Evaluation of fine needle aspiration cytology as the initial diagnostic test in cases of cervical lymphadenopathy

2016-11-16T23-52-51Z
Source: International Journal of Research in Medical Sciences
Gunjan P. Upadhyay, Rameshchandra M. Thakker.
Background: Cervical lymph node enlargement is common amongst the various causes of neck swelling. Proper diagnosis and early treatment is necessary for cervical lymph node disease and it is also necessary to rule out potentially curable causes as against malignancy in which the treatment is generally palliative. Fine needle aspiration cytology (FNAC) is now a day the initial investigation in most of the cases of cervical lymph node enlargement. Aims and Objectives of the study were to evaluate the sensitivity and specificity of FNAC in the diagnosis of cervical lymph node disease with an emphasis on discordant cases between the cytology and the histopathology. Methods: Patients admitted with cervical lymph node enlargement in a tertiary hospital of western India (attached with a medical college) from October 2014 to September 2016 were prospectively studied. Detailed history, clinical examination and necessary investigations of all patients were done especially fine needle aspiration cytology and histopathology examination and inference was obtained after the diagnosis was confirmed. Results: The cytological diagnoses were found to be malignant in 48 cases (30.6%) and benign in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2%, while the overall discordance rate was 17.8%. Conclusions: FNAC is the initial investigation of choice in the diagnostic approach to most of the cases of cervical lymphadenopathy and it has good diagnostic sensitivity and specificity.


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Is diesel equipment in the workplace safe or not?

Objectives

Recently, diesel motor exhaust (DME) has been classified as a known human carcinogen. We used data from epidemiological studies of diesel exposures to perform a quantitative risk assessment to calculate DME exposure levels, expressed as elemental carbon (EC), corresponding to acceptable risk (AR) and maximum tolerable risk (MTR) levels of 4 to 10^–5 and 4 to 10^–3 for the lifetime excess probability of dying from lung cancer.

Methods

Previously published slope estimates (n=14) of the exposure–response curve (ERC) for EC exposure and lung cancer were used in life-table analyses to calculate EC exposure levels corresponding to the specified AR and MTR levels.

Results

Considered ERC slope factors ranged from 0.00060 to 0.0012 natural logarithm of the relative rate (InRR) per μg/m³ years based on different selections of studies and study-specific risk estimates. Exposure limits based on these slope factors were between 0.009–0.017 and 0.85–1.67 μg/m³ EC for the AR and MTR, respectively.

Conclusions

Derived exposure limits based on the AR and MTR are around or well below 1 μg/m³ EC. Such limits are below current occupational exposure levels, and in some instances even below environmental exposure levels. Although uncertainties exist in the exact slope factors, these results indicate that an acceptable excess lung cancer mortality risk can only be achieved at very low DME exposure levels, suggesting that diesel engines using older technologies should be removed from the workplace when possible or emissions strictly controlled.

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Scheduled evening sleep and enhanced lighting improve adaptation to night shift work in older adults

Objectives

We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance and sleep in young adults would also be effective in older adults.

Methods

We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy) and circadian timing (salivary dim-light melatonin onset, DLMO) in 18 older adults (57.2±3.8 years; mean±SD) in a simulated shift work protocol. 4 day shifts were followed by 3 night shifts in the laboratory. Participants slept at home and were randomised to either the treatment group (scheduled evening sleep and enhanced lighting during the latter half of night shifts) or control group (ad-lib sleep and typical lighting during night shifts).

Results

Compared with day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the treatment group but remained lower for the control group. Sleep duration in the treatment group remained similar to baseline (6–7 hours) following night shifts, but was shorter (3–5 hours) following night shifts in the control group. Treatment group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (–9.7±9.9 min) in the control group.

Conclusions

The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance.

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Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity

Objectives

To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods

A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results

The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions

The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

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Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery

Background

Hepatitis B virus (HBV) transmission is known to occur through direct contact with infected blood. There has been some suspicion that the virus can also be detected in aerosol form. However, this has never been directly shown. The purpose of this study was to sample and analyse surgical smoke from laparoscopic surgeries on patients with hepatitis B to determine whether HBV is present.

