Δευτέρα, 9 Μαΐου 2016

Trachway® stylet: a perfect tool for nasotracheal intubation – a reply



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Trachway® stylet: a perfect tool for nasotracheal intubation?



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Issue Information - Editorial Board



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On the Brink of Breakthroughs in Diagnosing and Treating Autism

Science is taking a more personalized approach to treating the disorder and to understanding its diverse causes

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Where No Maps Have Gone Before!

There's something wonderfully thrilling about geologic maps of places we've never mapped that way before! Scientists recently mapped a brand-new island and produced a beautifully-detailed map of...

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Immunohistochemical expression of DNA methyltransferases 1, 3a, and 3b in actinic cheilitis and lip squamous cell carcinomas

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Background

Epigenetic modifications, including DNA methylation of tumor suppressor genes carried out by DNA methyltransferases (DNMTs), are important events in carcinogenesis. Although there are studies concerning to its expression in several cancer types, DNMTs expression pattern is not known in photoinduced lip carcinogenesis. The aim of this study was to investigate the immunoexpression of DNMTs 1, 3a, and 3b in lip precancerous lesion (actinic cheilitis) and cancer.

Methods

Thirty cases of actinic cheilitis (AC), thirty cases of lip squamous cell carcinoma (LSCC), and twenty cases of non-neoplastic tissue (NNT) were selected for immunohistochemical investigation of DNMTs 1, 3a, and 3b.

Results

Nuclear DNMT 1 immunoreactivity was significantly higher in the LSCC group (68.6%) compared with NNT (47%), and nuclear DNMT 3b was higher in LSCC (70.9%) than in NNT (37.9%) and in AC (44%). Only DNMT 3a showed both higher nuclear and cytoplasmic expression in AC (35.9% and 35.5%, respectively) than in NNT (4.4% and 16.1%, respectively) and LSCC (8.8% and 13.2%, respectively) (P < 0.05).

Conclusions

The results suggested that DNMT 3a could play a key role in the methylation process of initial steps of UV carcinogenesis present in AC while DNMT 3b could be responsible for de novo methylation in already established lip cancer.



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Acoustic Absorption of Natural Fiber Composites

The current study is a bibliographic observation on prevailing tendencies in the development of acoustic absorption by natural fiber composites. Despite having less detrimental environmental effects and thorough availability, natural fibers are still unsuitable for wide implementation in industrial purposes. Some shortcomings such as the presence of moisture contents, thicker diameter, and lower antifungus quality hold up the progress of natural fiber composites in staying competitive with synthetic composites. The review indicates the importance of the pretreatment of fresh natural fiber to overcome these shortcomings. However, the pretreatment of natural fiber causes the removal of moisture contents which results in the decrease of its acoustic absorption performance. Incorporation of granular materials in treated fiber composite is expected to play a significant role as a replacement for moisture contents. This review aims to investigate the acoustic absorption behavior of natural fiber composites due to the incorporation of granular materials. It is intended that this review will provide an overview of the analytical approaches for the modeling of acoustic wave propagation through the natural fiber composites. The possible influential factors of fibers and grains were described in this study for the enhancement of low frequency acoustic absorption of the composites.

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Multicenter Study of Antibiotic Resistance Profile of H. pylori and Distribution of CYP2C19 Gene Polymorphism in Rural Population of Chongqing, China

This study was to investigate the antibiotic resistance profile of H. pylori and the distribution of CYP2C19 gene polymorphism in rural population of Chongqing, China. 214 and 111 strains of H. pylori were isolated from rural and urban patients, respectively. 99.53%, 20.09%, and 23.36% of the isolates in rural patients were found to be resistant to metronidazole, clarithromycin, and levofloxacin, while the resistant rate in urban patients was 82.88%, 19.82%, and 24.32%. The multiple antibiotic resistance percentage significantly increased from 28.26% (below 45 years) to 41.80% (above 45 years) in rural patients. Up to 44.39%, 45.79%, and 9.81% of rural patients from whom H. pylori was isolated were found to be extensive metabolizers, intermediate metabolizers, and poor metabolizers. No correlation was observed between antibiotic resistance profile of H. pylori and genetic polymorphism of CYP2C19 among rural population. There was a high prevalence of H. pylori strains resistant to metronidazole, clarithromycin, and levofloxacin in rural patients in Chongqing, China. The choice of therapy in this area should be based on local susceptibility patterns. Amoxicillin, gentamicin, and furazolidone are recommended as the first-line empiric regimen.

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Blastocystis sp. Infection Mimicking Clostridium Difficile Colitis

We report an unusual case of severe diarrhea related to Blastocystis sp. infection in a patient with end stage renal disease on hemodialysis. The patient was admitted due to profuse diarrhea associated with fever and leukocytosis. Pertinent stool work-up such as leukocytes in stool, stool culture, clostridium difficile toxin B PCR, and serology for hepatitis A, hepatitis B, and hepatitis C and cytomegalovirus screening were all negative. Ova and parasite stool examination revealed Blastocystis sp. The patient was given intravenous metronidazole with clinical improvement by day three and total resolution of symptoms by day ten.

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Splinting of Longitudinal Fracture: An Innovative Approach

Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth.

