Photochemotherapy of Cutaneous Graft-versus-Host Disease May Reduce Concomitant Visceral Disease

Background: Photochemotherapy may be used to treat cutaneous graft-versus-host disease (GvHD). Animal models show that in the days after photochemotherapy and antigen provocation, cells with an antigen-specific suppressive phenotype are elicited in the lymphoid organs. In GvHD, host antigens are present not only in the skin treated by photochemotherapy but also in the visceral tissues. Objective: The aim of this paper was to evaluate the effect on visceral acute GvHD (aGvHD) of photochemotherapy of the skin. Methods: We retrospectively evaluated 33 patients with aGvHD of the skin, the liver, and/or the gastrointestinal tract treated with photochemotherapy for their aGvHD of the skin and did a long-term follow-up of 10 years on survival. Results: The complete response (CR) to photochemotherapy was 39%, the complete and partial response was 64% and the 6-month survival was 64%. Total body irradiation (TBI) before hematopoietic stem cell transplantation predisposed for CR of aGvHD of the liver and the gastrointestinal tract (p = 0.045). In the TBI group, the accumulated dose (numbers of treatments) for CR of visceral aGvHD increased with the body surface area affected by disease, from 8 (min-max: 5-14) for skin disease stage 1 to 10.5 (6-33) for stage 2 and 13 (11-21) for stage 3 (p = 0.04). Skin disease stage 1 showed a trend to be associated with CR in visceral disease at 28, 56, and 100 days (p = 0.07). Overall CR in visceral disease predicted a better 10-year overall survival (p = 0.0036). Finally, after TBI aGvHD of the gastrointestinal tract without anti-thymocyte globulin (ATG), clearance of T cells and dendritic cells responded better than aGvHD of the liver and aGvHD of the gastrointestinal tract with ATG (p = 0.01). Conclusion: Photochemotherapy after ionizing irradiation regulates the cell-mediated immunity in the viscera, and the systemic efficacy increases when the skin itself is less affected by disease. ATG modulates the regulatory effect of the gastrointestinal tract.


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Humans decimating the diversity of life should worry us all

A global limit set for safe biodiversity loss may be a blunt tool, but we still need to worry about breaching it far and wide says Georgina Mace

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Environmental components of childhood obesity prevention interventions: an overview of systematic reviews

Summary

Childhood obesity has a complex multi-factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems-based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population-level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population-level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5–18 years). Sixty-three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy-relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision-making. © 2016 World Obesity

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Omentum and bone marrow: how adipocyte-rich organs create tumour microenvironments conducive for metastatic progression

Summary

A number of clinical studies have linked adiposity with increased cancer incidence, progression and metastasis, and adipose tissue is now being credited with both systemic and local effects on tumour development and survival. Adipocytes, a major component of benign adipose tissue, represent a significant source of lipids, cytokines and adipokines, and their presence in the tumour microenvironment substantially affects cellular trafficking, signalling and metabolism. Cancers that have a high predisposition to metastasize to the adipocyte-rich host organs are likely to be particularly affected by the presence of adipocytes. Although our understanding of how adipocytes influence tumour progression has grown significantly over the last several years, the mechanisms by which adipocytes regulate the metastatic niche are not well-understood. In this review, we focus on the omentum, a visceral white adipose tissue depot, and the bone, a depot for marrow adipose tissue, as two distinct adipocyte-rich organs that share common characteristic: they are both sites of significant metastatic growth. We highlight major differences in origin and function of each of these adipose depots and reveal potential common characteristics that make them environments that are attractive and conducive to secondary tumour growth. Special attention is given to how omental and marrow adipocytes modulate the tumour microenvironment by promoting angiogenesis, affecting immune cells and altering metabolism to support growth and survival of metastatic cancer cells. © 2016 World Obesity

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Central obesity and risks of pre- and postmenopausal breast cancer: a dose–response meta-analysis of prospective studies