Methods

A total of 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in this study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analysed by using nested PCR.

Results

Robotic or laparoscopic colorectal resections were performed in 5 cases, laparoscopic gastrectomies in 3 cases and laparoscopic hepatic wedge resections in another 3 cases. Preoperatively, all of the patients had positive hepatitis B surface antigen (HBsAg). 2 patients had detectable HBsAb, and 2 were positive for hepatitis B e antigen. 3 patients were taking antihepatitis B viral medications at the time of the study. The viral load measured in the patients’ blood was undetectable to 1.7x10⁸ IU/mL. HBV was detected in surgical smoke in 10 of the 11 cases.

Conclusions

HBV is detectable in surgical smoke. This study provides preliminary data in the investigation of airborne HBV infection.

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Effect of working hours and precarious employment on depressive symptoms in South Korean employees: a longitudinal study

Objectives

Long working hours and precarious employment are relatively common in South Korea. Since both can impact on mental health, this study examined their independent and combined effects on depressive symptoms of employees.

Methods

Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 2733 full-time employees without depressive symptoms were analysed. Hierarchical logistic regression models were used to investigate the effect of the number of working hours per week (eg, 35–40 hours, 41–52 hours, 53–68 hours, and >68 hours) and employment status (permanent vs precarious employment) on depressive symptoms, measured using the Center for Epidemiological Studies Depression (CES-D) 11 scale.

Results

Compared with individuals working 35–40 hours/week, employees working above 68 hours (OR 1.57, 95% CI 1.05 to 2.34) had higher odds of depressive symptoms after full adjustment. Similarly, precarious employees (OR 1.34, 95% CI 1.02 to 1.75) showed worse mental health than permanent employees. In the combined effect model, employees in precarious employment who worked above 68 hours/week (OR, 2.03 95% CI 1.08 to 3.83) exhibited the highest odds of depressive symptoms compared with permanent employees working 35 to 40 hours/week.

Conclusions

Long work hours and precarious employment status were associated with higher odds of depressive symptoms. The findings highlight the importance of monitoring and addressing the vulnerable groups of employees to reduce the mental health burden of economically active individuals.

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Prediction of prognosis for people off sick with upper extremity musculoskeletal disorders

Musculoskeletal disorders (MSDs) are the second most common cause of disability worldwide.1 Among people of working age, musculoskeletal conditions, including back pain, neck pain, upper limb disorders and arthritis account for almost a quarter of all sickness absence. Furthermore, MSDs contribute even more significantly to presenteeism (the reduction in working performance while at work because of ill health) and impaired in-work productivity (although these are more challenging to quantify accurately). Indeed, it is estimated that the total cost of lost productivity attributable to MSDs among people of working age in the European Union (EU) might be as high as 2% of gross domestic product.2 For these reasons, we urgently need to develop effective strategies to identify those individuals with recent-onset musculoskeletal pain or injury at greatest risk of long-term work disability and to develop effectual and cost-effective preventive and treatment interventions.

For these reasons, the...

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Genetic variation in EYA4 on the risk of noise-induced hearing loss in Chinese steelworks firm sample

Objectives

Noise-induced hearing loss is one of the most serious occupational diseases worldwide. It is caused by interactions between environmental and genetic factors. The purpose of this study was to examine the association between the genetic susceptibility of the eye absent homolog 4 (EYA4) gene and the risk of developing noise-induced hearing loss in China.

Methods

A case–control association study was carried out with 326 hearing loss cases and 326 controls matched with age and duration of noise exposure, drawn from a cohort of steel workers. Five single nucleotide polymorphisms (SNPs) in the EYA4 were selected and genotyped. Logistic regression was performed to analyse the main effect of genotypes and interactions between genotypes and individual/environmental factors adjusted for confounding factors. Moreover, generalised multiple dimensionality reduction was applied to further detect interaction among the 5 selected SNPs.

Results

Analysis revealed that locus polymorphism of rs3813346 was associated with the risk of developing noise-induced hearing loss in the dominance model, the codominance model and the addictive model (p=0.004, 0.009 and 0.003, respectively). A significant interaction between rs9321402 and cumulative noise exposure was found (p=0.002). A significant main effect p value (p=0.006) was obtained in the high-level exposure group (cumulative noise exposure ≥98 dB(A)). Generalised multiple dimensionality reduction indicated that the combined interaction of the 2 loci—rs3813346 and rs9493627—significantly affected the incidence of noise-induced hearing loss.

