMSCs in SAON.

RESULTS: PTA seeded with BMMSCs showed excellent biocompatibility. Additionally, SEM assay showed that BMMSCs adhered tightly and spread fully in the pores of PTA. Next, the expression of ALP and OPN mRNA in BMMSCs were significantly (p < 0.05) higher in the PTA-treated group compared to those in the PTA-untreated group. Furthermore, compared to those treated by only PTA, the dynamic bone formation in rabbits treated by PTA seeded with BMMSCs was significantly increased (p < 0.001) at both week 3rd and week 6th.

CONCLUSIONS: The product, PTA seeded with BMMSCs, was successfully produced, and was determined as high efficacy for treatment of steroid-associated osteonecrosis. PTA seeded with BMMSCs may afford a promising option for treating osteonecrosis.

L'articolo Porous tantalum seeded with bone marrow mesenchymal stem cells attenuates steroid-associated osteonecrosis sembra essere il primo su European Review.



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Involvement of ghrelin in nucleus tractus solitaries on gastric signal afferent and gastric motility in cisplatin-treated rats

OBJECTIVE: Ghrelin had been known to promote gastric motility in human and animals previously. We aim to investigate the role of ghrelin in chemotherapy-induced nausea and vomiting.

MATERIALS AND METHODS: In the present study, we observed the changes in food intake, kaolin consumption, body weight, plasma ghrelin concentration and expression of ghrelin and its receptor GHS-R1a in the stomach and nucleus tractus solitaries (NTS) in cisplatin-treated rats, and the effects of ghrelin microinjected into NTS on the discharge activity of gastric distension (GD) responsive neurons and gastric motility were also observed.

RESULTS: Cisplatin induced the decrease in food intake and the increase in kaolin consumption of rats. In addition, mRNA expression of GHS-R1a in the stomach and NTS increased significantly after cisplatin treatment. The discharge activity of GD excited (GD-E) and GD inhibited (GD-I) neurons in cisplatin-treated rats was weaker than that of saline treatment, while ghrelin administration into NTS excited most of GD-E and GD-I neurons. Cisplatin induced the decrease in gastric contraction while ghrelin administrated into NTS promoted the gastric motility significantly. However, the amplitude and frequency of gastric contraction promoted by ghrelin in NTS of cisplatin-treated rats were lower than that of saline treated rats. The effects of ghrelin could be completely blocked by its receptor antagonist BIM28163.

CONCLUSIONS: These results indicated that ghrelin in the NTS might participate in the regulation of GD-neurons and gastric motility via its receptor in cisplatin-treated rats.

L'articolo Involvement of ghrelin in nucleus tractus solitaries on gastric signal afferent and gastric motility in cisplatin-treated rats sembra essere il primo su European Review.



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Potential protective effect of resveratrol on acoustic trauma: electron microscopy study

OBJECTIVE: To investigate the potential preventive effect of resveratrol in rats exposed to acoustic trauma (AT).

MATERIALS AND METHODS: In this experimental study, Wistar albino rats were divided into three groups: Group 1 (Control, n = 6), Group 2 (AT, n = 6), and Group 3 (resveratrol + AT). The rats in Group 2 were exposed to AT. The rats in Group 3 received resveratrol (300 mg/kg/day) via gavage for 7 days. On day 7, the rats were exposed to AT 10 min following resveratrol treatment. Histological sections of the cochleae were examined using light microscopy, transmission (TEM), and scanning electron microscopy (SEM).

RESULTS: The cochlear hair cells, stereocilia, and Deiters’ cells of the control group appeared normal in all microscopic evaluations. In Group 2, light microscopy revealed predominantly inner hair cell loss, although the outer hair cells were affected. TEM and SEM examination showed severe loss of stereocilia and SEM revealed stereocilia arranged in an asymmetric array. The cochlear structure in Group 3 appeared well preserved under the light microscope, and although TEM and SEM revealed stereocilia loss, the hair cells and stereocilia appeared near normal compared with those of Group 2.

CONCLUSIONS: Resveratrol may have a protective effect against AT damage in the cochlea, most likely through its antioxidant activity. Our results may be useful for studies in humans exposed to AT and noise-induced hearing loss related to chronic exposure to occupational noise.

L'articolo Potential protective effect of resveratrol on acoustic trauma: electron microscopy study sembra essere il primo su European Review.



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Treatment of advanced breast cancer with a combination of highly agglutinative staphylococcin and vinorelbine-based chemotherapy

OBJECTIVE: Breast cancer is the most frequently diagnosed cancer among women in over 75% of countries worldwide accounting for one in four of all cancers in women. Highly agglutinative staphylococcin (HAS), a mixture of Staphylococcus aureus culture filtrates, has been used clinically as an immunomodifier in the treatment of a number of tumors for many years. The aim of present study is to evaluate the therapeutic effects and safety of treating advanced breast cancer patients with a combined therapy of HAS and vinorelbine-based chemotherapy compared to patients who receive standard chemotherapy alone.

PATIENTS AND METHODS: A total of 62 patients with advanced breast cancer were divided into 2 study groups. One group received intravenous injections of HAS and vinorelbine-based chemotherapy (n=31) compared to a control group assigned to receive vinorelbine-based standard chemotherapy (n=31).

RESULTS: Patients with advanced breast cancer who received HAS combined therapy showed a significantly higher overall response rate (Complete Response + Partial Response) of 67.7% compared with patients who received systemic chemotherapy alone (51.6%; p < 0.05). Overall, the occurrence of adverse effects was not significantly different between study groups. HAS was able to remedy the immunosuppressing effects of standard chemotherapy in these patients.

CONCLUSIONS: Treatment of advanced breast cancer with of HAS – in combination with vinorelbine-based chemotherapy – was generally more effective and just as safe compared to treatment with vinorelbine-based standard chemotherapy alone.

L'articolo Treatment of advanced breast cancer with a combination of highly agglutinative staphylococcin and vinorelbine-based chemotherapy sembra essere il primo su European Review.