Summary

Epidemiologic evidence has shown inconsistent findings regarding the relationships between abdominal fatness, as measured by waist circumferences (WC) or waist-to-hip ratio (WHR), and risks of pre- and postmenopausal breast cancer (BC). A dose–response meta-analysis of prospective studies was conducted to address these issues. Potentially eligible studies were identified by searching PubMed and EMBASE databases, and by carefully reviewing the bibliographies of retrieved publications and related reviews. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. When the most fully adjusted RRs were combined, both WC (14 studies, RR _{per 10-cm increase} = 1.06, 95% CI: 1.04–1.09, I² = 29.9%) and WHR (15 studies, RR _{per 0.1-unit increase} = 1.07, 95% CI: 1.01–1.14, I² = 52.9%) were significantly positively associated with postmenopausal BC, but neither WC (eight studies, RR _{per 10-cm increase} = 1.05, 95% CI: 0.99–1.10, I² = 0%) nor WHR (11 studies, RR _{per 0.1-unit increase} = 1.07, 95% CI: 0.95–1.21, I² = 59.7%) were associated with premenopausal BC. The WHR-postmenopausal BC association lost statistical significance after correcting publication bias (RR _{per 0.1-unit increase} = 1.06, 95% CI: 0.99–1.13). When considering BMI-adjusted RRs, WC was associated with both pre- (five studies, RR _{per 10-cm increase} = 1.09, 95% CI: 1.02–1.16, I² = 0%) and postmenopausal BC (seven studies, RR _{per 10-cm increase} = 1.05, 95% CI: 1.02–1.08, I² = 6.3%), whereas WHR was not associated with either pre- (seven studies, RR _{per 0.1-unit increase} = 1.12, 95% CI: 0.94–1.34, I² = 70.9%) or postmenopausal BC (eight studies, RR _{per 0.1-unit increase} = 1.05, 95% CI: 0.98–1.13, I² = 57.3%). Among non-current (former or never) users of hormone replacement therapy, the summary RR _{per 10-cm increase} of postmenopausal BC associated with WC was 1.08 (95% CI: 1.03–1.05, I² = 69.2%, seven studies; BMI-adjusted RR = 1.05, 95% CI: 1.02–1.09, I² = 22.8%, four studies). This meta-analysis indicates that central obesity measured by WC, but not by WHR, is associated with modestly increased risks of both pre- and postmenopausal BC independent of general obesity. © 2016 World Obesity

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Nutritional Status Associated to Skipping Breakfast in Brazilian Health Service Patients

Recent studies show that skipping breakfast is associated with an increased risk of obesity, diabetes and cardiovascular diseases. In this context, this study evaluated 400 patients from the Brazilian health service who had their nutritional status defined based on the body mass index and were classified as physically active or insufficient active. The energy intake and macronutrients was also assessed by a 24-hour dietary recall where the association of overweight/obesity with the investigated variables was evaluated using chi-square, Student's t test and multivariate analysis (p Ann Nutr Metab 2016;69:31-40

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IJERPH, Vol. 13, Pages 725: A Survey of Jellyfish Sting Knowledge among Naval Personnel in Northeast China

Background: Jellyfish envenomation is common along the coastal area, and can cause severe consequences. Naval personnel are among the high-risk population for this injury. The aim of this study was to assess knowledge regarding jellyfish envenomation among naval personnel in a navy unit in northeast China. Methods: A predesigned questionnaire was distributed to 120 naval members in January 2015. The data of 108 respondents were included in the statistical analysis. Results: We found that 38.0% of the respondents selected jellyfish sting as the common wound in their units, and 13.0% had experienced or observed this injury. In addition, 63.0% of the participants rated their own knowledge as “low” or “none”. The average score they got was 5.77 ± 2.50, with only 16.7% getting a score above 60% of the full score. The correct rates of five questions were below 60%. No statistical differences existed in the knowledge score among different groups of respondents defined by socio-demographic variables. Conclusions: Jellyfish sting is common in this navy unit, but personnel got a low score on the knowledge assessment. They also lacked confidence in first aid. Medical education and training should be implemented to address this issue.

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IJERPH, Vol. 13, Pages 724: Environment and Health: Not Only Cancer

The Hippocratic tradition emphasized environmental causes of diseases and the need for harmony between the individual and the natural environment as the right philosophy to maintain a good health status. Public awareness and scientific attention concerning environmental pollution is usually focused on the consequent increased risk of developing cancer. Air pollution has been recognized by the World Health Organization (WHO) to cause cardiovascular and respiratroy diseases, as well as lung cancer, after acute/chronic exposure to fine particulates (PM2.5 and PM10) even at concentrations which are 50% lower than those accepted as legal limits in many developed countries. An increase of 10 µg/m3 of PM2.5 produces a +4%–6% of overall mortality, a +10% of cardiovascular disease prevalence (arithmyas, acute myocardial infarctions, and heart failure) and a +22% of lung cancer prevalence. In addition to these chronic effects, acute hospitalizations are also affected, especially among susceptible populations such as children and diabetic patients. Water and soil contamination also have an additional detrimental effect on people’s health. Other issues concerning environment contamination and human health include male/female fertility, metabolic and thyroid conditions, but also professional exposures resulting in occupational diseases. Moreover, in the perspective of “gender medicine”, different acute or chronic effects of environmental pollution should be specifically assessed both in men and in women. This special issue on “Environmental Diseases” is aimed at providing a global overview about different threats to human health possibily originating from environmental contamination.