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Histone Lysine Methylation in TGF-β1 Mediated p21 Gene Expression in Rat Mesangial Cells

Transforming growth factor beta1- (TGF-β1-) induced p21-dependent mesangial cell (MC) hypertrophy plays a key role in the pathogenesis of chronic renal diseases including diabetic nephropathy (DN). Increasing evidence demonstrated the role of posttranscriptional modifications (PTMs) in the event; however, the precise regulatory mechanism of histone lysine methylation remains largely unknown. Here, we examined the roles of both histone H3 lysine 4 and lysine 9 methylations (H3K4me/H3K9me) in TGF-β1 induced p21 gene expression in rat mesangial cells (RMCs). Our results indicated that TGF-β1 upregulated the expression of p21 gene in RMCs, which was positively correlated with the increased chromatin marks associated with active genes (H3K4me1/H3K4me2/H3K4me3) and negatively correlated with the decreased levels of repressive marks (H3K9me2/H3K9me3) at p21 gene promoter. TGF-β1 also elevated the recruitment of the H3K4 methyltransferase (HMT) SET7/9 to the p21 gene promoter. SET7/9 gene silencing with small interfering RNAs (siRNAs) significantly abolished the TGF-β1 induced p21 gene expression. Taken together, these results reveal the key role of histone H3Kme in TGF-β1 mediated p21 gene expression in RMC, partly through HMT SET7/9 occupancy, suggesting H3Kme and SET7/9 may be potential renoprotective agents in managing chronic renal diseases.

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Selective Insulin Resistance in the Kidney

Insulin resistance has been characterized as attenuation of insulin sensitivity at target organs and tissues, such as muscle and fat tissues and the liver. The insulin signaling cascade is divided into major pathways such as the PI3K/Akt pathway and the MAPK/MEK pathway. In insulin resistance, however, these pathways are not equally impaired. For example, in the liver, inhibition of gluconeogenesis by the insulin receptor substrate (IRS) 2 pathway is impaired, while lipogenesis by the IRS1 pathway is preserved, thus causing hyperglycemia and hyperlipidemia. It has been recently suggested that selective impairment of insulin signaling cascades in insulin resistance also occurs in the kidney. In the renal proximal tubule, insulin signaling via IRS1 is inhibited, while insulin signaling via IRS2 is preserved. Insulin signaling via IRS2 continues to stimulate sodium reabsorption in the proximal tubule and causes sodium retention, edema, and hypertension. IRS1 signaling deficiency in the proximal tubule may impair IRS1-mediated inhibition of gluconeogenesis, which could induce hyperglycemia by preserving glucose production. In the glomerulus, the impairment of IRS1 signaling deteriorates the structure and function of podocyte and endothelial cells, possibly causing diabetic nephropathy. This paper mainly describes selective insulin resistance in the kidney, focusing on the proximal tubule.

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IJMS, Vol. 17, Pages 692: Study on the Application of the Combination of TMD Simulation and Umbrella Sampling in PMF Calculation for Molecular Conformational Transitions

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Free energy calculations of the potential of mean force (PMF) based on the combination of targeted molecular dynamics (TMD) simulations and umbrella samplings as a function of physical coordinates have been applied to explore the detailed pathways and the corresponding free energy profiles for the conformational transition processes of the butane molecule and the 35-residue villin headpiece subdomain (HP35). The accurate PMF profiles for describing the dihedral rotation of butane under both coordinates of dihedral rotation and root mean square deviation (RMSD) variation were obtained based on the different umbrella samplings from the same TMD simulations. The initial structures for the umbrella samplings can be conveniently selected from the TMD trajectories. For the application of this computational method in the unfolding process of the HP35 protein, the PMF calculation along with the coordinate of the radius of gyration (Rg) presents the gradual increase of free energies by about 1 kcal/mol with the energy fluctuations. The feature of conformational transition for the unfolding process of the HP35 protein shows that the spherical structure extends and the middle α-helix unfolds firstly, followed by the unfolding of other α-helices. The computational method for the PMF calculations based on the combination of TMD simulations and umbrella samplings provided a valuable strategy in investigating detailed conformational transition pathways for other allosteric processes.

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Average UK family can't afford cancer warns Macmillan

The average family in the UK would not be able to afford cancer, and could be forced to find hundreds of pounds a month if they were hit by the disease, according to new analysis released today by Macmillan Cancer Support. Macmillan calculates that the...

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Study suggests testosterone therapy does not raise risk of aggressive prostate cancer

Men with low levels of the male sex hormone testosterone need not fear that testosterone replacement therapy will increase their risk of prostate cancer. This is the finding of an analysis of more than a quarter-million medical records of mostly white...

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IJERPH, Vol. 13, Pages 478: Estimating Nitrogen Load Resulting from Biofuel Mandates

The Energy Policy Act of 2005 and the Energy Independence and Security Act (EISA) of 2007 were enacted to reduce the U.S. dependency on foreign oil by increasing the use of biofuels. The increased demand for biofuels from corn and soybeans could result in an increase of nitrogen flux if not managed properly. The objectives of this study are to estimate nitrogen flux from energy crop production and to identify the catchment areas with high nitrogen flux. The results show that biofuel production can result in an increase of nitrogen flux to the northern Gulf of Mexico from 270 to 1742 thousand metric tons. Using all cellulosic (hay) ethanol or biodiesel to meet the 2022 mandate is expected to reduce nitrogen flux; however, it requires approximately 25% more land when compared to other scenarios. Producing ethanol from switchgrass rather than hay results in three-times more nitrogen flux, but requires 43% less land. Using corn ethanol for 2022 mandates is expected to have double the nitrogen flux when compared to the EISA-specified 2022 scenario; however, it will require less land area. Shifting the U.S. energy supply from foreign oil to the Midwest cannot occur without economic and environmental impacts, which could potentially lead to more eutrophication and hypoxia.