Conclusions

The research suggests that EYA4 genetic variant and its interaction with noise levels may modify the susceptibility to develop noise-induced hearing loss in Chinese population.

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Traffic pollution and the incidence of cardiorespiratory outcomes in an adult cohort in London

Objectives

The epidemiological evidence for adverse health effects of long-term exposure to air and noise pollution from traffic is not coherent. Further, the relative roles of background versus near traffic pollution concentrations in this process are unclear. We investigated relationships between modelled concentrations of air and noise pollution from traffic and incident cardiorespiratory disease in London.

Methods

Among 211 016 adults aged 40–79 years registered in 75 Greater London practices between 2005 and 2011, the first diagnosis for a range of cardiovascular and respiratory outcomes were identified from primary care and hospital records. Annual baseline concentrations for nitrogen oxide (NO_x), particulate matter with a median aerodynamic diameter <2.5 μm (PM_2.5) attributable to exhaust and non-exhaust sources, traffic intensity and noise were estimated at 20 m² resolution from dispersion models, linked to clinical data via residential postcode. HRs were adjusted for confounders including smoking and area deprivation.

Results

The largest observed associations were between traffic-related air pollution and heart failure (HR=1.10 for 20 μg/m³ change in NO_x, 95% CI 1.01 to 1.21). However, no other outcomes were consistently associated with any of the pollution indicators, including noise. The greater variations in modelled air pollution from traffic between practices, versus within, hampered meaningful fine spatial scale analyses.

Conclusions

The associations observed with heart failure may suggest exacerbatory effects rather than underlying chronic disease. However, the overall failure to observe wider associations with traffic pollution may reflect that exposure estimates based on residence inadequately represent the relevant pattern of personal exposure, and future studies must address this issue.

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Effects of bioaerosol exposure on respiratory health in compost workers: a 13-year follow-up study

Objectives

To determine the risk of German compost workers developing chronic respiratory effects from long-term exposure to bioaerosols.

Methods

Respiratory health was determined in 74 currently exposed compost workers and 37 non-exposed controls after 13 years of follow-up. In addition, 42 former compost workers (drop-outs) who left their work during the follow-up period were also examined. Respiratory symptoms and working conditions were assessed using identical questionnaires as at baseline. In addition, lung function was measured using the same spirometer as in the initial study. Sera from both surveys were tested for specific IgE and IgG antibodies to moulds and the risk of work-related symptoms was evaluated using regression approaches for prospective studies with binary data.

Results

In the follow-up period, the number of participants reporting cough significantly increased in compost workers and drop-outs compared to the controls. Working as a compost worker for at least 5 years increased the relative risk for cough (RR 1.28; 95% CI 1.2 to 1.4) and for cough with phlegm (RR 1.32; 95% CI 1.2 to 1.5). Current and former compost workers had slightly lower predicted percentage of forced expiratory volume in 1 s and predicted percentage of forced vital capacity than controls, but decrease in lung function during follow-up was not different among the 3 groups. In addition, no significant changes could be detected in antibody concentrations.

Conclusions

Our results suggest that chronic exposure to bioaerosols in composting plants is related to a significantly higher risk for cough with phlegm, indicating chronic bronchitis. However, compost workers showed no higher incidence of deterioration of pulmonary function over the study.

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Comparing plasma, serum and whole blood indium concentrations from workers at an indium-tin oxide (ITO) production facility

Objective

Occupational exposure to indium compounds including indium-tin oxide (ITO) can result in potentially fatal indium lung disease. We compared plasma, serum and whole blood indium concentrations (In_P, In_S and In_B) from workers at a single ITO production facility to assess the comparability of these matrices used for biological monitoring of indium exposure.

Method

In_P, In_S and In_B were measured using inductively coupled mass spectrometry from consenting workers at an ITO production facility with specimen collection occurring during June–July 2014. Matched pairs from workers were assessed to determine the matrix relationships using the Pearson correlation, paired t-tests, per cent difference, linear regression and statistics.