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IJERPH, Vol. 13, Pages 728: Association by Spatial Interpolation between Ozone Levels and Lung Function of Residents at an Industrial Complex in South Korea

Spatial interpolation is employed to improve exposure estimates and to assess adverse health effects associated with environmental risk factors. Since various studies have reported that high ozone (O3) concentrations can give rise to adverse effects on respiratory symptoms and lung function, we investigated the association between O3 levels and lung function using a variety of spatial interpolation techniques and evaluated how different methods for estimating exposure may influence health results for a cohort from an industrial complex (Gwangyang Bay) in South Korea in 2009. To estimate daily concentrations of O3 in each subject, four different methods were used, which include simple averaging, nearest neighbor, inverse distance weighting, and kriging. Also, to compare the association between O3 levels and lung function by age-groups, we explored ozone’s impacts on three age-related groups: children (9–14 years), adults (15–64 years), and the elderly (≥65 years). The overall change of effect size on lung function in each age group tended to show similar patterns for lag and methods for estimating exposure. A significant negative association was only observed between O3 levels and FVC and FEV1 for most of the lag and methods in children. The largest effect of O3 levels was found at the average for the lung function test day and last 2 days (0–2 days). In conclusions, the spatial interpolation methods may benefit in providing individual-level exposure with appropriate temporal resolution from ambient monitors. However, time-activity patterns of residents, monitoring site locations, methodological choices, and other factors should be considered to minimize exposure misclassification.

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NHS plan is at risk from cuts to public health and social care, MPs warn

The NHS’s five year plan to transform health and care services in England is being jeopardised by cuts to public health, education and training, and social care, a new report from MPs has warned.1The...

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Severely obese teens who have bariatric surgery show improved mobility and less pain

Severely obese teenagers who undergo bariatric surgery show improved mobility and reduced musculoskeletal pain from walking as much as two years after surgery, a study published in JAMA Pediatrics...

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Fracking is linked to asthma increase, study finds

Fracking—a controversial method of extracting gas from the ground—is associated with an increased risk of asthma exacerbation, a study published by JAMA Internal Medicine has found.1The authors said...

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More of the same from the Department of Health?

“‘Reports of my death have been greatly exaggerated...’ Thrilled to be back in the best job in government.”1After a frantic morning at 10 Downing Street last week, during which some media were forced...

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Electrical Stimulation Normalizes c-Fos Expression in the Deep Cerebellar Nuclei of Depressive-like Rats: Implication of Antidepressant Activity

Abstract

The electrical stimulation of specific brain targets has been shown to induce striking antidepressant effects. Despite that recent data have indicated that cerebellum is involved in emotional regulation, the mechanisms by which stimulation improved mood-related behaviors in the cerebellum remained largely obscure. Here, we investigated the stimulation effects of the ventromedial prefrontal cortex (vmPFC), nucleus accumbens (NAc), and lateral habenular nucleus on the c-Fos neuronal activity in various deep cerebellar and vestibular nuclei using the unpredictable chronic mild stress (CMS) animal model of depression. Our results showed that stressed animals had increased number of c-Fos cells in the cerebellar dentate and fastigial nuclei, as well as in the spinal vestibular nucleus. To examine the stimulation effects, we found that vmPFC stimulation significantly decreased the c-Fos activity within the cerebellar fastigial nucleus as compared to the CMS sham. Similarly, there was also a reduction of c-Fos expression in the magnocellular part of the medial vestibular nucleus in vmPFC- and NAc core-stimulated animals when compared to the CMS sham. Correlational analyses showed that the anxiety measure of home-cage emergence escape latency was positively correlated with the c-Fos neuronal activity of the cerebellar fastigial and magnocellular and parvicellular parts of the interposed nuclei in CMS vmPFC-stimulated animals. Interestingly, there was a strong correlation among activation in these cerebellar nuclei, indicating that the antidepressant-like behaviors were possibly mediated by the vmPFC stimulation-induced remodeling within the forebrain-cerebellar neurocircuitry.

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Gewalt im Kontext der Kulturen. Prolog

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Kann sich ein Mächtiger aus seiner Macht herausreden?