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IJERPH, Vol. 13, Pages 479: Hospitalisation Resulting from Medicine-Related Problems in Adult Patients with Cardiovascular Diseases and Diabetes in the United Kingdom and Saudi Arabia

Cardiovascular diseases (CVDs) and diabetes (DM) are two interrelated conditions that have a heavy morbidity and mortality burden worldwide. Patients with the two conditions usually take multiple medicines and thus are more susceptible to medicine-related problems (MRPs). MRPs can occur at any stage of the treatment process and in many cases can lead to unplanned hospitalisations. The aim of the study was to determine the prevalence of hospitalisation resulting from MRPs in adult patients with CVDs and/or DM and to identify the main causes, risk factors, and medicine classes involved. A retrospective study included 300 adult patients from two hospitals, one in the United Kingdom and one in Saudi Arabia. To identify MRPs, medical records were reviewed for demographic data, clinical data, laboratory assay, and prescription records. A total of 197 (65.7%) patients had MRPs, of which less than 10% were severe. The main problems were lack of treatment effectiveness and adverse drug reactions. Moreover, polypharmacy and patient non-adherence were the main risk factors contributing to MRPs. The main medicine classes associated with MRPs were insulin and antihypertensive medicines. Further research should address the pharmaceutical care processes employed in treating CVDs and DM, and to empower patients/healthcare providers in tackling MRPs.

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Assessing Bowel Cleansing for Colonoscopy: Changing Our Focus to What Really Matters



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Efficient Sleep Scheduling Algorithm for Target Tracking in Double-Storage Energy Harvesting Sensor Networks

Target tracking is a typical application in wireless sensor networks. Both energy efficiency and tracking performance are important issues that need to be considered. They are a pair of contradictions most of the time. Saving energy often sacrifices tracking performance, while enhancing tracking performance needs to consume more energy. In this paper, an efficient sleep scheduling algorithm is put forward to tackle the above problem in energy harvesting sensor networks. At first, we modify the probability-based prediction and sleep scheduling (PPSS) algorithm to track the target and further use another sleep scheduling algorithm we proposed to wake tracking nodes when the target is likely to be missed (i.e., it is unsuccessful to wake next-moment tracking nodes). Secondly, a double-storage energy harvesting architecture is employed to increase residual energy of sensor nodes and to extend network lifetime. Simulation results reveal that the proposed sleep scheduling algorithm can improve tracking performance and prolong network lifetime compared with the PPSS algorithm and the proposed algorithm without energy harvesting.

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Modeling of the Stepped Leader Initiation Process in an Altitude Triggered Lightning

In an altitude triggered lightning, the potential and charge distribution of the triggering wire, a floating conductor, is unknown and changeable during the triggering process, which makes it difficult to simulate an altitude triggered lightning in a numerical work. To solve this problem, a 3D altitude triggered lightning model is developed in this paper, which contains two parts, a Thundercloud Model which is time-dependent and nonhydrostatic and takes 27 kinds of microphysical processes into consideration and a Triggering Model in which a charge conservation equation is introduced to describe the floating conductor and to ensure the overall neutrality of the leader channel. Numerical results of the stepped leader initiation process are given, which are in good agreement with experiment observations.

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Analysis and Control of the Complex Dynamics of a Multimarket Cournot Investment Game with Bounded Rationality

A dynamic multimarket Cournot model is introduced based on a specific inverse demand function. Puu’s incomplete information approach, as a realistic method, is used to contract the corresponding dynamical model under this function. Therefore, some stability analysis is carried out on the model to detect the stability and instability conditions of the system’s Nash equilibrium. Based on the analysis, some dynamic phenomena such as bifurcation and chaos are found. Numerical simulations are used to provide experimental evidence for the complicated behaviors of the system evolution. It is observed that the equilibrium of the system can lose stability via flip bifurcation or Neimark-Sacker bifurcation and time-delayed feedback control is used to stabilize the chaotic behaviors of the system.

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Effect of the Modification of the Start-Up Sequence on the Thermal Stresses for a Microgas Turbine

Microgas turbines (MGT) are an alternative for small-scale energy production; however, their small size becomes a drawback since it enhances the heat transfer among their components. Moreover, heat transfer drives to temperature gradients which become higher during transient cycles like start-up. The influence of different start-up curves on temperature and thermal stresses of a microgas turbine was investigated. Stationary and rotational blades of the turbine were numerically simulated using CFD and FEM commercial codes. Conjugated heat transfer cases were solved for obtaining heat transfer from fluid toward the blades. Changes of temperature gradients within the blades during the start-ups were calculated under transient state with boundary conditions according to each curve to assess accurate thermal stresses calculations. Results showed that the modification of the start-up curves had an impact on the thermal stresses levels and on the time when highest stresses appeared on each component. Furthermore, zones highly stressed were located near the constraints of blades where thermal strains are restricted. It was also found that the curve that had a warming period at the beginning of the start-up allowed reducing the peaks of stresses making it more feasible and safer for the turbine start-up operation.

