Παρασκευή, 14 Οκτωβρίου 2016

No Evidence That HIV-1 Subtype C Infection Compromises the Efficacy of Tenofovir-Containing Regimens: Cohort Study in the United Kingdom

Concern has been expressed that tenofovir-containing regimens may have reduced effectiveness in the treatment of human immunodeficiency virus type 1 (HIV-1) subtype C infections because of a propensity for these viruses to develop a key tenofovir-associated resistance mutation. We evaluated whether subtype influenced rates of virological failure in a cohort of 8746 patients from the United Kingdom who received a standard tenofovir-containing first-line regimen and were followed for a median of 3.3 years. In unadjusted analyses, the rate of failure was approximately 2-fold higher among patients infected with subtype C virus as compared to those with subtype B virus (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.50–2.31; P < .001). However, the increased risk was greatly attenuated in analyses adjusting for demographic and clinical factors (adjusted HR, 1.14; 95% CI, .83–1.58; P = .41). There were no differences between subtypes C and subtypes non-B and non-C in either univariate or multivariate analysis. These observations imply there is no intrinsic effect of viral subtype on the efficacy of tenofovir-containing regimens.



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Epithelioid Angiomyolipoma of kidney - An uncommon tumor mimicking renal cell carcinoma .

2016-10-14T06-58-00Z
Source: The Southeast Asian Journal of Case Report and Review
Kavitha K.P, Shalini Kuruvila, Jyotsna Yasodharan, Sajna V.M.Kutty, Lilly Madhavan.
Introduction: Epithelioid angiomyolipoma (EAML) is an uncommon variant of angiomyolipoma (AML) with malignant potential, frequently associated with tuberous sclerosis complex. Only few cases have been reported so far in the literature. Preoperative diagnosis is difficult. Differential diagnosis from renal cell carcinoma is often challenging because of its epithelioid morphology and carcinoma like growth pattern. Case report: A 52 year old man presented with progressive weight loss and abdominal pain .CT scan showed a large renal mass on right side .With a radiological diagnosis of renal cell carcinoma he underwent laparoscopic nephrectomy. With histopathological and immunohistochemical features a diagnosis of epithelioid angiomyolipoma was made .Retrospectively we came to know that he is a known case of tuberous sclerosis Conclusion: EAML should be a differential diagnosis when we are dealing with renal tumors in young patients with tuberous sclerosis and with epithelioid morphology and high nuclear grade. It is important to have a high index of suspicion so that a correct diagnosis can potentially direct clinician to a more effective targeted treatment using mTOR inhibitors especially in TSC associated cases.


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Cancers, Vol. 8, Pages 93: Hypericin in the Dark: Foe or Ally in Photodynamic Therapy?

Photosensitizers (PSs) in photodynamic therapy (PDT) are, in most cases, administered systemically with preferential accumulation in malignant tissues; however, exposure of non-malignant tissues to PS may also be clinically relevant, when PS molecules affect the pro-apoptotic cascade without illumination. Hypericin (Hyp) as PS and its derivatives have long been studied, regarding their photodynamic and photocytotoxic characteristics. Hyp and its derivatives have displayed light-activated antiproliferative and cytotoxic effects in many tumor cell lines without cytotoxicity in the dark. However, light-independent effects of Hyp have emerged. Contrary to the acclaimed Hyp minimal dark cytotoxicity and preferential accumulation in tumor cells, it was recently been shown that non-malignant and malignant cells uptake Hyp at a similar level. In addition, Hyp has displayed light-independent toxicity and anti-proliferative effects in a wide range of concentrations. There are multiple mechanisms underlying Hyp light-independent effects, and we are still missing many details about them. In this paper, we focus on Hyp light-independent effects at several sub-cellular levels—protein distribution and synthesis, organelle ultrastructure and function, and Hyp light-independent effects regarding reactive oxygen species (ROS). We summarize work from our laboratories and that of others to reveal an intricate network of the Hyp light-independent effects. We propose a schematic model of pro- and anti-apoptotic protein dynamics between cell organelles due to Hyp presence without illumination. Based on our model, Hyp can be explored as an adjuvant therapeutic drug in combination with chemo- or radiation cancer therapy.

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Evaluation of peripheral arterial occlusive disease by computed tomography angiography

2016-10-14T06-24-23Z
Source: International Journal of Research in Medical Sciences
Udhaya Kumar K., Shabnam Bhandari Grover, Sunil Kumar Jain, Sandeep Bansal, Jagdish Prasad, B. B. Thukral.
Background: Characterization of peripheral arterial occlusive disease (PAOD) can be performed with non-invasive angiography using computed tomography (CT). The present study was conducted to evaluate the CT angiographic spectrum of aortoiliac and the lower limb arterial disease in symptomatic patients of peripheral arterial occlusive disease (PAOD) and to classify the lesions according to the Trans-Atlantic Inter-Society Consensus II (TASC II). Methods: The study was carried out in the department of radio-diagnosis in collaboration with departments of cardiothoracic surgery, cardiology and surgery, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi. 50 patients aged above 40 years presenting with symptoms and (or) signs of lower limb peripheral arterial disease were recruited into the study after evaluating the renal function. Patients clinical history, ABI index and categories of PAOD according to the classification of Fontaine was noted. CT angiography of aortoiliac and lower limb arteries was performed with Philips Brilliance 40 CT unit. The findings in each CT angiography were analysed in respect to site, number, nature and distribution of the lesions and classified individually according to the TASC II. Results: The patients included in the study were all more than 40 years of age. The age range in the study group was 42 years to 75 years. The majority (86%) were male patients. Smoking and dyslipidemia were found to be the main risk factors in our patients. 24% of patients had documentary evidence of ischemic heart disease. On grading with ABI majority of patients (58%) presented in the end stage of the disease (stage IV). On CT angiography, number of lesions detected was 157. 97.4% of lesions were either stenotic or occlusive and 2.54% are with aneurysm. Maximum number of patients had femoropopliteal lesions followed by aortailiac lesions. 14 Winslow pathways were found in 10 patients. Maximum numbers of femoropopliteal lesions (47.29%) belong to type D, type B lesions account for 50% of total aortoiliac lesions based on TASC II classification. Out of 50, 40 were made follow up. Among them 8 were managed with conservative treatment and remaining 32 managed with treatment based TASC II classification. Conclusions: CT angiography is a reliable noninvasive imaging method for the comprehensive and multi parameter evaluation of patients with PAOD. CT angiographic findings are a highly accurate basis for treatment decisions and planning.


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Effect of intravenous dexmedetomidine and small dose fentanyl on shoulder tip pain in gynecological laparoscopic surgeries under spinal anaesthesia

2016-10-14T06-24-23Z
Source: International Journal of Research in Medical Sciences
Anjum Naz, Hasibul Hasan Shirazee.
Background: Shoulder tip pain and discomfort due to peritoneal stretching is the major limiting factor of spinal anaesthesia in laparoscopic surgeries. Aim of the study was to evaluate the effect of intravenous dexmedetomidine along with small dose fentanyl in abolishing the shoulder tip pain during gynaecological laparoscopic surgery and to assess its respiratory and hemodynamic effects. Methods: 50 ASA grade I and II, with age 18-50 yrs and weight 45-70 kgs, who were undergoing elective gynecological laparoscopic surgeries with estimated pneumoperitoneum time of one hour or less, were included in the study. Injection dexmedetomidine 1 mcg/kg was infused over a period of ten minutes before spinal anaesthesia with 3.5 ml of injection ropivacaine (0.75%) in lateral position. Injection fentanyl 0.5mcg/kg was given intravenously before intraperitoneal insufflation. Shoulder tip pain, peri-operative heart rate, noninvasive blood pressure, end tidal carbon dioxide, respiratory rate and sedation level using Ramsay sedation score were assessed at frequent intervals. Results: 35 patients were comfortable with no complaints, 11 patients had mild and two patients had moderate shoulder tip pain which was relieved by reducing abdominal pressure or/and an additional dose of fentanyl (25 mcg). One patient had severe pain and had to be converted to general anaesthesia. Ready sedation score was 2 or 3 for all the patients except one who was deeply sedated and had to be intubated. The drug combination used reduced the shoulder tip pain in gynaecological laparoscopic surgeries performed under spinal anaesthesia while maintaining the stable intra-operative hemodynamics. Conclusions: This study has provided the preliminary evidence of feasibility of use of dexmedetomidine along with low dose fentanyl to reduce the discomfort and shoulder tip pain during gyanaecological laparoscopic procedures of short duration under spinal anaesthesia in selected patients.