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Study to elucidate molecular mechanism behind zinc chemo-preventive role during lung carcinogenesis

OBJECTIVE: The present planned to elucidate the mechanistic role zinc supplementation in the modulation of p53 post-translational acetylation, the activity of cyclooxygenase-2 (COX-2) along with other biophysical parameters during benzo(a)pyrene (BP) induced lung carcinogenesis in mice.

MATERIALS AND METHODS: The mice were segregated into four groups viz., normal control, BP treated, BP + zinc and zinc alone treated. Lung carcinogenesis was induced by a single intra-peritoneal (IP) injection of BP (100 mg/kg body weight). Zinc was supplemented to mice at dose levels of 227 mg/kg body weight in drinking water. All the treatments were continued for 20 weeks.

RESULTS: The BP caused a significant rise in the expression of p53. On the other hand, protein expressions of acetylated (lys382)-p53 were significantly decreased, following BP treatment. Also, a significant decrease was observed in the enzyme activities of caspase 3 and caspase 9. Moreover, BP treatment brought about a significant increase in the activity of COX-2. Supplementation of zinc to BP treated mice stimulated acetylation of p53 as observed by an increase in the protein expression of acetylated (lys382)-p53. Also, the enzyme activities of caspase 3 and caspase 9 showed a significant elevation upon zinc supplementation. On the other hand, the zinc supplementation brought about moderation in the expression of enzymatic activity of COX-2 which was restored within the normal limits. Further, BP treatment recorded increased 3H-thymidine uptake as well as enhanced 14C-glucose uptake and its turnover which were reduced significantly following simultaneous treatment with zinc.

CONCLUSIONS: The treatment with zinc has the potential to modulate p53 acetylation to stimulate apoptosis against experimentally induced lung carcinogenesis.

L'articolo Study to elucidate molecular mechanism behind zinc chemo-preventive role during lung carcinogenesis sembra essere il primo su European Review.



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Helicobacter pylori infection is associated with high methane production during lactulose breath test

OBJECTIVE: Despite a growing interest toward the interplay between H. pylori and gastric microbiota, few data are available about this correlation. The aim of this study was to explore the relationship between H. pylori infection and gas production during lactulose breath test.

MATERIALS AND METHODS: Data of patients undergoing both 13C-urea breath test (UBT) and lactulose breath test (LBT) under standard conditions in our GI unit were retrospectively analyzed. GI symptoms, such as dyspepsia, bloating, abdominal pain/discomfort, and epigastric pain on an eleven-point scale were also analyzed and correlate with the results of those tests. H2 and CH4 were calculated using the trapezoidal rule; a considerable CH4 production was defined by AUCCH4 ≥1200 ppm*4h. Statistical analyses were performed with Fisher’s exact test and independent samples Mann-Whitney test.

RESULTS: Data of 136 patients during a period of time of 3 months were analyzed. 36 patients (26.5%) showed a positive UBT. We do not find any difference as regards age, sex, symptom complaints, and small intestinal bacterial overgrowth between HP negative and positive patients. A greater methane production was observed in infected rather than non-infected patients (47.2% vs. 26% respectively, p=0.02). Furthermore, 25% infected and 10% non-infected produced greater amounts of CH4 compared to H2, resulting in a AUCCH4/AUCH2 ratio >1 (p=0.046).

CONCLUSIONS: This study shows for the first time, a significant association between H. pylori infection and methane production, suggesting that H. pylori might influence gut microbiota composition. Further studies are needed to clarify mechanisms underlying this phenomenon.

L'articolo Helicobacter pylori infection is associated with high methane production during lactulose breath test sembra essere il primo su European Review.



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Bitter truth: How we’re making fruit and veg less healthy

In an effort to cater to our sweet tooth, food producers are making fruit and veg taste less bitter. The trouble is, that's making them worse for us

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Higher resting heart rate variability predicts skill in expressing some emotions

Abstract

Vagally mediated heart rate variability (vmHRV) is a measure of cardiac vagal tone, and is widely viewed as a physiological index of the capacity to regulate emotions. However, studies have not directly tested whether vmHRV is associated with the ability to facially express emotions. In extending prior work, the current report tested links between resting vmHRV and the objectively assessed ability to facially express emotions, hypothesizing that higher vmHRV would predict greater expressive skill. Eighty healthy women completed self-reported measures, before attending a laboratory session in which vmHRV and the ability to express six emotions in the face were assessed. A repeated measures analysis of variance revealed a marginal main effect for vmHRV on skill overall; individuals with higher resting vmHRV were only better able to deliberately facially express anger and interest. Findings suggest that differences in resting vmHRV are associated with the objectively assessed ability to facially express some, but not all, emotions, with potential implications for health and well-being.



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Bitter truth: How we’re making fruit and veg less healthy

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In an effort to cater to our sweet tooth, food producers are making fruit and veg taste less bitter. The trouble is, that's making them worse for us

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IJERPH, Vol. 13, Pages 856: Components of Height and Blood Pressure among Ellisras Rural Children: Ellisras Longitudinal Study

To date, there has been no study done investigating the relationship between the components of height and blood pressure (BP) in rural South African children. Therefore, the aim of this study was to investigate the relationship between height, sitting height (SH), leg length (LL), and SH-to-height ratio (SH/H) with BP in Ellisras rural children. All children underwent anthropometric and BP measurements using standard procedure. Linear regression was used to assess the relationship between height, SH, LL, SH/H, and BP. The regression showed a positive significant (p < 0.001) association between systolic BP (SBP) with height and SH (β ranged from 0.127 to 0.134 and 95% CI ranged from 0.082 to 0.415). Diastolic BP (DBP) also showed a positive significant (p < 0.001) association with height and SH (β ranged from 0.080 to 0.088 and 95% CI ranged from 0.042 to 0.259). After having been adjusted for age, gender, body mass index, and waist circumference, DBP showed a positive significant (p < 0.05) association with height. There was a positive significant association between DBP and SBP together with the components of height amongst Ellisras rural children.