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Married Couples in the Middle Ages? The Case of the Devil’s Advocate

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Imprimer les "vieux romans" de chevalerie à la Renaissance : l’éditeur et le remanieur, nouvelle(s) instance(s) auctoriale(s) de la matière romanesque

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Neural stem cells in lead toxicity

Lead (Pb) exposure in the early stages of neurodevelopment results in long-lasting alterations that ultimately cognitive function and behaviour. The prime targets of lead toxicity are the multipotent neural stem cells (NSCs). The present review article will discuss the basic molecular physiology involved in the toxicity mechanisms induced by lead and its resultant counter effects on nervous system and physiology. The article shall help researchers working in the area to design new drugs and therapeutics for the efficient management of neuro-toxic states especially upon prenatal exposure to lead.

L'articolo Neural stem cells in lead toxicity sembra essere il primo su European Review.

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IJERPH, Vol. 13, Pages 729: Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%). After adjustment for socio-demographic and clinical factors, compared to women living in very high accessibility areas, women in high (Odds Ratio (OR) 0.58 (95% confidence intervals (CI) 0.49, 0.69)), low (OR 0.47 (0.41, 0.54)) and very low (OR 0.44 (0.34, 0.56)) accessibility areas had lower odds of having BCS, while  the odds for women from middle (OR 0.81 (0.69, 0.94)) and most disadvantaged (OR 0.87 (0.71, 0.98)) areas was significantly lower than women living in affluent areas. The association between accessibility and the type of surgery reduced over time (interaction p = 0.028) but not for area disadvantage (interaction p = 0.209). In making informed decisions about surgical treatment, it is crucial that any geographical-related barriers to implementing their preferred treatment are minimised.

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Prosecutors seek detention of train blast suspect - Focus Taiwan News Channel

Prosecutors seek detention of train blast suspect Focus Taiwan News Channel He has been treated for tonsil cancer and mental illness and faced financial difficulties in recent years, according to police. When questioned by police on July 15, however, Lin said he simply wanted to draw attention from the public. Lin also said he ... and more »

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Shock and Vibration in Transportation Engineering

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Association of Living Arrangement Conditions and Socioeconomic Differentials with Anemia Status among Women in Rural Bangladesh

In Bangladesh, iron deficiency is the most common cause of anemia and remains a significant public health concern. Being a high anemia prevalent country, numerous efforts have been made to confront the issue especially among women and children by both local and international actors. Though the situation has substantially improved in recent years, a staggering number of adult women are currently living with anemia. The etiology of anemia is a multifactorial problem and has been proposed to be associated with various household, societal, economic, cultural factors apart from dietary habits. However, evidence regarding the household arrangements and socioeconomic determinants of anemia is scarce, especially in the context of Bangladesh. To this end, we utilized the 2011 demographic and health survey data to explore the association between anemia status and selected demographic, socioeconomic, and household characteristics. Our result showed significant correlation of anemia with both sociodemographic and household characteristics. Among the sociodemographic variables the following were found to be significantly associated with anemia status: age (; OR = 1.195; 95% CI = 1.036–1.378) and microcredit membership (; OR = 1.19; 95% CI = 1.037–1.386). Regarding the household arrangements, women utilizing biomass fuel for cooking (; OR = 1.82; 95% CI = 0.981–2.460) were more likely to be anemic.

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Effect of Insecticide Seed Treatment on Safening Rice from Reduced Rates of Glyphosate and Imazethapyr

Field experiments were conducted in 2013 and 2014 to evaluate the effect of insecticide seed treatments on exposure of young conventional rice to reduced rates of glyphosate and imazethapyr. During the two-year study, “Roy J” rice seed was treated with CruiserMaxx® Rice, thiamethoxam plus fungicide, or a fungicide-only treatment. Subsequently, glyphosate (Roundup PowerMax®) at 39.42, 78.76, or 157.54 g ae/ha or imazethapyr (Newpath®) at 4.39, 8.74, or 17.49 g ai/ha was applied at the 2- to 3-leaf growth stage of rice. Results in 2013 indicated that rice plants from seed treated with CruiserMaxx Rice exhibited significantly less injury 1, 3, and 6 weeks after either imazethapyr or glyphosate was applied in comparison to the plants having fungicide-only treated seed. The addition of an insecticide seed treatment also resulted in higher yields when both herbicides were applied compared to the fungicide-only seed treatment receiving the same herbicide treatments. In 2014, an overall decrease in injury from both herbicides was observed when rice seed was treated with CruiserMaxx Rice compared to receiving a fungicide-only seed treatment. Significant yield loss from low rates of glyphosate or imazethapyr was not observed in 2014, with or without a seed treatment. Based on the positive effects observed from the CruiserMaxx Rice seed treatment in reducing injury and maintaining rice yields, the insecticide seed treatment appears to provide some safening to rice against low rates of glyphosate and imazethapyr.