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Cervicofacial flap revisited

2016-10-14T06-24-23Z
Source: International Journal of Research in Medical Sciences
Dhananjay V. Nakade, Jitendra Mehta, Manish Zade, Pawan Shahane.
Background: Cheek defect is difficult to reconstruct .The cervicofacial flap give cosmetically good result with minimum scar and good colour match to the skin and skin texure. It is useful in elderly people because of skin laxity and their scars hidden well in wrinkles. It causes minimal morbidity. Methods: We have studied 12 cases of cervicofacial flap in our series that underwent repair for variety of cheek defects in our hospital from 2012 to 2015. We have used anterior based flaps. We have used subcutaneous flaps in the face and subplatysmal flaps in neck. Their data collected and analysed. Results: In our study mean age was 56 years and male to female ratio was 1:1. Defect size was ranging from 4x7 cms to 7 x 11 cms. The eitiology was trauma in 5 cases, 2 cases of Basal cell Carcinoma, 2 cases of squamous cell carcinoma, 2 cases of angio-neurofibroma and one case of Hemangioma of face. All patients were satisfied with result of cervicofacial flap. FTSG used in four cases accepted very well. Mucosal advancement and z plasty in one case has given good result. PMMC in one case has done to reconstruct cheek. In one case Auricular cartilage used to reconstruct and support lower eyelid. Conclusions: Cervicofacial flap is simple, easy to operate, consume less operating time as compared to microvascular flap. It is less complicated and especially useful in diabetic, hypertensives and old debilitated patients with high risk of anaesthesia.


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Seropositivity of hepatitis B viral infection among liver disorder patients, voluntary blood donors and hospital personnel

2016-10-14T06-24-23Z
Source: International Journal of Research in Medical Sciences
Vikas Chandra Yadav, Mohammad Zoyev Khan, Sujan Narayan Agrawal, Vepada Ravi Kiran.
Background: HBV is highly infectious when compared with HIV even minute traces of infected blood as little as 0.0001 ml can transmit infection. Several of the routine therapeutic, diagnostic, prophylactic invasive procedures are capable of spreading HBV infection. Objectives of the study were to study the prevalence of hepatitis B surface antigen in voluntary blood donors, health care workers (medical and paramedical personnel) and patients with liver disorders Methods: Present study was hospital based cross sectional study carried out among 75 subjects during a period of one year. These 75 subjects consisted of 25 patients with liver disorder, 25 health care workers and 25 voluntary blood donors. All of these were selected randomly. After obtaining informed consent, detailed history and examination was carried out. The blood samples were collected and sent for detection of HBsAg by ELISA. Data was entered and analyzed using proportions. Results: Maximum subjects 40 (53.3%) belonged to the age group of 21-30 years overall as well as among the voluntary blood donors i.e. 60%. Among voluntary blood donors, 96% were males. 60% belonged to urban areas. Among rural subjects, maximum (53.3%) were having liver disorders. Only 28% were illiterate. Liver disorder was more common among illiterates i.e. it was 76.2%. Overall only 24% were having high risk behavior and all of them were heterosexuals. 76% were not having any high risk behavior. Liver disorder was more common (66.7%) among heterosexual high risk behavior subjects compared to only 22.8% with no high risk behavior. Seropositivity was found highest among patients with liver disorder (64%) followed by among health care workers (12%). No one was seropositive among voluntary blood donors. Overall the seropositivity was 25.4%. Conclusions: Patients with liver disorders especially chronic hepatitis were mostly seropositive. Among health care workers, being a doctor was an important risk factor for acquiring hepatitis B infection. Hence all health care workers should be immunized for hepatitis B.


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More cases of tuberculosis than previously thought, WHO reports

The global incidence of tuberculosis (TB) is higher than previously thought, after it was found that earlier estimates of the disease were too low.According to the World Health Organization’s Global...
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New optical sensing technique of tissue viability and blood flow based on nanophotonic iterative multi-plane reflectance measurements



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Cytotoxic effects of ZnO nanoparticles on mouse testicular cells

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Amorphous silica nanoparticles trigger vascular endothelial cell injury through apoptosis and autophagy via reactive oxygen species-mediated MAPK/Bcl-2 and PI3K/Akt/mTOR signaling



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Synergistic effects of A-B-C-type amphiphilic copolymer on reversal of drug resistance in MCF-7/ADR breast carcinoma



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Viruses, Vol. 8, Pages 285: Single Amino Acid Substitution N659D in HIV-2 Envelope Glycoprotein (Env) Impairs Viral Release and Hampers BST-2 Antagonism

BST-2 or tetherin is a host cell restriction factor that prevents the budding of enveloped viruses at the cell surface, thus impairing the viral spread. Several countermeasures to evade this antiviral factor have been positively selected in retroviruses: the human immunodeficiency virus type 2 (HIV-2) relies on the envelope glycoprotein (Env) to overcome BST-2 restriction. The Env gp36 ectodomain seems involved in this anti-tetherin activity, however residues and regions interacting with BST-2 are not clearly defined. Among 32 HIV-2 ROD Env mutants tested, we demonstrated that the asparagine residue at position 659 located in the gp36 ectodomain is mandatory to exert the anti-tetherin function. Viral release assays in cell lines expressing BST-2 showed a loss of viral release ability for the HIV-2 N659D mutant virus compared to the HIV-2 wild type virus. In bst-2 inactivated H9 cells, those differences were lost. Subtilisin treatment of infected cells demonstrated that the N659D mutant was more tethered at the cell surface. Förster resonance energy transfer (FRET) experiments confirmed a direct molecular link between Env and BST-2 and highlighted an inability of the mutant to bind BST-2. We also tested a virus presenting a truncation of 109 amino acids at the C-terminal part of Env, a cytoplasmic tail partial deletion that is spontaneously selected in vitro. Interestingly, viral release assays and FRET experiments indicated that a full Env cytoplasmic tail was essential in BST-2 antagonism. In HIV-2 infected cells, an efficient Env-mediated antagonism of BST-2 is operated through an intermolecular link involving the asparagine 659 residue as well as the C-terminal part of the cytoplasmic tail.

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Erratum: Occupational exposure to diesel engine exhaust and alterations in lymphocyte subsets

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Lan Q, Vermeulen R, Dai Y, Ren D, Hu W, Duan H, Niu Y, Xu J, Fu W, Meliefste K, Zhou B, Yang J, Ye M, Jia X, Meng T, Bin P, Kim C, Bassig BA, Hosgood HD III, Silverman D, Zheng Y, Rothman N. Occupational exposure to diesel engine exhaust and alterations in lymphocyte subsets. Occup Environ Med 2015;72:354–59.

There are two corresponding authors for this paper as follows:

Qing Lan, Occupational & Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH 9609 Medical Center Drive, Room 6E138, Rockville, Maryland 20850, USA; qingl@mail.nih.gov

Yuxin Zheng, National Institute of Occupational Health and Poison Control, China CDC No 29, Nanwei Road, Beijing, 100050, P. R. China; zhengyx@chinacdc.cn



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Unemployment and mental health

This edition of the Occupational and Environmental Medicine includes an analysis of the link between unemployment benefits and purchased prescription drugs, and to what extent the two tended to co-occur over a 6-year period.1 The authors show that an incident prescription of a psychotropic drug was twofold to threefold more likely to occur close to a period of unemployment than the same individual's risk when unemployment was not an issue. This relationship was stronger for men, more pronounced for psychotropic drugs than other classes of prescription drugs, and was at its highest 1–3 months prior to onset of unemployment. The timing coincides with the notice period in Norway, where the study was carried out.

The results add to the well-established relationship between mental health and unemployment: on average, those who are involuntarily out of work have higher levels of psychological distress than those who have work. Previous systematic...



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Persistent and contemporaneous effects of job stressors on mental health: a study testing multiple analytic approaches across 13 waves of annually collected cohort data

Objectives

This study investigated the extent that psychosocial job stressors had lasting effects on a scaled measure of mental health. We applied econometric approaches to a longitudinal cohort to: (1) control for unmeasured individual effects; (2) assess the role of prior (lagged) exposures of job stressors on mental health and (3) the persistence of mental health.

Methods

We used a panel study with 13 annual waves and applied fixed-effects, first-difference and fixed-effects Arellano-Bond models. The Short Form 36 (SF-36) Mental Health Component Summary score was the outcome variable and the key exposures included: job control, job demands, job insecurity and fairness of pay.

Results

Results from the Arellano-Bond models suggest that greater fairness of pay (β-coefficient 0.34, 95% CI 0.23 to 0.45), job control (β-coefficient 0.15, 95% CI 0.10 to 0.20) and job security (β-coefficient 0.37, 95% CI 0.32 to 0.42) were contemporaneously associated with better mental health. Similar results were found for the fixed-effects and first-difference models. The Arellano-Bond model also showed persistent effects of individual mental health, whereby individuals' previous reports of mental health were related to their reporting in subsequent waves. The estimated long-run impact of job demands on mental health increased after accounting for time-related dynamics, while there were more minimal impacts for the other job stressor variables.

Conclusions

Our results showed that the majority of the effects of psychosocial job stressors on a scaled measure of mental health are contemporaneous except for job demands where accounting for the lagged dynamics was important.



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Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees

Objectives

The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk.

Methods

The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions.

Results

Purchases of all psychotropic drugs increased 1–3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations.

Conclusions

Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process.



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Does chronic exposure to high levels of nitrogen dioxide exacerbate the short-term effects of airborne particles?

Background

Long-term exposure to air pollutants has been hypothesised as a factor in susceptibility to short-term exposure to particulate matter (PM), but results are not coherent. We studied the short-term effects of PM10 on mortality and assessed whether long-term exposure to nitrogen dioxide (NO2) modifies this association.

Methods

We used a case-crossover design to evaluate daily PM10-related mortality among 124 432 35+ year-old participants who died in Rome between 2001 and 2010 and maintained the same address for at least 5 years before death. Modification of PM10-related mortality by long-term NO2 exposure was determined by two-way interaction, while a three-way interaction was used to assess effect modification of high NO2 levels in population groups defined by sociodemographic position and pre-existing diseases.