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Cellular uptake mechanism and comparative evaluation of antineoplastic effects of paclitaxel–cholesterol lipid emulsion on triple-negative and non-triple-negative breast cancer cell lines

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IJMS, Vol. 17, Pages 1420: Cleome rutidosperma and Euphorbia thymifolia Suppress Inflammatory Response via Upregulation of Phase II Enzymes and Modulation of NF-κB and JNK Activation in LPS-Stimulated BV2 Microglia

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Cleome rutidosperma DC. and Euphorbia thymifolia L. are herbal medicines used in traditional Indian and Chinese medicine to treat various illnesses. Reports document that they have antioxidant and anti-inflammatory activities; nonetheless, the molecular mechanisms involved in their anti-inflammatory actions have not yet been elucidated. The anti-neuroinflammatory activities and underlying mechanisms of ethanol extracts of Cleome rutidosperma (CR) and Euphorbia thymifolia (ET) were studied using lipopolysaccharide (LPS)-stimulated microglial cell line BV2. The morphology changes and production of pro-inflammatory mediators were assayed. Gene expression of inflammatory genes such as inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, interleukin (IL)-1β, and CC chemokine ligand (CCL)-2, as well as phase II enzymes such as heme oxygenase (HO)-1, the modifier subunit of glutamate cysteine ligase (GCLM) and NAD(P)H quinone dehydrogenase 1 (NQO1), were further investigated using reverse transcription quantitative-PCR (RT-Q-PCR) and Western blotting. The effects of CR and ET on mitogen activated protein kinases (MAPKs) and nuclear factor (NF)-κB signaling pathways were examined using Western blotting and specific inhibitors. CR and ET suppressed BV2 activation, down-regulated iNOS and COX-2 expression and inhibited nitric oxide (NO) overproduction without affecting cell viability. They reduced LPS-mediated tumor necrosis factor (TNF) and IL-6 production, attenuated IL-1β and CCL2 expression, but upregulated HO-1, GCLM and NQO1 expression. They also inhibited p65 NF-κB phosphorylation and modulated Jun-N terminal kinase (JNK) activation in BV2 cells. SP600125, the JNK inhibitor, significantly augmented the anti-IL-6 activity of ET. NF-κB inhibitor, Bay 11-7082, enhanced the anti-IL-6 effects of both CR and ET. Znpp, a competitive inhibitor of HO-1, attenuated the anti-NO effects of CR and ET. Our results show that CR and ET exhibit anti-neuroinflammatory activities by inhibiting pro-inflammatory mediator expression and production, upregulating HO-1, GCLM and NQO1, blocking NF-κB and modulating JNK signaling pathways. They may offer therapeutic potential for suppressing overactivated microglia and alleviating neurodegeneration.

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Fact or Friction: Examination of the Transparency, Reliability and Sufficiency of the ACE-V Method of Fingerprint Analysis

Fingerprints are commonly accepted by lay people as a highly valuable and reliable means of identification. Traders in early China used their fingerprints in clay seals, or on silk or paper to legitimise documents or loans, and by C13th, Eastern doctors noted the use of fingerprints to identify people. However, it wasn’t until Sir Francis Galton published his classification of fingerprint patterns that they began to attract attention in the forensic community [1]. Resting on the principles of persistence and individuality [2], fingerprint matching has been relied upon in court since 1892.

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“Who” should be focused? The influence of focus status on pronoun resolution

Abstract

Focus is assumed to be able to enhance the salience of a focused constituent and thereby facilitate the interpretation of a pronoun that refers to a focused antecedent relative to an unfocused antecedent. To assess how discourse-based focus structure influences the interpretation of a pronoun and whether this process is modulated by the grammatical role of the antecedent, we conducted an ERP study in which the focus status of a pronoun's potential antecedents was manipulated by means of a wh-question-answer structure. We found that, relative to those in the focused position, pronouns referring to antecedents in the unfocused position evoked enhanced positive responses in both early (180–230 ms) and late time windows (400–800 ms). Moreover, while a larger positivity was evoked by object-referring pronouns compared to subject-referring pronouns in the 400–800 ms time window over the right hemisphere, there was no effect of grammatical role in the 180–230 ms time window. These findings indicate that, while the initial stage of pronoun resolution is modulated by focus information assigned via a wh-question structure, integration of the pronoun and its antecedent into a coherent discourse representation at the later stage could be constrained by various factors, including the focus status and possibly the grammatical role of the antecedent.



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Automatic emotion regulation in response inhibition: The temporal dynamics of emotion counter-regulation during a go/no-go task

Abstract

Recent behavioral studies indicate that emotion counter-regulation automatically allocates attention to events that are opposite in the valence to the experienced emotional state. The present study explored the effect of emotion counter-regulation on response inhibition by using ERPs in a go/no-go paradigm. We recruited 58 subjects and randomly assigned them to either the angry priming group (watching Nanjing Massacre movie clips) or the neutral priming group (watching “mending a computer” movie clips). The behavioral results revealed that participants in the angry priming group responded significantly more accurately to go happy and no-go angry faces than go angry and no-go happy faces. The analyses of ERPs revealed that the amplitudes of the no-go N2 and no-go P3 were significantly larger for the happy faces than for the angry faces in the angry priming group. However, no such effects were found in the neutral priming group. These results suggest that highly aroused angry emotion could prompt a priority response to happy emotion stimuli and restrict the responses to angry emotion stimuli through emotion counter-regulation.



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Expectancy affects the feedback-related negativity (FRN) for delayed feedback in probabilistic learning

Abstract

Learning from feedback is a prerequisite for adapting to the environment. Prediction error signals coded by midbrain dopamine (DA) neurons are projected to the basal ganglia and anterior cingulate cortex (ACC). It has been suggested that neuronal activity shifts away from the DA system when feedback is delayed. The feedback-related negativity (FRN), an ERP that is generated in the ACC and has been shown to be sensitive to feedback valence and prediction error magnitude, was found to be reduced for delayed feedback. It has, however, not yet been investigated if the FRN for delayed feedback reflects a reward prediction error. In this study, effects of feedback delay (1 s vs. 7 s) on the processing of expected and unexpected positive and negative feedback were investigated in a between-subjects design in healthy human participants conducting a probabilistic feedback learning task. FRN and P300 amplitudes were decreased for subjects learning from delayed compared to immediate feedback. Importantly, the FRN, extracted from the negative-positive feedback difference wave, was significantly smaller for expected compared to unexpected feedback for both the immediate and delayed feedback conditions. Expectancy effects for the P300 were also seen, but did not interact with feedback valence. These results demonstrate an influence of feedback expectancy, and thus the prediction error, on early feedback processing even for delayed feedback, suggesting that neuronal structures underlying feedback processing are comparable for immediate and delayed feedback, at least to some extent. Modulations of the P300 by feedback delay may be linked to feedback salience.