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Sensors for Environmental Monitoring

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Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate

This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis) to polymethyl methacrylates (PMMA). Fifty specimens were divided into 5 groups () according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing), NF (Nealon technique and finishing), NP (Nealon technique and manual polishing), MF (3 : 1 ratio and manual finishing), and MP (3 : 1 ratio and manual polishing). For each group, five specimens were submitted to bacterial adhesion tests and analyzed by scanning electron microscopy (SEM). Two additional specimens were subjected to surface topography analysis by SEM and the remaining three specimens were subjected to surface roughness measurements. Data were compared by one-way ANOVA. The mean bacterial counts were as follows: NF, ; MP, ; NP, ; MF, ; and LP, (CFU). The mean surface roughness values were as follows: NF, ; MP, ; NP, ; MF, ; and LP, (m). A reduction in the surface roughness was observed to be directly related to a decrease in bacterial adhesion. It was verified that the laboratory processing of PMMA might decrease the surface roughness and consequently the adhesion of S. sanguinis to this material.

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Analysis of Denial of Service Impact on Data Routing in Mobile eHealth Wireless Mesh Network

Wireless mesh networks (WMNs) are a promising technology that has emerged with the combination of several wireless networks. These wireless networks and devices communicate in a mesh network manner, to provide edge-to-edge, easy, and cost-effective data communication. Many current and future promising applications depend on WMN and one of the most important applications is eHealthcare, where the confidential information transfers with the help of WMN. WMN devices communicate over a wireless medium, which opens the system to a number of vulnerabilities; thus, an intruder can launch malicious activities through many types of attacks that can result in denial of service (DoS). In this paper, the available solutions to overcome these attacks are simulated and evaluated in terms of data packet delivery ratio, end-to-end delay, and network throughput and under different cases of static and mobile WMNs, which helps in providing suggestions to enhance existing protocols and mitigate the effect of DoS caused by such attacks.

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Generalized Information Equilibrium Approaches to EEG Sleep Stage Discrimination

Recent advances in neuroscience have raised the hypothesis that the underlying pattern of neuronal activation which results in electroencephalography (EEG) signals is via power-law distributed neuronal avalanches, while EEG signals are nonstationary. Therefore, spectral analysis of EEG may miss many properties inherent in such signals. A complete understanding of such dynamical systems requires knowledge of the underlying nonequilibrium thermodynamics. In recent work by Fielitz and Borchardt (2011, 2014), the concept of information equilibrium (IE) in information transfer processes has successfully characterized many different systems far from thermodynamic equilibrium. We utilized a publicly available database of polysomnogram EEG data from fourteen subjects with eight different one-minute tracings of sleep stage 2 and waking and an overlapping set of eleven subjects with eight different one-minute tracings of sleep stage 3. We applied principles of IE to model EEG as a system that transfers (equilibrates) information from the time domain to scalp-recorded voltages. We find that waking consciousness is readily distinguished from sleep stages 2 and 3 by several differences in mean information transfer constants. Principles of IE applied to EEG may therefore prove to be useful in the study of changes in brain function more generally.

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Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1–10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, , and health status (VAS) from 40.6 to 61.9, . Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.

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Relationship between Lower Limb Angular Kinematic Variables and the Effectiveness of Sprinting during the Acceleration Phase

The ability to reach a high running velocity over a short distance is essential to a high playing performance in team games. The aim of this study was to determine the relationship between running time over a 10-meter section of a 30-meter sprint along a straight line and changes in the angle and angular velocity that were observed in the ankle, knee, and hip joints. The possible presence may help to optimize motion efficiency during acceleration sprint phase. Eighteen girls involved in team sports were examined in the study. The Fusion Smart Speed System was employed for running time measurements. The kinematic data were recorded using the Noraxon MyoMotion system. Statistically significant relationships were found between running time over a 10-meter section and the kinematic variables of hip and ankle joints. An excessively large flexion in hip joints might have an unfavorable effect on running time during the acceleration phase. Furthermore, in order to minimize running time during the acceleration phase, stride should be maintained along a line (a straight line) rather than from side to side. It is also necessary to ensure an adequate range of motion in the hip and ankle joints with respect to the sagittal axis.