Results

Mortality increased by 0.82% (0.23–1.41%) for each 10 µg/m3 increase in PM10. Mortality rose by 1.22% (0.17–2.38%) in participants exposed to NO2 levels ≥50 µg/m3 and by 0.69% (0.03–1.34%) in those exposed to levels <50 µg/m3 with no effect modification (p-interaction 0.378). A suggestion of effect modification was seen in 85+-year-olds (3.10%; p-interaction 0.043), as well as in those with a pre-existing arrhythmia (3.26%; p-interaction 0.014) and chronic obstructive pulmonary disease (3.52%; p-interaction 0.042).

Conclusions

Long-term exposure to NO2 is not likely to induce susceptibility to short-term PM10 exposure in the overall population. However, an effect modification of NO2 is probable in the elderly and in those suffering from arrhythmias and chronic obstructive pulmonary disease.



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Biomechanical and psychosocial exposures are independent risk factors for carpal tunnel syndrome: assessment of confounding using causal diagrams

Background

Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships.

Objective

This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS.

Methods

1605 participants, without CTS at enrolment, were followed for up to 3.5 years (2471 person-years). Demographic information, medical history and workplace psychosocial stress measures were collected at baseline. Individual workplace biomechanical exposures were collected for each task and combined across the workweek using time-weighted averaging (TWA). CTS case criteria were based on symptoms and results of electrophysiological testing. HRs were estimated with Cox proportional hazard models. Confounding was assessed using causal diagrams and an empirical criterion of 10% or greater change in effect estimate magnitude.

Results

There were 109 incident CTS cases (IR=4.41/100 person-years; 6.7% cumulative incidence). The relationships between CTS and forceful repetition rate, % time forceful hand exertion and the Threshold Limit Value for Hand Activity Level (TLV-HAL) were slightly confounded by decision latitude with effect estimates being attenuated towards the null (10–14% change) after adjustment. The risk of CTS among participants reporting high job strain was attenuated towards the null by 14% after adjusting for the HAL Scale or the % time forceful hand exertions.

Conclusions

Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.



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'Should we consider renaming 'Mesoamerican Nephropathy as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL)?

Mesoamerican nephropathy (MAN) refers to a kidney disease that primarily afflicts male labourers (usually in the agricultural sector) and has been mainly identified in regions of Central America.1 While the global prevalence and incidence is not known, in the regions where the condition has been recognised, the prevalence has been noted to be between 10% and 15%. Nearly 20 000 deaths have been attributed to this condition from El Salvador alone.2 The aetiology is unclear. It is thought to be contributed to by dehydration, malnutrition, fructose ingestion, electrolyte imbalance, pesticides, environmental toxins and heat injury. The role of genetics or other patient factors is unclear. Clusters of kidney disease with similar presentation have been identified in agricultural labourers in India, Egypt and Sri Lanka. The histopathology of this condition is characterised by interstitial fibrosis and tubular atrophy with glomerulosclerosis similar to that from Central America.



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Sedentary work and the risk of breast cancer in premenopausal and postmenopausal women: a pooled analysis of two case-control studies

Objectives

There is limited research on the association between sedentary behaviour and breast cancer risk, particularly whether sedentary behaviour is differentially associated with premenopausal and postmenopausal breast cancer. We pooled data from 2 case–control studies from Australia and Canada to investigate this association.

Methods

This pooled analysis included 1762 incident breast cancer cases and 2532 controls. Participants in both studies completed a lifetime occupational history and self-rated occupational physical activity level. A job-exposure matrix (JEM) was also applied to job titles to assess sedentary work. Logistic regression analyses (6 pooled and 12 study-specific) were conducted to estimate associations between both self-reported and JEM-assessed sedentary work and breast cancer risk among premenopausal and postmenopausal women.

Results

No association was observed in the 6 pooled analyses, and 10 of the study-specific analyses also showed null results. 2 study-specific analyses provided inconsistent and contradictory results, with 1 showing statistically significant increased risk of breast cancer for self-reported sedentary work among premenopausal women cancer in the Canadian study, and the other a non-significant inverse association between JEM-assessed sedentary work and breast cancer risk among postmenopausal women in the Australian study.

Conclusions

While a suggestion of increased risk was seen for premenopausal women in the Canadian study when using the self-reported measure, overall this pooled study does not provide evidence that sedentary work is associated with breast cancer risk.



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Resurgent coal mine dust lung disease: wave of the future or a relic of the past?

Black lung, coal workers' pneumoconiosis (CWP), miners' asthma and most recently the all-encompassing term coal mine dust lung disease (CMDLD) are names given to lung diseases caused by overexposure to coal mine dust. Most of us studied these diseases in medical school, but were under the impression that they were relics of a bygone age. We believed that modern mining technologies and dust controls, which have been in place for decades, had eliminated this scourge.

We were wrong. Unfortunately, what we eliminated or weakened were essential components of public health surveillance and prevention programmes, leaving holes through which this disease has re-emerged. China is now experiencing an epidemic of CWP in association with its enormous domestic demand for coal and loosely regulated mining industry.1 The USA is in the midst of a resurgence of CWP that started in the mid-1990s after decades of reduction. Cases of advanced...



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Occupational exposure to solar ultraviolet radiation and the risk of prostate cancer

Objectives

Preventable risk factors for prostate cancer are poorly understood; sun exposure is a possible protective factor. The goal of this study was to investigate prostate cancer risk in outdoor workers, a population with high sun exposure.

Methods

Prostate cancer cases and controls from a large study (conducted between 1994 and 1997) were used for this analysis. A job exposure matrix (JEM) was used to assign solar ultraviolet radiation (UVR) at work as moderate (2 to <6 hours outside/day) or high (≥6 hours). Average daily satellite UV-B measures were linked to the latitude/longitude of the residences of each participant. Several other exposure metrics were also examined, including ever/never exposed and standard erythemal dose by years (SEDxyears). Logistic regression was used to evaluate the association between solar UVR exposure and the odds of prostate cancer.

Results

A total of 1638 cases and 1697 controls were included. Men of Indian and Asian descent had reduced odds of prostate cancer (ORs 0.17 (0.08 to 0.35) and 0.25 (0.15 to 0.41), respectively) compared with Caucasian men, as did single men (OR 0.76 (0.58 to 0.98)) compared with married men. Overall, no statistically significant associations were observed between sun exposure and prostate cancer with 1 exception. In the satellite-enhanced JEM that considered exposure in high category jobs only, prostate cancer odds in the highest quartile of cumulative exposure was decreased compared with unexposed men (OR 0.68 (0.51 to 0.92)).

Conclusions

This study found limited evidence for an association with prostate cancer, with the exception of 1 statistically significant finding of a decreased risk among workers with the longest term and highest sun exposure.



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Personal exposure to static and time-varying magnetic fields during MRI procedures in clinical practice in the UK

Background

MRI has developed into one of the most important medical diagnostic imaging modalities, but it exposes staff to static magnetic fields (SMF) when present in the vicinity of the MR system, and to radiofrequency and switched gradient electromagnetic fields if they are present during image acquisition. We measured exposure to SMF and motion-induced time-varying magnetic fields (TVMF) in MRI staff in clinical practice in the UK to enable extensive assessment of personal exposure levels and variability, which enables comparison to other countries.

Methods

8 MRI facilities across National Health Service sites in England, Wales and Scotland were included, and staff randomly selected during the days when measurements were performed were invited to wear a personal MRI-compatible dosimeter and keep a diary to record all procedures and tasks performed during the measured shift.

Results

98 participants, primarily radiographers (71%) but also other healthcare staff, anaesthetists and other medical staff were included, resulting in 149 measurements. Average geometric mean peak SMF and TVMF exposures were 448 mT (range 20–2891) and 1083 mT/s (9–12 355 mT/s), and were highest for radiographers (GM=559 mT and GM=734 mT/s). Time-weighted exposures to SMF and TVMF (GM=16 mT (range 5–64) and GM=14 mT/s (range 9–105)) and exposed-time-weighted exposures to SMF and TVMF (GM=27 mT (range 11–89) and GM=17 mT/s (range 9–124)) were overall relative low—primarily because staff were not in the MRI suite for most of their shifts—and did not differ significantly between occupations.

Conclusions

These results are comparable to the few data available from the UK but they differ from recent data collected in the Netherlands, indicating that UK staff are exposed for shorter periods but to higher levels. These data indicate that exposure to SMF and TVMF from MRI scanners cannot be extrapolated across countries.



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Asbestos exposure and histological subtype of malignant mesothelioma

Background

Malignant mesothelioma (MM) has distinct histological subtypes (epithelioid, sarcomatoid and biphasic) with variable behaviour and prognoses. It is well recognised that survival time varies with the histological subtype of MM. It is not known, however, if asbestos exposure characteristics (type of asbestos, degree of exposure) are associated with different histological subtypes.

Aim

To determine if the pathological MM subtype is associated with the type of asbestos or the attributes of asbestos exposure.

Methods

Cases of MM for the period 1962 until 2012, their main histological subtype and their most significant source of asbestos exposure were collected from the Western Australian Mesothelioma Registry. Exposure characteristics included, degree of asbestos exposure (including total days exposed, years since first exposure and, for crocidolite only, calculated cumulative exposure), source of exposure (occupational or environmental), form of asbestos handled (raw or processed) and type of asbestos (crocidolite only or mixed fibres).