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Differences in Cortical Representation and Structural Connectivity of Hands and Feet between Professional Handball Players and Ballet Dancers

It is known that intensive training and expertise are associated with functional and structural neuroadaptations. Most studies, however, compared experts with nonexperts; hence it is, specifically for sports, unclear whether the neuroplastic adaptations reported are sport-specific or sport-general. Here we aimed at investigating sport-specific adaptations in professional handball players and ballet dancers by focusing on the primary motor and somatosensory grey matter (GM) representation of hands and feet using voxel-based morphometry as well as on fractional anisotropy (FA) of the corticospinal tract by means of diffusion tensor imaging-based fibre tractography. As predicted, GM volume was increased in hand areas of handball players, whereas ballet dancers showed increased GM volume in foot areas. Compared to handball players, ballet dancers showed decreased FA in both fibres connecting the foot and hand areas, but they showed lower FA in fibres connecting the foot compared to their hand areas, whereas handball players showed lower FA in fibres connecting the hand compared to their foot areas. Our results suggest that structural adaptations are sport-specific and are manifested in brain regions associated with the neural processing of sport-specific skills. We believe this enriches the plasticity research in general and extends our knowledge of sport expertise in particular.

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Decentralized Optimization for a Novel Control Structure of HVAC System

A decentralized control structure is introduced into the heating, ventilation, and air conditioning (HVAC) system to solve the high maintenance and labor cost problem in actual engineering. Based on this new control system, a decentralized optimization method is presented for sensor fault repair and optimal group control of HVAC equipment. Convergence property of the novel method is theoretically analyzed considering both convex and nonconvex systems with constraints. In this decentralized control system, traditional device is fitted with a control chip such that it becomes a smart device. The smart device can communicate and operate collaboratively with the other devices to accomplish some designated tasks. The effectiveness of the presented method is verified by simulations and hardware tests.

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Diversity of Virulence Factors Associated with West Australian Methicillin-Sensitive Staphylococcus aureus Isolates of Human Origin

An extensive array of virulence factors associated with S. aureus has contributed significantly to its success as a major nosocomial pathogen in hospitals and community causing variety of infections in affected patients. Virulence factors include immune evading capsular polysaccharides, poly-N-acetyl glucosamine, and teichoic acid in addition to damaging toxins including hemolytic toxins, enterotoxins, cytotoxins, exfoliative toxin, and microbial surface components recognizing adhesive matrix molecules (MSCRAMM). In this investigation, 31 West Australian S. aureus isolates of human origin and 6 controls were analyzed for relative distribution of virulence-associated genes using PCR and/or an immunoassay kit and MSCRAMM by PCR-based typing. Genes encoding MSCRAMM, namely, Spa, ClfA, ClfB, SdrE, SdrD, IsdA, and IsdB, were detected in >90% of isolates. Gene encoding α-toxin was detected in >90% of isolates whereas genes encoding β-toxin and SEG were detectable in 50–60% of isolates. Genes encoding toxin proteins, namely, SEA, SEB, SEC, SED, SEE, SEH, SEI, SEJ, TSST, PVL, ETA, and ETB, were detectable in >50% of isolates. Use of RAPD-PCR for determining the virulence factor-based genetic relatedness among the isolates revealed five cluster groups confirming genetic diversity among the MSSA isolates, with the greatest majority of the clinical S. aureus (84%) isolates clustering in group IIIa.

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Mutation Analysis of the Common Deafness Genes in Patients with Nonsyndromic Hearing Loss in Linyi by SNPscan Assay

Hearing loss is a common sensory disorder, and at least 50% of cases are due to a genetic etiology. Although hundreds of genes have been reported to be associated with nonsyndromic hearing loss, GJB2, SLC26A4, and mtDNA12SrRNA are the major contributors. However, the mutation spectrum of these common deafness genes varies among different ethnic groups. The present work summarized mutations in these three genes and their prevalence in 339 patients with nonsyndromic hearing loss at three different special education schools and one children’s hospital in Linyi, China. A new multiplex genetic screening system “SNPscan assay” was employed to detect a total of 115 mutations of the above three genes. Finally, 48.67% of the patients were identified with hereditary hearing loss caused by mutations in GJB2, SLC26A4, and mtDNA12SrRNA. The carrying rate of mutations in the three genes was 37.76%, 19.75%, and 4.72%, respectively. This mutation profile in our study is distinct from other parts of China, with high mutation rate of GJB2 suggesting a unique mutation spectrum in this area.