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Pharmacologic study (JP28927) of alectinib in Japanese patients with ALK+ NSCLC with or without prior crizotinib therapy

Summary

We report pharmacokinetics, efficacy, and safety data for a new 150 mg alectinib capsule in ALK+ non-small-cell lung cancer in a multicenter, open-label pharmacologic study (JP28927). Eligible patients (≥20 years, locally advanced/metastatic ALK+ disease, ALK inhibitor-naïve and -pretreated [including crizotinib refractory]) were randomized 1:1 to receive one of two sequences of alectinib 300 mg twice daily (comprising different schedules of 20/40 mg and 150 mg capsules) until investigator-determined lack of clinical benefit. Co-primary endpoints were: bioequivalence of alectinib 20/40 mg versus 150 mg; food effect with 150 mg; and safety. Thirty-five patients were enrolled; median treatment duration was 13.1 months (range 1.1−15.0). Under fasting conditions, exposure of the two formulations was similar; mean AUClast ± standard deviation 3230 ± 914 h•ng/mL versus 3710 ± 1040 h•ng/mL, respectively, for 150 mg versus 20/40 mg capsules. Food effect with 150 mg alectinib was negligible. Treatment-related adverse events in >20% of patients were constipation (31.4%), dysgeusia (25.7%), and decreased white blood cell and neutrophil count (22.9% each). No treatment-related grade 4/5 events occurred. Median time to response was 1.2 months (95% CI 1.1−2.1). For the full analysis set (n = 35) and crizotinib-failure subpopulations (n = 23), overall response rate was 70.0% (95% CI 50.6−85.3) and 65.0% (95% CI 40.8−84.6), and median progression-free survival was 13.9 months (95% CI 11.1−not reached) and 12.9 months (95% CI 3.9−not reached), respectively. The 150 mg capsule had a similar exposure profile to 20/40 mg capsules. Alectinib demonstrated promising efficacy and was well tolerated.

This article is protected by copyright. All rights reserved.



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IJERPH, Vol. 13, Pages 858: Addressing Environmental Health Inequalities

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), “Addressing Environmental Health Inequalities—Proceedings from the ISEE Conference 2015”, we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics.

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IJERPH, Vol. 13, Pages 857: Comprehensive Comparison between Empty Nest and Non-Empty Nest Elderly: A Cross-Sectional Study among Rural Populations in Northeast China

This study aimed to comprehensively compare the general characteristics, lifestyles, serum parameters, ultrasonic cardiogram (UCG) parameters, depression, quality of life, and various comorbidities between empty nest and non-empty nest elderly among rural populations in northeast China. This analysis was based on our previous study which was conducted from January 2012 to August 2013, using a multistage, stratified, random cluster sampling scheme. The final analyzed sample consisted of 3208 participants aged no less than 60 years, which was further classified into three groups: non-empty nest group, empty nest group (living as a couple), and empty nest group (living alone). More than half of the participants were empty nest elderly (60.5%). There were no significant statistical differences for serum parameters, UCG parameters, lifestyles, dietary pattern, and scores of Patient Health Questionnaire-9 (PHQ-9) and World Health Organization Quality of Life questionnaire, abbreviated version (WHOQOL-BREF) among the three groups. Empty nest elderly showed no more risk for comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, left atrial enlargement (LAE), and stroke. Our study indicated that empty nest elderly showed no more risk for depression, low quality of life and comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, LAE, and stroke among rural populations in northeast China.

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Fact or Friction: Examination of the Transparency, Reliability and Sufficiency of the ACE-V Method of Fingerprint Analysis

Fingerprints are commonly accepted by lay people as a highly valuable and reliable means of identification. Traders in early China used their fingerprints in clay seals, or on silk or paper to legitimise documents or loans, and by C13th, Eastern doctors noted the use of fingerprints to identify people. However, it wasn’t until Sir Francis Galton published his classification of fingerprint patterns that they began to attract attention in the forensic community [1]. Resting on the principles of persistence and individuality [2], fingerprint matching has been relied upon in court since 1892.

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Tectonic Tragedy in Italy

The 2016 Central Italy Earthquake has claimed hundreds of lives and destroyed cities.

-- Read more on ScientificAmerican.com
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Gemcitabine treatment promotes pancreatic cancer stemness through the Nox/ROS/NF-κB/STAT3 signaling cascade

• A new mechanism for gemcitabine resistance via stemness induction is proposed.• Gemcitabine induces pancreatic CSCs and stemness-associated genes.• Gemcitabine enhances cell migration, chemoresistance, and tumorigenesis.• STAT3 pathway partially mediates gemcitabine-induced CSC properties and tumor relapse.• Nox/ROS/NF-κB participates in gemcitabine-induced STAT3 activation and stemness.

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Influence of physical effort on aortic stiffness in young male athletes

OBJECTIVE: The progression of cardiovascular disease is blunted by regular exercise training as a common non-pharmacological treatment. Recent findings have confirmed that central aortic pressure is more strongly related to cardiovascular events than brachial blood pressure. The aim of the study was to evaluate the influence of a single bout of significant physical effort on central aortic pressure and pulse wave velocity in young male athletes.

PATIENTS AND METHODS: The study group consisted of 16 healthy male athletes undergoing regular endurance training. The subjects of the study (21.6 ± 2.85 years of age) underwent a submaximal exercise test consisting of cycling for 30 minutes. Aortic pulse wave velocity (PWV) and derivatives (augmentation index set to 75 heart beats, AIx75; pulse pressure amplification, PPA), ejection duration (ED), subendocardial viability ratio (SEVR) and central blood pressure were examined before and after the exercise test Blood pressure and pulse waveform were evaluated in the supine position after a 15-minute rest by means of the oscillometric method the oscillometric method.