Results

Patients with the biphasic subtype were more likely to have occupational exposure (OR 1.83, 1.12 to 2.85) and exposure to raw fibres (OR 1.58, 1.19 to 2.10). However, differences between subtypes in the proportions with these different exposure characteristics were small and unlikely to be biologically relevant. Other indicators of asbestos exposure were not associated with the histological subtype of mesothelioma.

Conclusions

There was no strong evidence of a consistent role of asbestos exposure indicators in determining the histological subtype of MM.



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Occupational exposure to crystalline silica and gastric cancer: a systematic review and meta-analysis

Crystalline silica is a widely used industrial material that is readily available worldwide, and is one of the most common types of particulate mineral pollutants. It has been classified as a group 1 human carcinogen of the respiratory system; however, whether it is linked to gastric cancer remains uncertain. We conducted a systemic review and meta-analyses to search for evidence of the relationship between gastric cancer and occupational exposure to crystalline silica. We searched for articles on occupations involving silica exposure and gastric cancer studies up to December 2014. Pooled-risk estimates of the association between occupational crystalline silica exposure and risk of gastric cancer were calculated by a random effects model. Metaregression analyses of industry type and histological confirmation status, study design and industrial subgroup analyses were performed. 29 articles, including 9 case–control and 20 cohort studies, were analysed. The overall summary effects size was 1.25 (95% CI 1.18 to 1.34) for the association of occupational silica exposure with gastric cancer. Both heterogeneity and publication bias were partially attenuated after subgroup analyses. Heterogeneity of studies was attenuated after metaregression by industry. Higher overall effects were observed in the mining and foundry industries. We found a significant relationship between occupational crystalline silica exposure and gastric cancer. Our results were strengthened by various subgroup analyses and, considering the biological plausibility of our premise, further studies are required to better understand this association.



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Mediating pathways and gender differences between shift work and subjective cognitive function

Objectives

Increased injury risk among shift workers is often attributed to cognitive function deficits that come about as a result of sleep disruptions. However, little is known about the intermediate influences of other factors (eg, work stress, health) which may affect this relationship. In addition, gender differences in these the complex relationships have not been fully explored. The purpose of this study is to (1) identify the extent to which work and non-work factors mediate the relationship between shift work, sleep and subsequent subjective cognitive function; and (2) determine if the mediating pathways differ for men and women.

Methods

Data from the 2010 National Population Health Survey was used to create a cross-sectional sample of 4255 employed Canadians. Using path modelling, we examined the direct and indirect relationships between shift work, sleep duration, sleep quality and subjective cognitive function. Multigroup analyses tested for significantly different pathways between men and women. Potential confounding effects of age and self-reported health and potential mediating effects of work stress were simultaneously examined.

Results

Work stress and sleep quality significantly mediated the effects of shift work on cognition. Age and health confounded the relationship between sleep quality and subjective cognition. No differences were found between men and women.

Conclusions

Occupational health and safety programmes are needed to address stress and health factors, in addition to sleep hygiene, to effectively address cognitive function among shift workers.



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In reply to: "Should we consider renaming 'Mesoamerican Nephropathy as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL)?"

We, from the Consortium on the Epidemic of Nephropathy in Central America and Mexico (CENCAM), read with interest Drs Subramanian and Javaid's letter,1 regarding Mesoamerican Nephropathy (MeN), a name assigned to a type of chronic kidney disease (CKD) not related to classic risk factors and also referred to as CKD of unknown (CKDu) or non-traditional causes. MeN is highly prevalent in Central America and a major health problem.2

We agree with the authors that it is important to focus attention on the occupational component of this disease, and therefore on its preventable nature. Nevertheless, we consider it premature and inappropriate to rename MeN and other regional nephropathies as Nephropathy of Unknown Cause in Agricultural Labourers (NUCAL). First, this would imply that there is enough evidence to confirm that what is being described in Mesoamerica and other CKDu epidemics in developing nations (ie, Sri Lanka, India,...



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Mortality and cancer incidence in a cohort of male paid Australian firefighters

Objectives

To investigate mortality and cancer incidence of paid male Australian firefighters and of subgroups of firefighters by era of first employment, duration of employment and number and type of incidents attended.

Methods

Participating fire agencies supplied records of individual firefighters including their job histories and incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. SMRs and SIRs were calculated. Firefighters were grouped into tertiles by duration of employment and by number of incidents attended and relative mortality ratios and relative incidence ratios calculated. Analyses were carried out separately for full-time and part-time male firefighters.

Results

Compared to the Australian population, there were significant increases in overall risk of cancer, for all paid firefighters SIR 1.09 (95% CI 1.03 to 1.14), in prostate cancer, full-time firefighters 1.23 (95% CI 1.10 to 1.37), part-time 1.51 (1.28 to 1.77), and melanoma full-time 1.45 (95% CI 1.26 to 1.66), part-time firefighters 1.43 (95% CI 1.15 to 1.76). Kidney cancer was associated with longer service in internal analyses for paid firefighters. Prostate cancer was associated with longer service and increased attendance at fires, particularly structural fires for full-time firefighters.The overall risk of mortality was significantly decreased and almost all major causes of death were significantly reduced for paid firefighters.

Conclusions

Male paid firefighters have an increased risk of cancer. They have reduced mortality compared with the general population, which is likely to be a result of a strong healthy worker effect and likely lower smoking rates among firefighters compared with the Australian population.



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Erratum: Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study

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Gwini SM, Kelsall HL, Sim MR, et al. Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study. Occup Environ Med 2016;73:195–8. The copyright line has been corrected for this article, it now reads: © 2016 Commonwealth of Australia. Published by BMJ Publishing Group Ltd. This has been updated online.



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Immune thrombocytopenia and its association with lymph node tuberculosis – A dilemma!

2016-10-14T05-27-44Z
Source: The Southeast Asian Journal of Case Report and Review
Sangita Deepak Kamath, Neeraj Jain, Saurabh Pathak, Ballamudi Srinivas Rao.
Background: Although various hematologic abnormalities are known to occur with tuberculosis, association of immune mediated thrombocytopenia with tuberculosis is uncommon. Newly diagnosed immune thrombocytopenia in TB is rare; only 27 cases have been reported so far. Case: We report a case of axillary lymph node tuberculosis who presented with immune thrombocytopenia. An eighteen year old girl was admitted to our hospital with excessive vaginal bleed of one week duration followed by the development of petechial lesions and ecchymosis over legs, hands and mouth. She also had solitary, firm, left axillary lymphadenopathy. A diagnosis of immune mediated thrombocytopenia (ITP) was made from peripheral blood smear and bone marrow examination. Intravenous methylprednisolone (30mg/kg body weight) followed by oral prednisolone (1mg/kg) failed to elicit any sustained platelet response. Fine needle aspiration cytology of the left axillary lymphadenopathy done later revealed tuberculosis. After two weeks of starting anti-tuberculous therapy, the platelet count returned to normal and she was off all therapy for ITP thereby suggesting likely association between tuberculosis and immune thrombocytopenia. Conclusion: This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.


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Association between irisin and major chronic diseases: a review

OBJECTIVE: Irisin is a muscle-secreted protein released into the circulation by cleavage of fibronectin type III domain containing protein 5(FNDC5). Since its discovery in 2012, it has been the subject of many researches due to its physiological role. It is believed that understanding irisin’s function may be the key to comprehend many diseases and their development. The aim of this study is to perform a systematic review in order to establish whether there is an association of irisin’s levels with obesity, diabetes mellitus, non-alcoholic steatohepatitis, chronic kidney disease and cancer in terms of prognosis.

MATERIALS AND METHODS: The articles that support these findings were selected from Medline using the keyword “irisin” and filtered with “humans only“. The selected articles were in English and with abstract.

RESULTS: Higher baseline irisin concentrations are associated with greater reductions in glycemia and insulinemia after weight loss in obese subjects. Besides, it was observed that macrovascular disease, a complication of diabetes, was developed when there were lower levels of irisin. In addition, although not statistically significant, high levels of irisin were associated with portal inflammation and severity of histological lesions. Its concentrations decreased with increasing chronic kidney disease stage, and they were not only independently and positively predicted by renal function and insulin resistance but also associated with sarcopenia and carotid atherosclerosis in patients undergoing peritoneal dialysis. Regarding cancer, irisin reduced the proliferation, viability and migration of malignant breast cells. Finally, it is also related to bone health once its concentration is associated with previous osteoporotic fractures.

CONCLUSIONS: In every condition studied, irisin’s concentrations were related to the development of the disease.

L'articolo Association between irisin and major chronic diseases: a review sembra essere il primo su European Review.



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miR-143 is involved in endothelial cell dysfunction through suppression of glycolysis and correlated with atherosclerotic plaques formation

OBJECTIVE: Atherosclerosis is recognized as a chronic inflammatory disease leading to hardening of the vessel wall and narrowing of arteries. Endothelial cells (ECs) exhibit highly active glycolysis, the dysfunction of which leads to accumulation of lipids in the arterial wall and formation of atherosclerotic plaque.