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Esophageal Stent for Refractory Variceal Bleeding: A Systemic Review and Meta-Analysis

Background. Preliminary studies suggest that covered self-expandable metal stents may be helpful in controlling esophageal variceal bleeding. Aims. To evaluate the effectiveness and safety of esophageal stent in refractory variceal bleeding in a systematic review and meta-analysis. Methods. A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 1970 to December 2015. Data were selected and abstracted from eligible studies and were pooled using a random-effects model. Heterogeneity was assessed using test. Results. Five studies involving 80 patients were included in the analysis. The age of patients ranged from 18 to 91 years. The mean duration of follow-up was 46.8 d (range, 30–60 d). The success rate of stent deployment was 96.7% (95% CI: 91.6%–99.5%) and complete response to esophageal stenting was in 93.9% (95% CI: 82.2%–99.6%). The incidence of rebleeding was 13.2% (95% CI: 1.8%–32.8%) and the overall mortality was 34.5% (95% CI: 24.8%–44.8%). Most of patients (87.4%) died from hepatic or multiple organ failure, and only 12.6% of patients died from uncontrolled bleeding. There was no stent-related complication reported and the incidence of stent migration was 21.6% (95% CI: 4.7%–46.1%). Conclusion. Esophageal stent may be considered in patients with variceal bleeding refractory to conventional therapy.

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Valproic Acid Induced Hyperammonemia in a Long Time Treated Patient

We report a case of a patient who had been on long time valproic acid for treatment of bipolar affective disorder. While being an inpatient, serology ammonia level testing revealed a very high ammonia level despite being asymptomatic. Dual therapy of carnitine and lactulose was provided to the patient for treatment of the hyperammonemia. It should also be noted that, during this treatment, valproic acid was not stopped. Consequently, this case illustrates that patients can present asymptomatically despite very high ammonia levels and hyperammonemia can occur in chronic valproic acid despite not increasing the dose of the medication and psychiatrists do not need to discontinue valproic acid in the presence of elevated levels of ammonia if the patient shows no signs of encephalopathy or delirium.

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Delivery after Operation for Deeply Infiltrating Endometriosis

Background. It has been suggested that, during pregnancy, endometriosis can cause a variety of disease-related complications. Objectives. The purpose of the study was to find out if women with histologically confirmed endometriosis do have a higher risk of adverse pregnancy outcome and if they suffer from a higher rate of complications during labor. Study Design. 51 women who underwent surgery because of deeply infiltrating endometriosis in the General Hospital Linz and the Women’s General Hospital Linz and who gave birth in the Women’s General Hospital Linz after the surgery were included in our survey. Results. 31 women (60.8%) had a spontaneous delivery and in 20 women (39.2%) a caesarean section was performed. There were no cases of third- and fourth-degree perineal lacerations. Collectively there were 4 cases (7.8%) of preterm delivery and one case (2.0%) of premature rupture of membranes. In two women (6.5%) a retained placenta was diagnosed. Conclusions. Our study is the first description on delivery modes after surgery for deeply infiltrating endometriosis. We did not find an elevated risk for perineal or vaginal laceration in women with a history of surgery for deeply infiltrating endometriosis, even when a resection of the rectum or of the posterior vaginal wall had been performed.

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A Joint Modeling Analysis of Passengers’ Intercity Travel Destination and Mode Choices in Yangtze River Delta Megaregion of China

Joint destination-mode travel choice models are developed for intercity long-distance travel among sixteen cities in Yangtze River Delta Megaregion of China. The model is developed for all the trips in the sample and also by two different trip purposes, work-related business and personal business trips, to accommodate different time values and attraction factors. A nested logit modeling framework is applied to model trip destination and mode choices in two different levels, where the lower level is a mode choice model and the upper level is a destination choice model. The utility values from various travel modes in the lower level are summarized into a composite utility, which is then specified into the destination choice model as an intercity impedance factor. The model is then applied to predict the change in passenger number from Shanghai to Yangzhou between scenarios with and without high-speed rail service to demonstrate the applicability. It is helpful for understanding and modeling megaregional travel destination and mode choice behaviors in the context of developing country.

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The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent -test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.

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Caffeoylquinic Acid Derivatives Extract of Erigeron multiradiatus Alleviated Acute Myocardial Ischemia Reperfusion Injury in Rats through Inhibiting NF-KappaB and JNK Activations