RESULTS: Comparing the rest condition to the period immediately following the exercise test, athletes showed lower central than peripheral systolic blood pressure both before (129 ± 11 mmHg and 112 ± 8 mmHg, respectively, p < 0.001) and after (130 ± 10 mmHg to 112 ± 8 mmHg, respectively, p < 0.001) the test. They also showed a decrease of ED from 339.7 ± 44.4 ms to 326.9 ± 41.4 ms (p < 0.02) and an increase of PPA from 136.2 ± 5.4% to 140.3 ± 5.0% (p < 0.02), whereas PWV, AIx75 and SEVR changed insignificantly.

CONCLUSIONS: We confirm that PPA is sensitive to an instant change in aortic elasticity. Furthermore, the hemodynamic response to a single physical effort composed of shorter ejection time and increased relative elasticity of the aorta prevents impairment of oxygen supply to the heart musculature.

L'articolo Influence of physical effort on aortic stiffness in young male athletes sembra essere il primo su European Review.



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The impact of the extent and severity of coronary artery disease on fractional flow reserve measurements

OBJECTIVE: Coronary angiography has a limitation to determine the severity of intermediate stenosis (30-70%)1,2. Fractional flow reserve (FFR) is a method for the assessment of the intermediate stenosis severity3. The effect of coronary artery disease (CAD) severity on the FFR results is not clear. In this study, we aimed to expose the effect of CAD severity calculated with Syntax and Gensini scores on FFR results.

PATIENTS AND METHODS: We scanned patients data (n=378) who had undergone fractional flow reserve measurements in our center. Patients with acute coronary syndrome in the last month, moderate or severe valvular diseases, acute heart failure, serious bradycardia, atrial fibrillation/flutter, severe left ventricular hypertrophy or patient with deficient data were excluded. 351 patients were included in the study. Syntax and Gensini scores were calculated and compared with FFR results. Hemodynamically significant result for FFR, ratio <0.80 was accepted.

RESULTS: The negative correlation between high Gensini, high Syntax scores and FFR results was statistically significant. Especially patients with Syntax scores >22 had notable more crucial lesions in FFR measurements (p<0.001). Cardiovascular disease risk factors such as age, gender, hypertension, diabetes mellitus and dyslipidemia did not correlate with the FFR results. Patients with intermediate stenosis (30-70%) and high Gensini and high Syntax scores were found to have more hemodynamically significant on FFR measurements (FFR <0.80).

CONCLUSIONS: Intermediate lesions with high Syntax score should be evaluated by hemodynamic procedures and treated more carefully with optimal medical treatment or revascularization. Revascularization method of CAD with high Syntax score should be decided with hemodynamic procedures as FFR measurements.

L'articolo The impact of the extent and severity of coronary artery disease on fractional flow reserve measurements sembra essere il primo su European Review.



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Κυριακή, 21 Αυγούστου 2016

Functionalized Fullerene Increases NF-κB Activity and Blocks Genotoxic Effect of Oxidative Stress in Serum-Starving Human Embryo Lung Diploid Fibroblasts

The influence of a water-soluble [] fullerene derivative containing five residues of 3-phenylpropionic acid and a chlorine addend appended to the carbon cage (F-828) on serum-starving human embryo lung diploid fibroblasts (HELFs) was studied. Serum deprivation evokes oxidative stress in HELFs. Cultivation of serum-starving HELFs in the presence of 0.1–1 µM F-828 significantly decreases the level of free radicals, inhibits autophagy, and represses expression of NOX4 and NRF2 proteins. The activity of NF-κB substantially grows up in contrast to the suppressed NRF2 activity. In the presence of 0.2–0.25 µM F-828, the DSB rate and apoptosis level dramatically decrease. The maximum increase of proliferative activity of the HELFs and maximum activity of NF-κB are observed at these concentration values. Conclusion. Under the conditions of oxidative stress evoked by serum deprivation the water-soluble fullerene derivative F-828 used in concentrations of 0.1 to 1 µM strongly stimulates the NF-κB activity and represses the NRF2 activity in HELFs.

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Different Vancomycin Immunoassays Contribute to the Variability in Vancomycin Trough Measurements in Neonates

Substantial interassay variability (up to 20%) has been described for vancomycin immunoassays in adults, but the impact of neonatal matrix is difficult to quantify because of blood volume constraints in neonates. However, we provide circumstantial evidence for a similar extent of variability. Using the same vancomycin dosing regimens and confirming similarity in clinical characteristics, vancomycin trough concentrations measured by PETINIA (2011-2012, ) were 20% lower and the mean difference was 1.93 mg/L compared to COBAS (2012–2014, ) measurements. The impact of vancomycin immunoassays in neonatal matrix was hereby suggested, supporting a switch to more advanced techniques (LC-MS/MS).

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Image-Guided Voronoi Aesthetic Patterns with an Uncertainty Algorithm Based on Cloud Model

Tessellation-based art is an important technique for computer aided aesthetic patterns generation, and Voronoi diagram plays a key role in the preprocessing, whose uncertainty mechanism is still a challenge. However, the existing techniques handle the uncertainty incompletely and unevenly, and the corresponding algorithms are not of high efficiency; thus it is impossible for users to obtain the results in real time. For a reference image, a Voronoi aesthetic pattern generation algorithm with uncertainty based on cloud model is proposed, including uncertain line representation using an extended cloud model and Voronoi polygon approximation filling with uncertainty. In view of the different parameters, seven groups of experiments and various experimental analyses are conducted. Compared with the related algorithms, the proposed technique performs better on running time, and its time complexity is approximatively linear related to the size of the input image. The experimental results show that it can produce visually similar effect with the frayed or cracked soil and has three advantages, that is, uncertainty, simplicity, and efficiency. The proposal can be a powerful alternative to the traditional methods and has a prospect of applications in the digital entertainment, home decoration, clothing design, and various fields.