MATERIALS AND METHODS: qRT-PCR was performed to compare the deregulated miR-143 between atherosclerotic plaque and normal vessel tissues. The direct target of miR-143 was verified by Western blot and luciferase assay. The metabolic enzymes in atherosclerotic plaque and normal vessel tissues were measured. HUVECs were transfected with miR-143 precursor or control microRNAs, and glucose uptake, lactate production, intracellular ATP, and oxygen consumption were measured.

RESULTS: In this study, we report a correlation between up-regulated miR-143, EC dysfunction, and atherosclerotic plaque formation. The glycolysis rate was significantly elevated in ECs, which show relatively low levels of miR-143. Importantly, miR-143 was upregulated in clinical atherosclerotic plaque samples compared with healthy arteries, suggesting that miR-143 might play important roles in the atherosclerotic plaque formation. Moreover, mRNA levels of key enzymes of glycolysis, such as HK2, LDHA, and PKM2 are significantly down-regulated in the atherosclerotic plaque samples. Overexpression of miR-143 in HUVECs suppresses glycolysis through direct targeting of HK2, leading to EC dysfunction. Restoration of HK2 expression rescues glycolysis in miR-143-overexpressing HUVECs.

CONCLUSIONS: This study provides further insight into the metabolic mechanisms involved in atherosclerotic plaque formation due to microRNAs.

L'articolo miR-143 is involved in endothelial cell dysfunction through suppression of glycolysis and correlated with atherosclerotic plaques formation sembra essere il primo su European Review.



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microRNA-125b contributes to high glucose-induced reactive oxygen species generation and apoptosis in HK-2 renal tubular epithelial cells by targeting angiotensin-converting enzyme 2

OBJECTIVE: Hyperglycemia induces apoptosis of renal tubular epithelial cells and contributes to tubular injury in diabetic nephropathy. Angiotensin-converting enzyme 2 (ACE2) is known to protect against diabetic kidney injury. However, the mechanism for the dysregulation of ACE2 expression in diabetic nephropathy is unclear.

MATERIALS AND METHODS: Bioinformatic analysis and luciferase reporter assay were done to identify ACE2-targeting microRNAs. Gain- and loss-of-function experiments were performed to determine the biological roles of the ACE2-targeting microRNAs in high glucose-induced damage to renal tubular epithelial cells.

RESULTS: We identified microRNA-125b (miR-125b) as a negative regulator of ACE2. After high glucose treatment, HK-2 renal tubular epithelial cells showed an upregulation of miR-125b and reduction of ACE2 expression. Knockdown of miR-125b with anti-miR-125b inhibitors significantly prevented high glucose-induced downregulation of ACE2 in HK-2 cells. Moreover, depletion of miR-125b significantly blocked reactive oxygen species (ROS) formation and apoptosis in high glucose-exposed HK-2 cells. In contrast, ectopic expression of miR-125b accelerated ROS production and apoptotic response in HK-2 cells, which was coupled with induction of Bax and reduction of Bcl-2. Rescue experiments demonstrated that overexpression of ACE2 reversed the effects of miR-125b on ROS generation, apoptosis, and deregulation of Bcl-2 and Bax in HK-2 cells.

CONCLUSIONS: Taken together, miR-125b mediates high glucose-induced ROS production and apoptosis in HK-2 renal tubular epithelial cells, largely through targeting ACE2. Accordingly, miR-125b represents a potential therapeutic target for the prevention of diabetic nephropathy.

L'articolo microRNA-125b contributes to high glucose-induced reactive oxygen species generation and apoptosis in HK-2 renal tubular epithelial cells by targeting angiotensin-converting enzyme 2 sembra essere il primo su European Review.



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Fibroblast growth factor 23 serum level in type 2 diabetic italian subjects with peripheral arterial disease and critical limb ischemia

OBJECTIVE: Fibroblast growth factor 23 (FGF23) was demonstrated to be involved in the occurrence and development of cardiovascular disease (CVD). The aim of this study was to investigate the potential role of FGF23 on presence and severity of peripheral arterial disease (PAD) in type 2 diabetic patients.

PATIENTS AND METHODS: In this study, we analyzed FGF23 serum levels in 413 type 2 diabetic patients with PAD and in 598 diabetic controls without lower limbs atherosclerosis.

RESULTS: We found that FGF23 median serum levels were significantly higher in patients than in diabetic controls (69.3 (58.8-75.1) pg/mL in PAD and 42.98 (37.1-49.8) pg/mL in subjects without PAD (p < 0.001) and were significantly and independently associated with critical limb ischemia (CLI) [OR, 7.69 (2.64-16.31); p = 0.001].

CONCLUSIONS: We have found, for the first time, that FGF23 could be associated with presence and severity of PAD in Italian patients with type 2 diabetes.

L'articolo Fibroblast growth factor 23 serum level in type 2 diabetic italian subjects with peripheral arterial disease and critical limb ischemia sembra essere il primo su European Review.



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Helicobacter pylori CagA antibodies and thyroid function in latent autoimmune diabetes in adults

OBJECTIVE: H. pylori infection is reportedly associated with autoimmune diseases such as chronic thyroiditis and autoimmune diabetes. The aim of this study is to determine the association between H. pylori infection and its virulent strain CagA with antibodies against thyroperoxidase (TPO Ab) and thyrotropin (TSH) in a cohort of latent autoimmune diabetes in adult (LADA) patients.

PATIENTS AND METHODS: We included 234 LADA patients (53.8% women). Antibodies against H. pylori whole antigens and CagA, TPO Ab and TSH were assessed in all patients.

RESULTS: Prevalence of IgG against H. pylori and GagA was 52.1% and 20.9% respectively. Antibodies against H. pylori were not associated with TPO Ab and TSH (rho = 0.067, p = 0.620 and rho = 0.156, p = 0.099, respectively). Antibodies against CagA showed a positive association with TSH and TPO Ab (respectively rho = 0.309, p = 0.036 and rho = 0.419, p = 0.037). Subjects with hypothyroidism (TSH ≥ 3.5 μU/ml) had an increased frequency of Ab anti CagA (p = 0.059).

CONCLUSIONS: The infection by H. pylori strains expressing CagA is associated with increased TPO Ab and TSH levels in LADA patients, suggesting a possible mechanism involved in thyroid autoimmunity and dysfunction of the gland. Further research is needed to test this hypothesis.

L'articolo Helicobacter pylori CagA antibodies and thyroid function in latent autoimmune diabetes in adults sembra essere il primo su European Review.



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Th17 cells associated cytokines and cancer

Cancer is one of the most common malignant tumors, which is a serious threat to human life. However, the etiology of cancer is not entirely clear. Under the action of tumorigenic factors, tissue cells lose normal regulation, resulting in abnormal proliferation and differentiation, so as to form a tumor. Cytokines promote the development of chronic inflammation, which may affect the development of cancer, and Th17 cells are a kind of immune cells which are closely related to the tumor. Therefore, this article focused on the role of Th17 cells and its related cytokines in tumor, which is very important for understanding the mechanism of tumor development. This will provide a direction for immunotherapy and gene-targeted therapy of cancer.

L'articolo Th17 cells associated cytokines and cancer sembra essere il primo su European Review.



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Multimodal approach of advanced gastric cancer: based therapeutic algorithm

Gastric cancer (GC) is the third leading cause of cancer death in both sexes worldwide, with the highest estimated mortality rates in Eastern Asia and the lowest in Northern America. However, the availability of modern treatment has improved the survival and the prognosis is often poor due to biological characteristics of the disease. In oncology, we are living in the “Era” of target treatment and, to know biological aspects, prognostic factors and predictive response informations to therapy in GC is mandatory to apply the best strategy of treatment.The purpose of this review, according to the recently published English literature, is to summarize existing data on prognostic aspects and predictive factors to response to therapy in GC and to analyze also others therapeutic approaches (surgery and radiotherapy) in locally, locally advanced and advanced GC. Moreover, the multidisciplinary approach (chemotherapy, surgery and radiotherapy) can improve the prognosis of GC.

The purpose of this review, according to the recently published English literature, is to summarize existing data on prognostic aspects and predictive factors to response to therapy in GC and to analyze also others therapeutic approaches (surgery and radiotherapy) in locally, locally advanced and advanced GC. Moreover, the multidisciplinary approach (chemotherapy, surgery and radiotherapy) can improve the prognosis of GC.

L'articolo Multimodal approach of advanced gastric cancer: based therapeutic algorithm sembra essere il primo su European Review.



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The role of ZNRF2 in the growth of non-small cell lung cancer

OBJECTIVE: ZNRF2 belongs to ubiquitin ligases of the RING superfamily, and has been recently shown to be regulated by Akt to interact with a Mechanistic target of rapamycin (mTor). Nevertheless, a role of ZNRF2 in tumorigenesis, especially in non-small cell lung cancer (NSCLC), is unknown. Here, we assessed ZNRF2 expression in NSCLC.

PATIENTS AND METHODS: We examined ZNRF2 levels by Western blot using NSCLC specimens, compared to the paired non-tumor controls. We also examined the effects of ZNRF2 on cell growth and cell survival in the presence of fluorouracil.