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The Reliability of a Novel Automated System for ANA Immunofluorescence Analysis in Daily Clinical Practice

Automated interpretation (AI) systems for antinuclear antibody (ANA) analysis have been introduced based on assessment of indirect immunofluorescence (IIF) patterns. The diagnostic performance of a novel automated IIF reading system was compared with visual interpretation (VI) of IIF in daily clinical practice to evaluate the reduction of workload. ANA-IIF tests of consecutive serum samples from patients with suspected connective tissue disease were carried out using HEp-2 cells according to routine clinical care. AI was performed using a visual analyser (Zenit G-Sight, Menarini, Germany). Agreement rates between ANA results by AI and VI were calculated. Of the 336 samples investigated, VI yielded 205 (61%) negative, 42 (13%) ambiguous, and 89 (26%) positive results, whereas 82 (24%) were determined to be negative, 176 (52%) ambiguous, and 78 (24%) positive by AI. AI displayed a diagnostic accuracy of 175/336 samples (52%) with a kappa coefficient of 0.34 compared to VI being the gold standard. Solely relying on AI, with VI only performed for all ambiguous samples by AI, would have missed 1 of 89 (1%) positive results by VI and misclassified 2 of 205 (1%) negative results by VI as positive. The use of AI in daily clinical practice resulted only in a moderate reduction of the VI workload (82 of 336 samples: 24%).

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Treatment Outcomes of Tuberculosis and Associated Factors in an Ethiopian University Hospital

Background. Tuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. Purpose. To assess the outcome of tuberculosis treatment and to identify factors associated with tuberculosis treatment outcome. Methods. A five-year retrospective cross-sectional study was employed and data were collected through medical record review. Data were analyzed using SPSS version 16 and binary and multiple logistic regression methods were used. A value of less than 0.05 was considered as statistically significant in the final model. Results. Out of the 1584 pulmonary TB patients (882 males and 702 females) including all age group, 60.1% had successful outcome and 39.9% had unsuccessful outcome. In the final multivariate logistic model, the odds of unsuccessful treatment outcome was higher among patients of weight category 30–39.9 kg (AOR = 1.51, 95% CI: 1.102–2.065) and smear negative pulmonary TB (AOR = 3.204, 95% CI: 2.277–4.509) and extrapulmonary TB (AOR = 3.175, 95% CI: 2.201–4.581) and retreatment (AOR = 6.733, 95% CI: 3.235–14.013) and HIV positive TB patients (AOR = 1.988, 95% CI: 1.393–2.838) and unknown HIV status TB patients (AOR = 1.506, 95% CI: 1.166–1.945) as compared to their respective comparison groups. Conclusion. In this study, high proportion of unsuccessful treatment outcome was documented. Therefore emphasis has to be given for patients with high risk of unsuccessful TB treatment outcome and targeted interventions should be carried out.

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A New Wavelet Threshold Function and Denoising Application

In order to improve the effects of denoising, this paper introduces the basic principles of wavelet threshold denoising and traditional structures threshold functions. Meanwhile, it proposes wavelet threshold function and fixed threshold formula which are both improved here. First, this paper studies the problems existing in the traditional wavelet threshold functions and introduces the adjustment factors to construct the new threshold function basis on soft threshold function. Then, it studies the fixed threshold and introduces the logarithmic function of layer number of wavelet decomposition to design the new fixed threshold formula. Finally, this paper uses hard threshold, soft threshold, Garrote threshold, and improved threshold function to denoise different signals. And the paper also calculates signal-to-noise (SNR) and mean square errors (MSE) of the hard threshold functions, soft thresholding functions, Garrote threshold functions, and the improved threshold function after denoising. Theoretical analysis and experimental results showed that the proposed approach could improve soft threshold functions with constant deviation and hard threshold with discontinuous function problems. The proposed approach could improve the different decomposition scales that adopt the same threshold value to deal with the noise problems, also effectively filter the noise in the signals, and improve the SNR and reduce the MSE of output signals.

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A Small Planar Antenna for 4G Mobile Phone Application

The analysis and design of a small planar multiband antenna operating in the 4G frequency bands are presented. The numerical and experimental results demonstrated that the proposed antenna satisfies the requirement of 6 dB return loss for the impedance bandwidth of the LTE700/LTE2300/LTE2500 and WiMAX3500 bands. The gains at 750 MHz/2.3 GHz/2.6 GHz/3.5 GHz are 2.1 dBi/4.9 dBi/4.7 dBi/4.3 dBi, respectively. The measured radiation patterns verify the suitability of the antenna to be employed in mobile phones. The dimensions of the radiant patch are 49 × 10 mm2. The proposed antenna can be easily fabricated and customized to various 4G mobile phones as a compact internal antenna.

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Kampen mot unødig prøvetaking

I laboratoriene forsøker vi å legge til rette for korrekt bruk av analyser. Det er lett å møte seg selv i døren.

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Idiopathic sclerosing encapsulating peritonitis presenting as a right iliac fossa mass in a teenaged girl

Sclerosing encapsulating peritonitis (SEP) is a rare peritoneal condition characterised by a firm and thick membrane that encases a part of or the whole of the small intestine. It can be idiopathic or secondary to a variety of conditions. It usually presents as an acute or subacute small bowel obstruction, however, the presentation can vary. It may be diagnosed by radiology, although definitive diagnosis is by laparoscopy or laparotomy. It is treated by excision of the covering membrane. We report a case of a teenaged girl who presented with abdominal pain and a palpable mass in the right iliac fossa. The patient underwent emergency laparotomy after her work up was inconclusive, and was found to have a case of SEP. The distal ileum and the sigmoid colon appeared to be covered by a thick membrane, which was excised. Follow-up of the patient was unremarkable.