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A Scheme for Verification on Data Integrity in Mobile Multicloud Computing Environment

In order to verify the data integrity in mobile multicloud computing environment, a MMCDIV (mobile multicloud data integrity verification) scheme is proposed. First, the computability and nondegeneracy of verification can be obtained by adopting BLS (Boneh-Lynn-Shacham) short signature scheme. Second, communication overhead is reduced based on HVR (Homomorphic Verifiable Response) with random masking and sMHT (sequence-enforced Merkle hash tree) construction. Finally, considering the resource constraints of mobile devices, data integrity is verified by lightweight computing and low data transmission. The scheme improves shortage that mobile device communication and computing power are limited, it supports dynamic data operation in mobile multicloud environment, and data integrity can be verified without using direct source file block. Experimental results also demonstrate that this scheme can achieve a lower cost of computing and communications.

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Tribological Performance of Si-Doped Hydrogenated Diamond-Like Carbon Coatings in Different Biodiesel

In this paper, two kinds of different biodiesel were tested in terms of their impact on wear resistance of Si-DLC coated 100Cr6 flat worn by an oscillating 100Cr6 ball. The knowledge about the tribological behaviour of different types of biodiesel is rare. Rape and soybean are two of the most common natural sources for biodiesel production. Also, if the quality of biodiesel seems to be similar and, according to the demands, biodiesel from different natural origin could affect changes in the tribological behaviour. Although, soybean methyl ester (SME) gives the best results at room temperature wear tests, 150°C SME reaches wear rates of Si-DLC flat against 100Cr6 ball almost double as high as rapeseed methyl ester (RME). It is evident that, with increasing fraction of oxidation stabilizer C23H32O2, the wear rate increases. For silicon doped hydrogenated diamond-like carbon is especially suitable, for use in biodiesels, where certain fraction of humidity, dissociated water, or polar functional groups may present.

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Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications

The aim of this review is to summarize data published on the use of perioperative hypnosis in patients undergoing breast cancer surgery (BCS). Indeed, the majority of BCS patients experience stress, anxiety, nausea, vomiting, and pain. Correct management of the perioperative period and surgical removal of the primary tumor are clearly essential but can affect patients on different levels and hence have a negative impact on oncological outcomes. This review examines the effect of clinical hypnosis performed during the perioperative period. Thanks to its specific properties and techniques allowing it to be used as complementary treatment preoperatively, hypnosis has an impact most notably on distress and postoperative pain. During surgery, hypnosis may be applied to limit immunosuppression, while, in the postoperative period, it can reduce pain, anxiety, and fatigue and improve wound healing. Moreover, hypnosis is inexpensive, an important consideration given current financial concerns in healthcare. Of course, large randomized prospective studies are now needed to confirm the observed advantages of hypnosis in the field of oncology.

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Protective Effect of Amphipterygium adstringens Extract on Dextran Sulphate Sodium-Induced Ulcerative Colitis in Mice

Amphipterygium adstringens is an endemic species in Mexico commonly known as “cuachalalate.” Healers to treat gastritis, gastric ulcers, and gastrointestinal cancer have traditionally used the bark. We investigated the effects of alcoholic extract of A. adstringens (AaEE) in DSS-induced colitis in mice. The protective effect of AaEE was determined at 200 mg/kg by oral gavage for 10 days. We determine the effect of AaEE on clinical features (disease activity index), antioxidants, anti-inflammatory, and immunomodulatory activities in relation to the activity of SOD, CAT, and GPx, levels of proinflammatory cytokines, and changes both macroscopic and microscopic of the colonic mucosa. AaEE significantly reduced the inflammation of colon and significantly increased SOD and GPx activities. AaEE also significantly decreased TNF-α, IFN-γ, and IL-1β cytokine levels compared to DSS-treated mice and reduced both infiltration of inflammatory cells and the mucosal damage in colon. The results suggested the protective potential of AaEE in DSS-induced colitis and this might be attributed to its phytochemicals compounds that have been found to induce a wide spectrum of activities such as reduction in oxidative stress, suppression of inflammation, modulating numerous signal transduction pathways, and induction of apoptosis. The findings of this study suggest that AaEE has substantial potential for the treatment of inflammatory colitis.

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Effects of Target Size and Test Distance on Stereoacuity

Target size and test distance effects on stereoacuity were investigated in 24 subjects using a three-dimensional monitor. Examination 1: Target Size Effects. The test distance was 2.5 m for 0.1°, 0.2°, 0.5°, and 0.9° target sizes; crossed parallax was presented in 22-second units. Average stereoacuity values for 0.1°, 0.2°, 0.5°, and 0.9° target sizes were , , , and seconds, respectively. Stereoacuity was significantly worse with a 0.1° target than with 0.2°, 0.5°, and 0.9° target sizes (, , and , resp.). Examination 2: Test Distance Effects. Test distances of 2.5, 5.0, and 7.5 m were investigated for a 0.5° target size; crossed parallax was presented in 22-second units. Average stereoacuity values at 2.5 m, 5.0 m, and 7.5 m test distances were , , and seconds, respectively. Stereoacuity at a 7.5 m distance was significantly better than at distances of 2.5 m and 5.0 m ( and , resp.). Stereoacuity at a 5.0 m distance was significantly better than at 2.5 m (). Stereoacuity should be estimated by both parallax and other elements, including test distance and target size.

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IPS Interest in the EEG of Patients after a Single Epileptic Seizure

Objective. This study aims to evaluate the incidence of pathological cerebral activity responses to intermittent rhythmic photic stimulation (IPS) after a single epileptic seizure. Patients and Methods. One hundred and thirty-seven EEGs were performed at the Neurophysiology Department of Mohamed V Teaching Military Hospital in Rabat. Clinical and EEG data was collected. Results. 9.5% of our patients had photoparoxysmal discharges (PPD). Incidence was higher in males than in females, but value was not significant (), and it was higher in children compared to adults with significant value (). The most epileptogenic frequencies were within the range 15–20 Hz. 63 patients had an EEG after 72 hours; among them 11 were photosensitive (). The frequency of the PPR was significantly higher in patients with generalized abnormalities than in focal abnormalities (). EEG confirmed a genetic generalized epilepsy in 8 cases among 13 photosensitive patients. Conclusion. PPR is age related. The frequencies within the range 15–20 Hz should inevitably be included in EEG protocols. The presence of PPR after a first seizure is probably more in favor of generalized seizure rather than the other type of seizure. PPR seems independent from the delay Seizure-EEG. Our study did not show an association between sex and photosensitivity.