RESULTS: We detected significant higher levels of ZNRF2 and mTor in NSCLC tissues, compared to the paired non-tumor controls. Moreover, ZNRF2 and mTor levels strongly correlated in NSCLC tissues. High ZNRF2 levels were correlated with poor prognosis of the NSCLC patients. In vitro, overexpression of ZNRF2 increased NSCLC cell growth and suppressed apoptotic cell death in the presence of Fluorouracil, while depletion of ZNRF2 decreased NSCLC cell growth and increased apoptotic cell death in the presence of fluorouracil. ZNRF2 appeared to augment mTor and its downstream targets CyclinD1 and CDK in NSCLC cells.

CONCLUSIONS: ZNRF2 may be a promising target for treating NSCLC.

L'articolo The role of ZNRF2 in the growth of non-small cell lung cancer sembra essere il primo su European Review.



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Regulation of Twist in the metastasis of non-small cell lung cancer by miR-92b

OBJECTIVE: It is well documented that some microRNAs (miRNAs) regulates tumorigenesis and cancer metastases of non-small cell lung cancer (NSCLC). Nevertheless, a role of miR-92b in control of the metastasis of NSCLC has not been acknowledged.

MATERIALS AND METHODS: Here, we reported that miR-92b levels were significantly decreased and Twist levels were significantly increased in NSCLC specimens, compared to paired adjacent non-tumor lung tissue. Moreover, the levels of miR-92b and Twist inversely correlated.

RESULTS: Bioinformatics analyses and luciferase-reporter assay showed that miR-92b targeted the 3’-UTR of Twist mRNA to inhibit its translation. Overexpression of miR-92b inhibited Twist-mediated cell invasiveness, while depletion of miR-92b increased Twist-mediated cell invasiveness in either a transwell cell migration assay or a scratch wound healing assay.

CONCLUSIONS: Together, our data suggest that re-expression of miR-92b may inhibit Twist-mediated NSCLC metastasis.

L'articolo Regulation of Twist in the metastasis of non-small cell lung cancer by miR-92b sembra essere il primo su European Review.



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Knockdown of long noncoding RNA AB073614 inhibits glioma cell proliferation and migration via affecting epithelial-mesenchymal transition

OBJECTIVE: This study was aimed to explore the role of long noncoding RNA (lncRNA) AB073614 and its potential mechanisms in the glioma development.

MATERIALS AND METHODS: Expression levels of lncRNA AB073614 in glioma tissues and glioma cell lines were evaluated by quantitative real-time PCR (qRT-PCR). MTT assays were conducted to explore the impact of AB073614 down-regulation on the proliferation of human glioma cells. The effects of AB073614 knockdown on cell proliferation and migration were evaluated by in vitro assays. EMT-related molecular markers expression level was detected by qRT-PCR assay and Western blot analysis.

RESULTS: We confirmed that AB073614 was significantly upregulated in glioma tissues and cell lines (p < 0.01). In vitro studies demonstrated that knockdown of AB073614 inhibits U251 cell proliferation and migration. Moreover, knockdown of AB073614 could inhibit epithelial-mesenchymal transition (EMT) phenotype in glioma cells.

CONCLUSIONS: AB073614 functions as a tumor promoter in glioma. This finding may provide a therapeutic approach for future treatment of glioma.

L'articolo Knockdown of long noncoding RNA AB073614 inhibits glioma cell proliferation and migration via affecting epithelial-mesenchymal transition sembra essere il primo su European Review.



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The database that is rewriting history to predict the future

predictinghistorymain-800x533.jpg

A vast store of facts about the past aims to separate history from legend. It could pin down why civilisations rose and fell – and guide the evolution of our own

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The database that is rewriting history to predict the future

A vast store of facts about the past aims to separate history from legend. It could pin down why civilisations rose and fell – and guide the evolution of our own

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Factors of metabolic dysfunction are associated with increased liver cancer risk https://t.co/V24SCPHhsf https://t.co/4J9mhPH9Ou

Factors of metabolic dysfunction are associated with increased liver cancer risk https://t.co/V24SCPHhsf https://t.co/4J9mhPH9Ou

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Breast cancer resistance to tamoxifen elucidated

Researchers have discovered that a protein found naturally in cells that provides some protection from viruses is responsible for creating mutations that drive resistance to tamoxifen treatment in breast cancer. Because the protein, known as APOBEC3B, is...

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Can Treating Nightmares Prevent Suicides?

These nighttime terrors have been shown to increase the risk of suicidal behavior independently of other risk factors

-- Read more on ScientificAmerican.com
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These are the foods you should eat if you want less smelly farts

gettyimages-535083100.jpg

By mixing faeces with food ingredients, researchers have worked out which foodstuffs can reduce the amount of “rotten-egg gas” produced by our gut bacteria

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These are the foods you should eat if you want less smelly farts

By mixing faeces with food ingredients, researchers have worked out which foodstuffs can reduce the amount of “rotten-egg gas” produced by our gut bacteria

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Modelling maintenance of wakefulness in rats: comparing potential non-invasive sleep-restriction methods and their effects on sleep and attentional performance

Summary

While several methods have been used to restrict the sleep of experimental animals, it is often unclear whether these different forms of sleep restriction have comparable effects on sleep–wake architecture or functional capacity. The present study compared four models of sleep restriction, using enforced wakefulness by rotation of cylindrical home cages over 11 h in male Wistar rats. These included an electroencephalographic-driven ‘Biofeedback’ method and three non-invasive methods where rotation was triggered according to a ‘Constant’, ‘Decreasing’ or random protocol based upon the ‘Weibull’ distribution fit to an archival Biofeedback dataset. Sleep–wake architecture was determined using polysomnography, and functional capacity was assessed immediately post-restriction with a simple response latency task, as a potential homologue of the human psychomotor vigilance task. All sleep restriction protocols resulted in sleep loss, behavioural task disengagement and rebound sleep, although no model was as effective as real-time electroencephalographic-Biofeedback. Decreasing and Weibull protocols produced greater recovery sleep than the Constant protocol, mirrored by comparably poorer simple response latency task performance. Increases in urinary corticosterone levels following Constant and Decreasing protocols suggested that stress levels may differ between protocols. Overall, these results provide insight into the value of choosing a specific sleep restriction protocol, not only from the perspective of animal welfare and the use of less invasive procedures, but also translational validity. A more considered choice of the physiological and functional effects of sleep-restriction protocols in rodents may improve correspondence with specific types of excessive daytime sleepiness in humans.



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Management of Hepatitis C Virus—Genotypes 4, 5, and 6 Using Direct Antiviral Agents: Review of Current Status

Opinion Statement

A small number of studies were done on Hepatitis C virus genotypes 4, 5, and 6; that is why limited data were available on the most effective management for these patients. In the past, treatment of this kind of patients depended on the use of the suboptimal regimen of interferon with ribavirin achieving moderate efficacy with numerous side effects. However, with the introduction of the new directly acting antiviral drugs (DAAs), multiple agents became available for treatment showing high success rates, excellent tolerability, and few adverse events.



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New Era of TB Drug Discovery and Its Impact on Disease Management

Opinion statement

Tuberculosis (TB) is a devastating infectious disease that continues to plague the world, despite improved hygiene, massive vaccination efforts and an arsenal of chemotherapeutic agents. Mycobacterium tuberculosis (Mtb), the causative agent of TB, is a slow-growing bacterium that naturally resists most currently known antibiotics. Emergences of ever-increasing drug-resistant Mtb strains threaten our ability to control the disease. Unfortunately, lethargic drug development efforts led to the approval of only one new TB drug in the last 50 years by the US Food and Drug Administration. This dismal progress warrants a re-evaluation of approaches and methods for new TB drug discovery. Although successful in the past, the continuous use of in vitro drug discovery methods eroded recent attempts towards TB drug discovery, caused by a pathogen that inhabits human cells. Advances in recent years include the development of new intracellular screening protocols using relevant disease models. Pilot studies have yielded new lead compounds filling the pipeline for further development. Furthermore, these studies have revealed new insights to forecast changes in diagnostics and chemotherapies against this notorious infectious agent.



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Expression of long non-coding RNA CRNDE in glioma and its correlation with tumor progression and patient survival

OBJECTIVE: Long non-coding RNAs (lncRNAs) CRNDE has been identified as a tumor oncogene in glioma. However, its clinical significance and prognostic value in glioma have not been investigated until now. The aim of this study was to explore CRNDE expression levels and evaluated its clinical significance in glioma patients.

PATIENTS AND METHODS: Expression levels of lncRNA CRNDE in 164 glioma specimens were determined by quantitative real-time PCR (qRT-PCR). The chi-square test was used to explore CRNDE expression with respect to clinicopathological parameters. The overall survival was analyzed by log-rank test, and survival curves were plotted according to Kaplan-Meier. Univariate and multivariate analyses were performed to analyze the prognostic significance of CRNDE expression.

RESULTS: Compared with nonneoplastic brain tissues, the expression level of CRNDE was significantly increased in glioma tissues (p < 0.01). CRNDE upregulation was correlated with larger tumor size (p = 0.011), higher WHO grade (p = 0.001), and recurrence (p = 0.008). Also, survival analysis proved that up-regulated CRNDE expression was associated with poor overall survival of glioma patients (p < 0.001). The multivariate Cox regression analysis indicated that CRNDE expression was an independent prognostic factor for overall survival.

CONCLUSIONS: These results indicated that lncRNA CRNDE was associated with tumor progression and could be an independent prognostic factor for glioma patients.