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Gingival leiomyomatous hamartoma of the maxilla: a rare entity

Hamartoma is a tumour-like malformation appearing as a focal overgrowth of normal cells. Leiomyomatous hamartomas (LHs) are rare in the oral cavity and commonly seen in the Japanese and less than 40 cases have been reported in the Japanese and English literature. The clinical differential diagnoses are irritational (traumatic) fibroma and congenital epulis. It has to be differentiated histopathologically from its neoplastic counterparts and mesenchymomas. Hence, we report such a case of LHs, which presented as a sessile gingival growth occurring in the midline in a 15-year-old girl. The final diagnosis was based on the histopathological appearance which was confirmed by immunohistochemical staining of various markers. A review of the literature of previous cases was also carried out.



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Scrub typhus masquerading as acute pancreatitis

The clinical spectrum of scrub typhus ranges from mild to fatal depending on the virulence of bacterial strain, susceptibility of the host and promptness with which treatment is started. We report a case of a 14-year-old child with scrub typhus who developed acute pancreatitis. On serological confirmation, doxycycline therapy was started. The patient responded well and had no complications on follow-up. This case report highlights the importance of recognising an uncommon presentation of this common tropical disease, and its prompt diagnosis and early treatment for prevention of serious complications of the condition.



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Sphingobacterium spiritivorum septicaemia associated with cellulitis in a patient with Parkinson's disease

Sphingobacterium spiritivorum, a Gram-negative bacillus, is abundant in nature and is rarely involved in causing human infections. However, it is intrinsically resistant to many commonly administered antibiotics and can thus be a life-threatening microorganism. We describe a case of an 89-year-old Caucasian man who presented with sepsis from S. spiritivorum cellulitis.



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Long-term outcome of magnetic resonance spectroscopic image–directed dose escalation for prostate brachytherapy

Publication date: Available online 20 April 2016
Source:Brachytherapy
Author(s): Martin T. King, Nicola J. Nasser, Nitin Mathur, Gil'ad N. Cohen, Marisa A. Kollmeier, Jasper Yuen, Hebert A. Vargas, Xin Pei, Yoshiya Yamada, Kristen L. Zakian, Marco Zaider, Michael J. Zelefsky
PurposeTo report the long-term control and toxicity outcomes of patients with clinically localized prostate cancer, who underwent low-dose-rate prostate brachytherapy with magnetic resonance spectroscopic image (MRSI)–directed dose escalation to intraprostatic regions.Methods and MaterialsForty-seven consecutive patients between May 2000 and December 2003 were analyzed retrospectively. Each patient underwent a preprocedural MRSI, and MRS-positive voxels suspicious for malignancy were identified. Intraoperative planning was used to determine the optimal seed distribution to deliver a standard prescription dose to the entire prostate, while escalating the dose to MRS-positive voxels to 150% of prescription. Each patient underwent transperineal implantation of radioactive seeds followed by same-day CT for postimplant dosimetry.ResultsThe median prostate D90 (minimum dose received by 90% of the prostate) was 125.7% (interquartile range [IQR], 110.3–136.5%) of prescription. The median value for the MRS-positive mean dose was 229.9% (IQR, 200.0–251.9%). Median urethra D30 and rectal D30 values were 142.2% (137.5–168.2%) and 56.1% (40.1–63.4%), respectively. Median followup was 86.4 months (IQR, 49.8–117.6). The 10-year actuarial prostate-specific antigen relapse–free survival was 98% (95% confidence interval, 93–100%). Five patients (11%) experienced late Grade 3 urinary toxicity (e.g., urethral stricture), which improved after operative intervention. Four of these patients had dose-escalated voxels less than 1.0 cm from the urethra.ConclusionsLow-dose-rate brachytherapy with MRSI-directed dose escalation to suspicious intraprostatic regions exhibits excellent long-term biochemical control. Patients with dose-escalated voxels close to the urethra were at higher risk of late urinary stricture.



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CT-based adaptive high-dose-rate endorectal brachytherapy in the preoperative treatment of locally advanced rectal cancer: Technical and practical aspects

Publication date: Available online 16 April 2016
Source:Brachytherapy
Author(s): R.A. Nout, S. Devic, T. Niazi, J. Wyse, M. Boutros, V. Pelsser, T. Vuong
PurposeDuring the last decade due to the availability of a CT scan in the brachytherapy suite, high-dose-rate endorectal brachytherapy (HDREBT) has evolved as a CT-based daily adaptive treatment. An update of the technical and practical aspects of HDREBT is provided.Methods and MaterialsDescription of technical and practical aspects of HDREBT focused on the preoperative treatment of locally advanced rectal cancer. During preoperative HDREBT, 26 Gy is delivered in four daily applications of 6.5 Gy prescribed to the 100% isodose, covering the clinical target volume. Daily CT scans are obtained and used for plan optimization, leaving patient positioning unchanged between CT scan and treatment delivery.ResultsAll steps of HDREBT treatment procedure are discussed in detail: flexible proctosigmoidoscopy and clipping; patient setup; applicator placement; target delineation; treatment planning and delivery; and patient care. Afterward, treatment results are reviewed.ConclusionsCT-based adaptive preoperative HDREBT is a practical and feasible therapy for locally advanced rectal cancer, offering excellent local control with a favorable toxicity profile.