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Septic Arthritis of the Pediatric Shoulder: From Infancy to Adolescence

Background. Septic arthritis of the glenohumeral joint in the pediatric population (

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A Case-Control Study on the Oxidative Balance of 50% Autologous Serum Eye Drops

Importance. Autologous serum (AS) eye drops are recommended for severe dry eye in patients with ocular surface disease. No description of the antioxidant balance of AS eye drops has been reported in the literature. Objective. This study sought to evaluate the total reactive antioxidant potential (TRAP) and concentration of reactive oxygen species (ROS) in samples of 50% AS eye drops and their correlations with the demographic characteristics and lifestyle habits of patients with ocular surface disease and healthy controls. Design. This was a case-control study with a 3-month follow-up period. Participants. 16 patients with severe dry eye disease of different etiologies and 17 healthy controls matched by age, gender, and race were included. Results. TRAP and ROS were detected at all evaluated times. There were no differences in the mean ROS () or TRAP () levels between cases and controls. No statistically significant differences in the concentrations of ROS or TRAPs were found at 0, 15, or 30 days ( for ROS = 0.087 and for TRAP = 0.93). Neither the demographic characteristics nor the lifestyle habits were correlated with the oxidative balance of the 50% AS eye drops. Conclusions and Relevance. Both fresh and frozen 50% AS eye drops present antioxidant capacities and ROS in an apparently stable balance. Moreover, patients with ocular surface disease and normal controls produce equivalent AS eye drops in terms of oxidative properties.

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Relationship between Sowing Time, Variety, and Quality in Safflower

This research was carried out to determine the rates of protein and oil production and fatty acid composition and their correlation coefficients in four safflower cultivars (Remzibey, Dincer, Balci, and Yenice) sown in the autumn and spring from 2013 to 2015. The experiment was carried out using split plots in a randomized block design and was replicated 3 times. The study found protein production rates between 15.20 and 18.08%, oil production rates between 24.58 and 31.99%, palmitic acid production rates between 5.93 and 7.01%, stearic acid production rates between 2.13 and 2.53%, oleic acid production rates between 12.08 and 31.58%, linoleic acid production rates between 78.61 and 59.08%, and linolenic acid production rates between 0.11 and 0.15%. Higher seed oil content values were obtained from spring sowing compared to autumn sowing (27.42% and 26.10%), and, in terms of both the evaluated sowing times and cultivars, the highest oil production rates were found in the Balci cultivar (32.20% and 31.78%) for both sowing times. It was determined that there is a positive and significant () relationship between oil with protein production rates but a negative and significant relationship between oil and linolenic acid production rates (). The oleic acid production rate was strongly negatively and significantly correlated with the linoleic acid production rate ().

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Substituent Effects on Regioselectivity of the Diels-Alder Reactions: Reactions of 10-Allyl-1,8-dichloroanthracene with 2-Chloroacrylonitrile, 1-Cyanovinyl Acetate and Phenyl Vinyl Sulfone

Diels-Alder reaction of 10-allyl-1,8-dichloroanthracene (3) with 2-chloroacrylonitrile (4) and 1-cyanovinyl acetate (5) gives exclusively the ortho isomer while its reaction with phenyl vinyl sulfone (10) yields a mixture of two isomeric adducts with priority to ortho isomer. The reactions proceeded under microwave condition in xylene. Configurations of these isomers have been assigned with the help of NMR spectra. The results indicated that the steric effect is dominating toward the isomer regioselectivity in the Diels-Alder reaction of the present compounds.

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Kidney Expression of Toll Like Receptors in Lupus Nephritis: Quantification and Clinicopathological Correlations

Objective. The study aimed at locating and quantifying Toll Like Receptor (TLR) 3, 7, 8, and 9 expression in kidney of patients with lupus nephritis (LN) and correlating them with clinicopathological features. Methods. Kidney sections from 26 LN patients and 4 controls were analyzed by immunohistochemistry using anti-human TLR3, TLR7, TLR8, and TLR9 polyclonal antibodies; the number of TLR-positive nuclei/mm2 was evaluated on digitalized images. Results. Compared to controls, LN showed a significantly higher amount of glomerular and tubulointerstitial TLR9 ( and ), whole and tubulointerstitial TLR3 ( and ), and a higher tubulointerstitial TLR7 (). TLR9 positively correlated with activity index () and tubular TLR7 with chronicity index (). TLR9 positively correlated with Renal-SLEDAI (). Conclusions. This is the first study quantifying kidney expressions of TLRs in LN patients; the results show an overexpression of TLR3, TLR7, and TLR9 and demonstrate a correlation with clinicopathological indices supporting a role of these mediators in the pathogenesis of LN.

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Higher Spin Symmetries of the Free Schrödinger Equation

It is shown that the Schrödinger symmetry algebra of a free particle in spatial dimensions can be embedded into a representation of the higher spin algebra. The latter spans an infinite dimensional algebra of higher-order symmetry generators of the free Schrödinger equation. An explicit representation of the maximal finite dimensional subalgebra of the higher spin algebra is given in terms of nonrelativistic generators. We show also how to convert Vasiliev’s equations into an explicit nonrelativistic covariant form, such that they might apply to nonrelativistic systems. Our procedure reveals that the space of solutions of the Schrödinger equation can be regarded also as a supersymmetric module.

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A Concealed Car Extraction Method Based on Full-Waveform LiDAR Data

Concealed cars extraction from point clouds data acquired by airborne laser scanning has gained its popularity in recent years. However, due to the occlusion effect, the number of laser points for concealed cars under trees is not enough. Thus, the concealed cars extraction is difficult and unreliable. In this paper, 3D point cloud segmentation and classification approach based on full-waveform LiDAR was presented. This approach first employed the autocorrelation coefficient and the echo ratio to determine concealed cars areas. Then the points in the concealed cars areas were segmented with regard to elevation distribution of concealed cars. Based on the previous steps, a strategy integrating backscattered waveform features and the view histogram descriptor was developed to train sample data of concealed cars and generate the feature pattern. Finally concealed cars were classified by pattern matching. The approach was validated by full-waveform LiDAR data and experimental results demonstrated that the presented approach can extract concealed cars with accuracy more than 78.6% in the experiment areas.