L'articolo Expression of long non-coding RNA CRNDE in glioma and its correlation with tumor progression and patient survival sembra essere il primo su European Review.



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Expression of lncRNA HULC in cervical cancer and its correlation with tumor progression and patient survival

OBJECTIVE: To investigate Long non-coding RNA HULC (HULC) expression in cervical cancer and to evaluate its clinical significance.

PATIENTS AND METHODS: HULC expression in 244 pairs of human cervical cancer and adjacent normal tissues was detected by real-time quantitative RT-PCR assay. The correlation between HULC and clinicopathological factors was also evaluated. The clinical and prognostic significance of HULC expression was analyzed statistically by Kaplan-Meier estimate and Cox regression model.

RESULTS: HULC expression was high in cervical cancer (p < 0.01). Also, the high HULC expression was significantly associated with the FIGO stage, lymph node metastasis and depth of cervical invasion (p < 0.05). Kaplan-Meier analysis showed that cervical cancer pa¬tients with high expression of HULC possessed poorer outcome than those with low expression of HULC (p < 0.001). Based on the univariate and multivariate analysis, the elevated expression of the HULC protein was a significant predictor of poor prognosis for cervical cancer patients (p = 0.001).

CONCLUSIONS: Our data firstly showed that the expression of HULC was upregulated in cervical cancer, and associated with overall survival, indicating that HULC may serve as a predictive biomarker for the prognosis of cervical cancer.

L'articolo Expression of lncRNA HULC in cervical cancer and its correlation with tumor progression and patient survival sembra essere il primo su European Review.



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Long noncoding RNA PVT1 as a novel serum biomarker for detection of cervical cancer

OBJECTIVE: To investigate long noncoding RNA PVT1 expression in the serum of cervical cancer patients, and to evaluate serum PVT1 level as a diagnostic biomarker for cervical cancer.

PATIENTS AND METHODS: Eighty-eight cervical cancer patients, 64 cervical intraepithelial neoplasia patients, 25 breast cancer patients, 25 ovarian cancer patients, and 111 healthy control subjects were enrolled into this study. PVT1 serum level in these participants and PVT1 expression in 20 pairs of cervical cancer tissues and adjacent paired normal tissues was measured by quantitative reverse transcription-polymerase chain reaction. The diagnostic values of serum PVT1 were evaluated by receiver operating characteristic curves analysis.

RESULTS: Serum PVT1 level is significantly increased in cervical cancer patients and correlated with tumor size, clinical stage, and lymph node metastasis of cervical cancer. Serum PVT1 could accurately discriminate cervical cancer patients from cervical intraepithelial neoplasia patients and healthy control subjects, and also discriminate early stage cervical cancer patients from healthy control subjects. But serum PVT1 level is not changed in breast cancer and ovarian cancer patients. Furthermore, serum PVT1 level is positively correlated with tissue PVT1 expression, and could indicate cervical cancer dynamics.

CONCLUSIONS: Long noncoding RNA PVT1 may be a novel noninvasive biomarker for early diagnosis of cervical cancer.

L'articolo Long noncoding RNA PVT1 as a novel serum biomarker for detection of cervical cancer sembra essere il primo su European Review.



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The impact of the multifocality and subtypes of papillary thyroid carcinoma on central compartment lymph node metastasis

OBJECTIVE: Papillary thyroid carcinoma (PTC) may often appear as multifocal disease. Few studies demonstrated a higher rate of central compartment lymph node metastasis (CCLNM) in multifocal PTC patients. Therefore, the effect of different histological subtypes of multifocal PTC on CCLNM is another subject for further examination. The aim of the present study is to evaluate the rate of central lymph node positivity in multifocal PTC as compared to unifocal disease, and to identify the role of different histologic subtypes of PTC on central neck lymph node positivity.

PATIENTS AND METHODS: Patients with PTC who underwent total thyroidectomy (TT) + central cervical lymph node dissection (CCLND) at authors’ institution between January 2012 and June 2016 were included (n=274). Independent Samples t-test, Mann-Whitney U test and Chi-square tests were used to determine univariate associations, and multivariate analysis was conducted by logistic regression.

RESULTS: The rate of CCLND positivity in multifocal PTC is higher than unifocal tumors and the difference is significant (p < 0.05). The univariate analysis demonstrated significant relation with male sex, lymphovascular invasion and size of dominant nodule > 10 mm regarding of CCLND positivity in multifocal PTC patients. The comparison between solitary and mixed histologic subtype of multifocal PTC is also significant (p < 0.05).

CONCLUSIONS: Multifocality is an important risk factor for CCLNM. Male sex, dominant tumor size >10 mm and mixed histological subtype in multifocal PTC may play an important role in CCLND positivity.

L'articolo The impact of the multifocality and subtypes of papillary thyroid carcinoma on central compartment lymph node metastasis sembra essere il primo su European Review.



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Craniofacial morphology and airflow in children with primary snoring

OBJECTIVE: Sleep-disordered breathing (SDB) is among the most common diseases and includes a group of pathological conditions that form a severity continuum from primary snoring (PS) to obstructive sleep apnea (OSA). SDB presents a multifactorial etiology and in children, it is often linked to adenotonsillar hypertrophy, which may lead to an alteration of the breathing pattern. Therefore, several studies hinted at the existence of a correlation between SDB and the alteration of craniofacial growth. However, these studies concentrated on the most severe forms of SDB and little evidence still exists for the mildest form of SDB, namely PS. This preliminary study investigates the association between nasal airflow, measured through rhinomanometry, and cephalometric parameters in a sample of young children with PS.

PATIENTS AND METHODS: A sample of 30 children with habitual snoring aged between 5 and 8 years was selected by a SDB validated questionnaire at the Pediatric Allergology and Immunology Center of “Sapienza” University of Rome, Italy. To assess the degree of nasal obstruction, all children underwent anterior active rhinomanometry while nocturnal pulse oximetry and polysomnography were used to characterize the SDB. Cephalometric analysis was used to evaluate relevant orthodontic parameters associated to the sagittal and vertical craniofacial development and to the position of the hyoid bone.

RESULTS: We found a statistically significant association between the Frankfurt mandibular angle (FMA), which measures the total facial vertical divergence, and the severity of the airflow’s obstruction (p = 0.014).

CONCLUSIONS: The present study supports the association between the level of nasal obstruction in children with PS and the alteration of cephalometric parameters associated with the vertical craniofacial growth, thus placing the evaluation of craniofacial parameters in the growth period in a privileged position to determine an early diagnosis of a possible insurgence of sleep disorders.

L'articolo Craniofacial morphology and airflow in children with primary snoring sembra essere il primo su European Review.



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The efficacy of open nephron-sparing surgery in the treatment of complex renal cell carcinoma

OBJECTIVE: To analyze the efficacy of open nephron-sparing surgery (NSS) in the treatment of complex renal cell carcinoma.

PATIENTS AND METHODS: A total of 118 patients with complex renal cell carcinoma (T1N0M0, clear cell carcinoma) were included in this study, and assigned into open radical nephrectomy (RN) group (35 patients), open NSS group (45 patients) and laparoscopic NSS group (38 patients). After 3 years of follow-up, the clinical efficacy was analyzed.

RESULTS: Both the mean surgery time and ischemia blocking time in the open NSS group were comparable to those in the RN group, and significantly shorter than the laparoscopic NSS group, p < 0.05. The rate of positive margin in the open NSS group was significantly lower than the laparoscopic NSS group. The occurrence of total complications in the open NSS group was comparable to that in the laparoscopic NSS group and significantly lower than the RN group. The successful rate of surgery in the open NSS group was significantly higher than the laparoscopic NSS group, p < 0.05. The 75% survival was 30.0 months in the RN group, > 35.0 months in the open NSS group and 34.0 months in the laparoscopic NSS group, the difference was significant (p < 0.001). The mortality was similar in the open NSS group and the laparoscopic NSS group, and significantly smaller than the RN group, p < 0.05.

CONCLUSIONS: Open NSS was more safe and effective in the treatment of complex renal cell carcinoma than RN and laparoscopic NSS.

L'articolo The efficacy of open nephron-sparing surgery in the treatment of complex renal cell carcinoma sembra essere il primo su European Review.



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Doctors beat computer programs in making diagnoses

102.1, 102.2, 102.3, 102.4, 102.5, 102.6, 102.7, 102.8, 102.9, 102.10, 210.2.1, 202.35.3Doctors made the correct diagnosis more than twice as often as 23 commonly used online symptom checker...
recent?d=yIl2AUoC8zA recent?d=dnMXMwOfBR0 recent?i=zjDGBN4ZLSc:Jx-kO77E8LE:V_sGLiP recent?d=qj6IDK7rITs recent?i=zjDGBN4ZLSc:Jx-kO77E8LE:gIN9vFw recent?d=l6gmwiTKsz0 recent?d=7Q72WNTAKBA recent?i=zjDGBN4ZLSc:Jx-kO77E8LE:F7zBnMy recent?i=zjDGBN4ZLSc:Jx-kO77E8LE:-BTjWOF


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Feedback: Fruitloopy serum is a carrot smoothie for your face

eyecare-serum-800x533.jpg

Plus: making a meal out of Brexit, the man who laid golden eggs, Greenland's strange operators, a flying visit to Green Island, quantum truck stops, and more

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A Cost-Utility Analysis of Recurrent Laryngeal Nerve Monitoring in the Setting of Total Thyroidectomy.