Erigeron multiradiatus (Lindl.) Benth. has been used in Tibet folk medicine to treat various inflammatory diseases. The aim of this study was to investigate antimyocardial ischemia and reperfusion (I/R) injury effect of caffeoylquinic acids derivatives of E. multiradiatus (AE) in vivo and to explain underling mechanism. AE was prepared using the whole plant of E. multiradiatus and contents of 6 caffeoylquinic acids determined through HPLC analysis. Myocardial I/R was induced by left anterior descending coronary artery occlusion for 30 minutes followed by 24 hours of reperfusion in rats. AE administration (10, 20, and 40 mg/kg) inhibited I/R-induced injury as indicated by decreasing myocardial infarct size, reducing of CK and LDH activities, and preventing ST-segment depression in dose-dependent manner. AE decreased cardiac tissue levels of proinflammatory factors TNF-α and IL-6 and attenuated leukocytes infiltration. AE was further demonstrated to significantly inhibit I-κB degradation, nuclear translocation of p-65 and phosphorylation of JNK. Our results suggested that cardioprotective effect of AE could be due to suppressing myocardial inflammatory response and blocking NF-κB and JNK activation pathway. Thus, caffeoylquinic acids might be the active compounds in E. multiradiatus on myocardial ischemia and be a potential natural drug for treating myocardial I/R injury.

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Decision-Making Approach to Selecting Optimal Platform of Service Variants

Nowadays, it is anticipated that service sector companies will be inspired to follow mass customization trends of industrial sector. However, services are more abstract than products and therefore concepts for mass customization in manufacturing domain cannot be transformed without a methodical change. This paper is focused on the development of a methodological framework to support decisions in a selection of optimal platform of service variants when compatibility problems between service options occurred. The approach is based on mutual relations between waste and constrained design space entropy. For this purpose, software for quantification of constrained and waste design space is developed. Practicability of the methodology is presented on a realistic case.

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Modeling and Nonlinear Response of the Cam-Follower Oblique-Impact System

In order to quickly and accurately analyze the complex behavior of cam-follower oblique-impact system, a mathematical model which can describe separation, impact, and contact was established in this paper. The transient impact hypothesis was extended, and the oblique collision model was established by considering the tangential slip. Moreau time-stepping method was employed to solve the linear complementarity problem which transformed by the oblique-impact equations. The simulation results show that the cam and follower kept permanent contact when the cam rotational speed was low. With the increase of the cam rotational speed, the cam and follower would be separated and then impact under the gravity action. The system performance shows very complex nonlinear characteristics.

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The Predictability of Preoperative Pilocarpine-Induced Lens Shift on the Outcomes of Accommodating Intraocular Lenses Implanted in Senile Cataract Patients

Purpose. To evaluate the predictability of lens shift induced by pilocarpine () on the outcomes of accommodating intraocular lens (Acc-IOL) implantation. Methods. Twenty-four eyes of 24 senile cataract patients who underwent phacoemulsification and Acc-IOL implantation were enrolled. was evaluated with anterior segment optical coherence tomography (AS-OCT). At 3 months postoperatively, the best corrected distance visual acuities (BCDVA), distance-corrected near visual acuities (DCNVA), and subjective and objective accommodations were measured. IOL shifts under accommodation stimulus () were evaluated with AS-OCT. Results. The mean was 112.29 ± 30.72 µm. was not associated with any preoperative parameters. The mean was 130.46 ± 42.71 µm. The mean subjective and objective accommodation were 1.54 ± 0.39 D and 1.27 ± 0.41 D, respectively. The mean postoperative BCDVA and DCNVA (log MAR value) were 0.22 ± 0.11 and 0.24 ± 0.12, respectively. positively correlated with (; ), subjective accommodation (; ), and objective accommodation (; ), respectively. Conclusion. is an independent preoperative parameter associated with the postoperative Acc-IOL mobility and pseudophakic accommodation. It may offer valuable information for ophthalmologists in determining the suitable candidates for Acc-IOL implantation.

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Mesenchymal Stromal Cells from Osteoarthritic Synovium Are a Distinct Population Compared to Their Bone-Marrow Counterparts regarding Surface Marker Distribution and Immunomodulation of Allogeneic CD4+ T-Cell Cultures

Introduction. The participation of an inflammatory joint milieu has been described in osteoarthritis (OA) pathogenesis. Mesenchymal stromal cells (MSCs) play an important role in modulating inflammatory processes. Based on previous studies in an allogeneic T-cell coculture model, we aimed at further determining the role of synovial MSCs in OA pathogenesis. Methods. Bone-marrow (BM) and synovial membrane (SM) MSCs from hip joints of late stage OA patients and CD4+ T-cells from healthy donors were analysed regarding surface marker expression before and after coculture. Proliferation upon CD3/CD28 stimulation and cytokine analyses were compared between MSCs. Results. SM-MSCs differed from BM-MSCs in several surface markers and their osteogenic differentiation potential. Cocultures of both MSCs with CD4+ T-cells resulted in recruitment of CD45RA+ FoxP3+ regulatory T-cells. Upon stimulation, only SM-MSCs suppressed CD4+ T-cell proliferation, while both SM-MSCs and BM-MSCs modified cytokine profiles through suppressing IL-2 and TNF-α as well as increasing IL-6 secretion. Conclusions. Synovial MSCs from OA joints are a unique fraction that can be distinguished from their bone-marrow derived counterparts. Their unique ability to suppress CD3/CD28 induced CD4+ T-cell proliferation makes them a potential target for future therapeutic approaches.