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Prospective comparison of rectal dose reduction during intracavitary brachytherapy for cervical cancer using three rectal retraction techniques

Publication date: Available online 16 April 2016
Source:Brachytherapy
Author(s): Iwa Kong, Sachi Vorunganti, Malti Patel, Thomas Farrell, Emilia Timotin, Sean Quinlan-Davidson, Greg Pond, Ranjan Sur, Robert Hunter
PurposeTo compare three rectal retraction methods on dose to organs at risk, focusing on rectal dose, in cervix cancer patients treated with high-dose-rate intracavitary brachytherapy.Methods and MaterialsA prospective study was conducted on patients with cervical carcinoma treated with chemoradiotherapy, including external beam radiation and four fractions of high-dose-rate intracavitary brachytherapy prescribed to Point A using a ring and tandem applicator under conscious sedation. Rectal retraction methods included: a rectal retractor blade (RR), vaginal gauze packing (VP), and a tandem Foley balloon (FB). All three methods were used in all patients. The RR was used first, and the following applications were randomly assigned to VP or FB. CT planning was used to calculate D2cc for rectum, sigmoid, small bowel, and bladder. The Wilcoxon signed rank test was used to determine if the median dose differences between methods were statistically significant.ResultsIn these 11 patients, median dose (min, max) in cGy to the rectum using RR, FB, and VP was 131 (102, 165), 199 (124, 243), and 218 (149, 299), respectively. The RR demonstrated lower median intrapatient doses to rectum compared with FB and VP (−55 cGy; p = 0.014 and −76 cGy; p = 0.004, respectively). The RR also resulted in lower sigmoid doses. No differences in dose were observed between the VP and FB methods.ConclusionThe rectal retractor significantly reduced the dose to rectum and sigmoid compared with FP and VP. In patients treated under conscious sedation, the RR method provides the best rectal sparing. There were no significant differences in dose observed between the FB and VP techniques.



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Multicatheter breast implant during breast conservative surgery: Novel approach to deliver accelerated partial breast irradiation

Publication date: Available online 26 April 2016
Source:Brachytherapy
Author(s): Mauricio Cambeiro, Fernando Martinez-Regueira, Natalia Rodriguez-Spiteri, Begoña Olartecoechea, Luis Pina Insausti, Arlette Elizalde, Miguel Idoate Gastearena, Jesús Sola Gallego, Marta Santisteban Eslava, Jose Manuel Aramendía, José Javier Aristu, Leire Arbea Moreno, Marta Moreno-Jiménez, German Valtueña, Rafael Martínez-Monge
PurposeTo assess the safety, feasibility, and efficacy of free-hand intraoperative multicatheter breast implant (FHIOMBI) and perioperative high-dose-rate brachytherapy (PHDRBT) in early breast cancer.Methods and MaterialsPatients with early breast cancer candidates for breast conservative surgery (BCS) were prospectively enrolled. Patients suitable for accelerated partial breast irradiation (APBI) (low or intermediate risk according GEC-ESTRO criteria) received PHDRBT (3.4 Gy BID × 10 in 5 days). Patients not suitable for APBI (high risk patients according GEC-ESTRO criteria) received PHDRBT boost (3.4 Gy BID × 4 in 2 days) followed by whole breast irradiation.ResultsFrom June 2007 to November 2014, 119 patients were treated and 122 FHIOMBI procedures were performed. Median duration of FHIOMBI was 25 minutes. A median of eight catheters (range, 4–14) were used. No severe intraoperative complications were observed. Severe early postoperative complications (bleeding) were documented in 2 patients (1.6%), wound healing complications in 3 (2.4%), and infection (mastitis or abscess) in 2 (1.6%). PHDRBT was delivered as APBI in 88 cases (72.1%) and as a boost in 34 (27.8%). The median clinical target volume T was 40.8 cc (range, 12.3–160.5); median D90 was 3.32 Gy (range, 3.11–3.85); median dose homogeneity index was 0.72 (range, 0.48–0.82). With a median followup of 38.4 months (range, 8.7–98.7) no local, elsewhere, or regional relapses were observed; there was only one distant failure in PHDRBT boost. No major (acute or late) RTOG grade 3 or higher were documented in any of the 119 patients treated with PHDRBT. Cosmetic outcome in APBI patients was excellent or good in (87.0%) and fair or poor in (11.9%) while in boost patients was excellent or good in (76.4%) and fair in (23.5%).ConclusionThe FHIOMBI-PHDRBT program does not add complications to conservative surgery. It allows precise selection of APBI patients and offers excellent results in disease control and cosmetics. It also offers logistic advantages because it dramatically shortens the time of local treatment and avoids further invasive procedures.