A Cost-Utility Analysis of Recurrent Laryngeal Nerve Monitoring in the Setting of Total Thyroidectomy.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 13;:

Authors: Rocke DJ, Goldstein DP, de Almeida JR

Abstract
Importance: Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is used as a tool to decrease the rate of nerve injury, although study findings are divergent on IONM efficacy. The cost-effectiveness of this approach to total thyroidectomy has not been well studied.
Objective: To determine whether IONM is a cost-effective intervention in the setting of total thyroidectomy.
Design and Setting: This study creates a decision-tree model of total thyroidectomy to analyze, from a societal perspective, the cost-effectiveness of universal IONM (ie, use in every case) vs selective IONM (ie, high-risk cases including reoperative cases, substernal or toxic goiters, and cases with known cancer) vs no IONM (visual identification only). Parameters for the model were derived from review of the literature, and deterministic and probabilistic analyses were performed to test the model's robustness. All analyses were performed from the model; there were no human participants.
Interventions: Modeled total thyroidectomy with and without IONM of the RLN.
Main Outcomes and Measures: Cost-effectiveness of universal IONM vs selective IONM vs visual identification only of the RLN.
Results: Visual identification of the RLN led to a cost savings of $179.40 and $683.20 per patient, and an improvement of 0.001 and 0.004 quality-adjusted life-years, over selective IONM and universal IONM, respectively. Visual identification was the most cost-effective approach, despite variations in costs and utilities in both deterministic and probabilistic sensitivity analyses. In a 1-way sensitivity analysis, decreasing the probability of RLN injury with IONM made selective IONM more cost-effective. When the rate of RLN injury for visual identification was kept constant (at 3.86%), selective IONM became the most cost-effective approach when its RLN injury rate dropped below 1.9%. As the rate of RLN injury with IONM dropped below 50.4% of the visual identification RLN injury rate, selective IONM became the most cost-effective approach.
Conclusions and Relevance: Visual identification of the RLN is more cost-effective than any use of IONM. If a clinician can, with use of IONM, decrease the rate of RLN injury by 50.4% or more compared with visual identification, selective use of IONM in high-risk cases is most cost-effective.

PMID: 27737451 [PubMed - as supplied by publisher]



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Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society.

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 13;:

Authors: Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O, Harris J

Abstract
Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking.
Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction.
Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel.
Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting.
Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

PMID: 27737447 [PubMed - as supplied by publisher]



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Expression of β-Adrenergic Receptor Subtypes in Proliferative, Involuted, and Propranolol-Responsive Infantile Hemangiomas.

Expression of β-Adrenergic Receptor Subtypes in Proliferative, Involuted, and Propranolol-Responsive Infantile Hemangiomas.

JAMA Facial Plast Surg. 2016 Oct 13;:

Authors: Phillips JD, Zhang H, Wei T, Richter GT

Abstract
Importance: Propranolol hydrochloride has become the primary medical treatment for problematic infantile hemangioma; however, the expression of propranolol's target receptors during growth, involution, and treatment of hemangioma remains unclear.
Objective: To measure and compare the expression of β1-, β2-, and β3-adrenergic receptors (ADBR1, ADBR2, and ADBR3, respectively) in proliferative (n = 10), involuted (n = 11), and propranolol-responsive (n = 12) hemangioma tissue.
Design, Setting, and Participants: Infantile hemangioma specimens were harvested for molecular investigation. Messenger RNA (mRNA) expression of the ADBR1, ADBR2, and ADBR3 genes was detected by real-time polymerase chain reaction. Protein level expression was measured by Western blot and standardized with densitometry. A total of 33 specimens were collected from patients in a tertiary pediatric hospital who underwent excision of problematic hemangiomas. This study was conducted from January 18, 2011, to September 24, 2013, and data analysis was performed from February 25, 2015, to June 25, 2016.
Results: Of the 33 patients included, 21 were female (64%). The mean (SD) patient age at the time of excision was 7 (2.5) months for the proliferative group lesions, 23.5 (10) months for the involuted group, and 16 (10) months for the propranolol group. The mean level of ADBR1 mRNA expression was significantly higher in proliferative hemangioma than in propranolol-responsive hemangioma (1.05 [0.56] vs 0.52 [0.36]; P = .01; 95% CI, 0.12-0.94). There was no difference in ADBR2 expression among the groups. Protein expression of ADBR3 was significantly higher in involuted (0.64 [0.12] vs 0.26 [0.04]; P < .01; 95% CI, 0.26-0.49) and propranolol-responsive hemangioma (0.66 [0.31] vs 0.26 [0.04]; P = .01; 95% CI, 0.16-0.68) compared with proliferative hemangioma.
Conclusions and Relevance: These data demonstrate the variable expression of ADBR subtypes among infantile hemangiomas during growth, involution, and response to treatment. These findings may have clinical implications regarding the use of selective vs nonselective β-blockade.
Level of Evidence: 2.

PMID: 27737446 [PubMed - as supplied by publisher]



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Association of Clinical Risk Factors and Postoperative Complications With Unplanned Hospital Readmission After Head and Neck Cancer Surgery.

Association of Clinical Risk Factors and Postoperative Complications With Unplanned Hospital Readmission After Head and Neck Cancer Surgery.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 13;:

Authors: Bur AM, Brant JA, Mulvey CL, Nicolli EA, Brody RM, Fischer JP, Cannady SB, Newman JG

Abstract
Importance: Unplanned hospital readmission is costly and in recent years has become a focus of health care legislation intended to reduce health care expenditures. Greater understanding of which perioperative complications are associated with hospital readmission after surgery for head and neck cancer is needed to reduce unplanned readmissions.
Objective: To determine which clinical risk factors and complications are associated with 30-day unplanned readmission after surgery for malignant neoplasms of the head and neck.
Design, Setting, and Participants: This retrospective longitudinal claims analysis included data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from January 1, 2012, to December 31, 2014. Patients undergoing surgery for malignant tumors of the head and neck were included; those with a primary diagnosis of thyroid malignant disease and those undergoing free autologous tissue transfer were excluded.
Main Outcomes and Measures: Clinical risk factors and complications were analyzed for association with unplanned hospital readmission using multivariable regression analysis. Statistical significance was determined using P < .05.
Results: A total of 7605 patients (5007 men [65.8%]; mean [SD] age, 64.2 [0.2] years) were identified and included for analysis. Overall, 1472 complications occurred in 912 cases. Three hundred eighty-eight patients (5.1%) had an unplanned readmission, which was lower than the previously published overall readmission rate for noncardiac surgical procedures in the NSQIP (6.8%). Clinical factors that were independently associated with unplanned readmission were age (adjusted odds ratio [AOR], 1.12; 95% CI, 1.03-1.22), diabetes (AOR, 1.60; 95% CI, 1.01-2.43), preoperative dyspnea at rest (AOR, 2.89; 95% CI, 1.40-5.55) and with moderate exertion (AOR, 1.48; 95% CI, 1.01-2.11), long-term use of corticosteroids (AOR, 2.45; 95% CI, 1.63-3.58), disseminated cancer (AOR, 1.57; 95% CI, 1.14-2.20), and a contaminated wound (AOR, 2.05; 95% CI, 1.05-3.7). When specific complications were examined, superficial incisional surgical site infection (SSI) (AOR, 2.02; 95% CI, 1.14-3.40), deep incisional SSI (AOR, 2.57; 95% CI, 1.26-5.03), organ or space SSI (AOR, 13.27; 95% CI, 6.57-26.61), wound disruption (AOR, 3.58; 95% CI, 1.95-6.31), pneumonia (AOR, 3.39; 95% CI, 1.88-5.96), deep vein thrombosis (AOR, 5.60; 95% CI, 1.90-15.25), pulmonary embolism (AOR, 20.72; 95% CI, 7.86-55.68), urinary tract infection (AOR, 2.66; 95% CI, 1.00-6.34), stroke (AOR, 12.42; 95% CI, 3.99-36.50), sepsis (AOR, 2.64; 95% CI, 1.27-5.30), and septic shock (AOR, 4.12; 95% CI, 1.10-15.81) were all associated with 30-day unplanned hospital readmission.
Conclusions and Relevance: This study evaluated clinical factors and postoperative complications to determine which ones were associated with 30-day unplanned hospital readmission among patients undergoing surgery for malignant tumors of the head and neck. Further understanding of which complications are associated with unplanned readmission after head and neck surgery will allow for improved risk stratification and development of postoperative care protocols to reduce unplanned hospital readmission.

PMID: 27737442 [PubMed - as supplied by publisher]



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Intraoperative Nerve Monitoring During Thyroidectomy-More Complex Than Cost Alone.

Intraoperative Nerve Monitoring During Thyroidectomy-More Complex Than Cost Alone.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 13;:

Authors: Krakovitz PR, Boss EF

PMID: 27737441 [PubMed - as supplied by publisher]



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A Toddler With Nasal Congestion and a Limp.

A Toddler With Nasal Congestion and a Limp.

JAMA Otolaryngol Head Neck Surg. 2016 Oct 13;:

Authors: Davis RJ, Boyce AM, Mydlarz WK

PMID: 27737440 [PubMed - as supplied by publisher]



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