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Simulation on the Self-Compacting Concrete by an Enhanced Lagrangian Particle Method

The industry has embraced self-compacting concrete (SCC) to overcome deficiencies related to consolidation, improve productivity, and enhance safety and quality. Due to the large deformation at the flowing process of SCC, an enhanced Lagrangian particle-based method, Smoothed Particles Hydrodynamics (SPH) method, though first developed to study astrophysics problems, with its exceptional advantages in solving problems involving fragmentation, coalescence, and violent free surface deformation, is developed in this study to simulate the flow of SCC as a non-Newtonian fluid to achieve stable results with satisfactory convergence properties. Navier-Stokes equations and incompressible mass conservation equations are solved as basics. Cross rheological model is used to simulate the shear stress and strain relationship of SCC. Mirror particle method is used for wall boundaries. The improved SPH method is tested by a typical 2D slump flow problem and also applied to L-box test. The capability and results obtained from this method are discussed.

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Thrombus Degradation by Fibrinolytic Enzyme of Stenotrophomonas sp. Originated from Indonesian Soybean-Based Fermented Food on Wistar Rats

Objective. To evaluate thrombus degrading effect of a fibrinolytic enzyme from food origin Stenotrophomonas sp. of Indonesia. Methods. Prior to animal study, the enzyme safety was tested using cell culture. The effect on expression of tissue plasminogen activator was also analysed in the cell culture. For in vivo studies, 25 Wistar rats were used: normal control, negative control, treatment groups with crude and semipurified enzyme given orally at 25 mg/kg, and positive control group which received Lumbrokinase at 25 mg/kg. Blood clot in the tail was induced by kappa carrageenan injection at 1 mg/kg BW. Results. Experiment with cell culture confirmed the enzyme safety at the concentration used and increased expression of tPA. Decreasing of thrombus was observed in the positive group down to 70.35 ± 23.11% of the negative control animals (100%). The thrombus observed in the crude enzyme treatment was down to 56.99 ± 15.95% and 71.5 ± 15.7% for semipurified enzyme. Scanning electron microscopy showed clearly that bood clots were found in the animals injected with kappa carrageenan; however, in the treatment and positive groups, the clot was much reduced. Conclusions. Oral treatment of enzyme from Stenotrophomonas sp. of Indonesian fermented food was capable of degrading thrombus induced in Wistar rats.

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Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints

Objective. To provide a comprehensive overview of published evidence on the impact of erythritol, a noncaloric polyol bulk sweetener, on oral health. Methods. A literature review was conducted regarding the potential effects of erythritol on dental plaque (biofilm), dental caries, and periodontal therapy. The efficacy of erythritol on oral health was compared with xylitol and sorbitol. Results. Erythritol effectively decreased weight of dental plaque and adherence of common streptococcal oral bacteria to tooth surfaces, inhibited growth and activity of associated bacteria like S. mutans, decreased expression of bacterial genes involved in sucrose metabolism, reduced the overall number of dental caries, and served as a suitable matrix for subgingival air-polishing to replace traditional root scaling. Conclusions. Important differences were reported in the effect of individual polyols on oral health. The current review provides evidence demonstrating better efficacy of erythritol compared to sorbitol and xylitol to maintain and improve oral health.

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Psychiatric Emergencies for Clinicians: Emergency Department Diagnosis and Management of Steroid Psychosis

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Publication date: Available online 20 August 2016
Source:The Journal of Emergency Medicine
Author(s): Bryan Corbett, Kimberly Nordstrom, Gary M. Vilke, Michael P. Wilson




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Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update

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Publication date: Available online 20 August 2016
Source:The Journal of Emergency Medicine
Author(s): Erica Simon, Brit Long, Alex Koyfman
BackgroundSickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention.ObjectiveOur aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications.DiscussionSCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease. Emergency physicians must recognize acute manifestations of SCD in order to deliver timely management and determine patient disposition.ConclusionsA comprehensive review of the emergency department management of acute SCD complications is provided. Comprehensive understanding of these aspects of SCD can assist physicians in expediting patient evaluation and treatment, thus decreasing the morbidity and mortality associated with this hemoglobinopathy.



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Acute Aortic Dissection Presenting as Bilateral Lower Extremity Paralysis: A Case Report

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Publication date: Available online 20 August 2016
Source:The Journal of Emergency Medicine
Author(s): Kate E. Hughes, Colin Seguin, Brent Felton, Mary J. Hughes, David Castle
BackgroundFirst described by Morgagni in 1761, aortic dissection (AD) is an acute life-threatening and time-sensitive disease process with an increasing mortality approaching 1% for every 1-hour delay in diagnosis within the first 48 hours. Despite continued surgical advancement, overall in-hospital mortality remains significant (27.4%).Case ReportA 56-year-old woman presented to an outlying emergency department with a complaint of isolated lumbar pain associated with right lower extremity paresthesia and paralysis that progressed to the left. Her medical history and a review of symptoms were significant for chronic obstructive pulmonary disease and tobacco abuse. The initial evaluation in the emergency department included laboratory values and a computed tomography scan of the lumbar spine that revealed minimal disease. After transfer to our tertiary care center for an emergent magnetic resonance imaging scan of the lumbar spine, her vital signs were as follows: blood pressure, 176/84 mm Hg; heart rate, 76 beats/min; respiratory rate, 24 breaths/min; afebrile; and oxygen saturation 98% on room air. A repeat examination revealed cold extremities with mottling, bilateral symmetric lower extremity flaccid paralysis, and a loss of pulses and reflexes. She was insensate below the T10 dermatome. Her upper extremities and cranial nerves were normal. She underwent computed tomography angiography, revealing an extensive Stanford type A AD with interim thrombus formation. After successful endograft stenting, she died 24 hours later.Why Should an Emergency Physician Be Aware of This?Comprising <2% of all ADs, the pathophysiology of paraplegia as the initial presentation of AD is caused by compression of the anterior spinal artery, resulting in ischemia of the spinal cord. Acute AD is a life-threatening medical emergency that requires a high clinical level of suspicion because of its often variable presentation and high incidence of mortality.



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