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Optimism over cancer treatments should always be cautious

Efforts to turn everyday drugs into cancer treatments bring a glimmer of hope, but dangers of hype too

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Contents Vol. 85, 2016

Horm Res Paediatr 2016;85:I-VI

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What Drives Public Health Care Expenditure Growth? Evidence from Swiss Cantons, 1970-2012

Publication date: Available online 18 July 2016
Source:Health Policy
Author(s): Thomas Braendle, Carsten Colombier
A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970–2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth.



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Copayments and Physicians Visits: A panel data study of Swedish regions 2003-2012

Publication date: Available online 18 July 2016
Source:Health Policy
Author(s): Niklas Jakobsson, Mikael Svensson
ObjectiveThis paper analyzes how primary care physician visits are affected by the level of copayment in Sweden.Data SourceWe use data between the years 2003 to 2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between €10 and €20 for these years and regions.Study designOur strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends.Principal findingWe cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the “zero effect” with very high precision.ConclusionIn a setting with sub-national regions with autonomy to set co-payments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low.



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Comparing Nationwide Prevalences of Hypertension and Depression based on Claims Data and Survey Data: An Example from Germany

Publication date: Available online 18 July 2016
Source:Health Policy
Author(s): Janina Frank
IntroductionCoded diagnoses in claims data offer a comprehensive basis for health sciences and health policy decisions. For example, morbidity-based risk adjustment schemes use coded diagnoses to allocate resources. Therefore a routinely performed validation is important. Data reconciliation with medical records would be first best, but is not possible here. This paper validates population-based prevalences of hypertension and depression based on claims data by comparing them with prevalences stem from two different epidemiological survey data.MethodData sources accessible are a nationwide sample based on outpatient claims data (GSPR), a nationwide health interview and examination survey (DEGS1) and a nationwide telephone interview survey (GEDA). The analysis includes SHI-insured aged 18 to 79 who live in 2010 in Germany.ResultsThere was high agreement for hypertension prevalences between GSPR (28,98% [28.95-29.02]) and DEGS1 (28.0% [26.5-29.5]) but not with GEDA (22.9% [22.1-23.7]). The agreement for depression prevalences was high between the two surveys (DEGS1: 7.6% [6.7-8.5] and GEDA: 6.7% [6.3-7.2]) and moderate compared to GSPR (12.23% [12.21-12.26]).ConclusionFor an objectifiable disease, such as hypertension, diagnostic coding with claims data seems to be valid to be used for risk adjustment in German outpatient health care. Even though depression prevalences differ between claims data and survey data, more effort is required to understand the magnitude of a reference systems impact on prevalence estimates.



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Measuring and Improving Quality in University Hospitals in Canada: the Collaborative for Excellence in Healthcare Quality

Publication date: Available online 18 July 2016
Source:Health Policy
Author(s): Chantal Backman, Saskia Vanderloo, Alan J. Forster
Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today’s health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance.



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RT @EACRnews : Watch here some highlights on the #EACR24 - see you at the next EACR Congress in 2018 in Amsterdam! https://t.co/3UrPplgxiJ @…

RT @EACRnews : Watch here some highlights on the #EACR24 - see you at the next EACR Congress in 2018 in Amsterdam! https://t.co/3UrPplgxiJ @…

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RT @EACRnews : Congratulations to Professor Yardena Samuels who was awarded the Pezcoller Foundation-EACR Cancer Researcher Award! https://t…

RT @EACRnews : Congratulations to Professor Yardena Samuels who was awarded the Pezcoller Foundation-EACR Cancer Researcher Award! https://t…

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Dr Di Meco to present future smart surgical approaches for brain metastases at #lungcancer16 https://t.co/SXEXuW5WnW https://t.co/8gtDfo2sQv

Dr Di Meco to present future smart surgical approaches for brain metastases at #lungcancer16 https://t.co/SXEXuW5WnW https://t.co/8gtDfo2sQv

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Genetic drivers of immune response to cancer discovered through 'big data' analysis

Results could lead to new immunotherapies - over 100 new genetic regions that affect the immune response to cancer identified The findings, published in Cancer Immunology Research, could inform the development of future immunotherapy treatments that...

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