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Don't judge a book by its cover, don't judge a study by its abstract. Common statistical errors seen in medical papers



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Q&A With Dr. Fabian J. David

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Movement Disorders: Volume 31, Number 5, May 2016



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Q&A With Drs. Daniela Berg and Ronald Postuma

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Issue Information - Table of Contents



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Issue Information – Masthead



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Launching the movement disorders society genetic mutation database (MDSGene)

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Characterization of isoform expression and subcellular distribution of MYPT1 in intestinal epithelial cells

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Publication date: 15 August 2016
Source:Gene, Volume 588, Issue 1
Author(s): Juan-Min Zha, Hua-Shan Li, Yi-Tang Wang, Qian Lin, Min Tao, Wei-Qi He
The regulation of intestinal epithelial permeability requires phosphorylation of myosin regulatory light chain (MLC). The phosphorylation status of MLC is regulated by myosin light chain phosphatase (MLCP) activities. The activity of the catalytic subunit of MLCP (PP1cδ) toward MLC depends on its regulatory subunit (MYPT1). In this study, we revealed the presence of two MYPT1 isoforms, full length and variant 2 in human intestinal (Caco-2) epithelial cells and isolated intestinal epithelial cells (IECs) from mice. In confluent Caco-2 cells, MYPT1 was distributed at cell–cell contacts and colocalized with F-actin. These results suggest that MYPT1 isoforms are expressed in intestinal epithelial cells and MYPT1 may be involved in the regulation of intestinal epithelial barrier function.



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Gene expression profiles of autophagy-related genes in multiple sclerosis

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Publication date: 15 August 2016
Source:Gene, Volume 588, Issue 1
Author(s): Mehri Igci, Mehmet Baysan, Remzi Yigiter, Mustafa Ulasli, Sirma Geyik, Recep Bayraktar, İbrahim Bozgeyik, Esra Bozgeyik, Ali Bayram
Multiple sclerosis (MS) is an imflammatory disease of central nervous system caused by genetic and environmental factors that remain largely unknown. Autophagy is the process of degradation and recycling of damaged cytoplasmic organelles, macromolecular aggregates, and long-lived proteins. Malfunction of autophagy contributes to the pathogenesis of neurological diseases, and autophagy genes may modulate the T cell survival. We aimed to examine the expression levels of autophagy-related genes. The blood samples of 95 unrelated patients (aged 17–65years, 37 male, 58 female) diagnosed as MS and 95 healthy controls were used to extract the RNA samples. After conversion to single stranded cDNA using polyT priming: the targeted genes were pre-amplified, and 96×78 (samples×primers) qRT-PCR reactions were performed for each primer pair on each sample on a 96.96 array of Fluidigm BioMark™. Compared to age- and sex-matched controls, gene expression levels of ATG16L2, ATG9A, BCL2, FAS, GAA, HGS, PIK3R1, RAB24, RGS19, ULK1, FOXO1, HTT were significantly altered (false discovery rate<0.05). Thus, altered expression levels of several autophagy related genes may affect protein levels, which in turn would influence the activity of autophagy, or most probably, those genes might be acting independent of autophagy and contributing to MS pathogenesis as risk factors. The indeterminate genetic causes leading to alterations in gene expressions require further analysis.



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Analysis of differentially expressed genes between fluoride-sensitive and fluoride-endurable individuals in midgut of silkworm, Bombyx mori

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Publication date: 15 August 2016
Source:Gene, Volume 588, Issue 1
Author(s): Heying Qian, Gang Li, Qingling He, Huaguang Zhang, Anying Xu
Fluoride tolerance is an economically important trait of silkworm. Near-isogenic lines (NILs) of the dominant endurance to fluoride (Def) gene in Bombyx mori has been constructed before. Here, we analyzed the gene expression profiles of midgut of fluoride-sensitive and fluoride-endurable individuals of Def NILs by using high-throughput Illumina sequencing technology and bioinformatics tools, and identified differentially expressed genes between these individuals. A total of 3,612,399 and 3,567,631 clean tags for the libraries of fluoride-endurable and fluoride-sensitive individuals were obtained, which corresponded to 32,933 and 43,976 distinct clean tags, respectively. Analysis of differentially expressed genes indicates that 241 genes are differentially expressed between the two libraries. Among the 241 genes, 30 are up-regulated and 211 are down-regulated in fluoride-endurable individuals. Pathway enrichment analysis demonstrates that genes related to ribosomes, pancreatic secretion, steroid biosynthesis, glutathione metabolism, steroid biosynthesis, and glycerolipid metabolism are down-regulated in fluoride-endurable individuals. qRT-PCR was conducted to confirm the results of the DGE. The present study analyzed differential expression of related genes and tried to find out whether the crucial genes were related to fluoride detoxification which might elucidate fluoride effect and provide a new way in the fluorosis research.



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BACH1, the master regulator gene: A novel candidate target for cancer therapy

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Publication date: 15 August 2016
Source:Gene, Volume 588, Issue 1
Author(s): Sadaf Davudian, Behzad Mansoori, Neda Shajari, Ali Mohammadi, Behzad Baradaran
BACH1 (BTB and CNC homology 1, basic leucine zipper transcription factor 1) is a transcriptional factor and a member of cap ‘n’ collar (CNC) and basic region leucine zipper factor family. In contrast to other bZIP family members, BACH1 appeared as a comparatively specific transcription factor. It acts as transcription regulator and is recognized as a recently hypoxia regulator and functions as an inducible repressor for the HO-1 gene in many human cell types in response to stress oxidative. In regard to studies lately, although, BACH1 has been related to the regulation of oxidative stress and heme oxidation, it has never been linked to invasion and metastasis. Recent studies have showed that BACH1 is involved in bone metastasis of breast cancer by up-regulating vital metastatic genes like CXCR4 and MMP1. This newly discovered aspect of BACH1 gene provides new insight into cancer progression study and stands on its master regulator role in metastasis process, raising the possibility of considering it as a potential target for cancer therapy.



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