Results

Indium matrices were collected from 80 workers. Mean (SD) In_P, In_S and In_B were 3.48 (3.84), 3.90 (4.15) and 4.66 (5.32) mcg/L, respectively. The In_S–In_P difference was 14%; In_S was higher in all but two workers. In_P and In_S were highly correlated (r=>0.99). The In_B–In_S difference was 19%; In_B was higher in 85% of workers. The In_B–In_P difference was 34%; In_B was higher in 66% of workers. In_B was highly correlated with both In_P and In_S (r=0.97 and 0.96, respectively). Statistics were 0.84, 0.83 and 0.82 for In_P, In_S and In_B, respectively, for individuals with each matrix ≥1 mcg/L (p<0.01).

Conclusions

While all matrices were highly correlated, we encourage the use of In_P and In_S to reliably compare studies across different populations using different matrices. The higher per cent difference and increased variability of In_B may limit its utility in comparisons with In_P and In_S in different populations.

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Cancer incidence and mortality from exposure to radon progeny among Ontario uranium miners

Objectives

The study objectives were to extend the follow-up of the Ontario uranium miners cohort, one of the largest cohorts of uranium miners with low cumulative exposures, to examine the relationship between radon exposure and lung cancer mortality and, for the first time incidence, and address gaps in the literature, including dose–response relationship between radon exposure and other cancer sites, and non-cancer mortality.

Methods

The cohort of mine and mill workers was created using data from Canada's National Dose Registry and the Ontario Mining Master File. The follow-up for the cohort was recently extended for mortality (1954–2007) and for the first time includes cancer incidence (1969–2005). The Poisson regression was used to estimate relative risks (RR) and excess relative risks (ERR) and their 95% CIs with levels of cumulative radon exposure.

Results

The cohort consisted of 28 546 male miners with a mean cumulative radon exposure of 21.0 working level months (WLM). An increased risk of lung cancer and a dose–response relationship was observed with cumulative radon exposure. Miners exposed to >100 WLM demonstrated a twofold increase in the risk of lung cancer incidence (RR=1.89, CI 1.43 to 2.50) compared with the non-exposed group, and a linear ERR of 0.64/100 WLM (CI 0.43 to 0.85), with similar results observed for mortality. No association was observed for other cancer sites (stomach, leukaemia, kidney and extrathoracic airways) or non-cancer sites (cardiovascular diseases) with increasing cumulative exposure to radon.

Conclusions

These findings suggest no increased risk of cancer sites other than lung or non-cancer mortality from relatively low cumulative exposure to radon.

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Working hours and the onset of depressive disorder: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to examine whether working beyond the standard working hours was associated with a greater risk of depressive disorder among workers included in published prospective studies. This manuscript was prepared according to the PRISMA guideline checklist. A database search was conducted using MEDLINE (PubMed), PsycINFO, and PsycARTICLES using a relevant set of keywords. The eligibility criteria were as follows: (1) participants were adult workers; (2) exposure was defined as overtime work; (3) outcome were depressive disorders clinically diagnosed or assessed by a structured interview and (4) the study design was prospective or cohort. 7 studies were identified in the systematic review and meta-analysis. Overtime work was associated with a small, non-significant, elevated risk of depressive disorder (pooled relative risk=1.075; 95% CI 0.834 to 1.387; p=0.575) in a random effects model. The association tended to be greater for women. The risk of working 50 or more hours per week was slightly but not significantly increased (pooled relative risk=1.241; 95% CI 0.880 to 1.750; p=0.218). The effect of overtime work on depressive disorder remains inconclusive and may be small if not negligible. Sex differences and the effect of longer working hours on depressive disorder should be addressed in the future.

Trial registration number

Prospero CRD42015020003; Results.

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IJMS, Vol. 17, Pages 1906: An Overview of Hardware for Protein Crystallization in a Magnetic Field

Protein crystallization under a magnetic field is an interesting research topic because a magnetic field may provide a special environment to acquire improved quality protein crystals. Because high-quality protein crystals are very useful in high-resolution structure determination using diffraction techniques (X-ray, neutron, and electron diffraction), research using magnetic fields in protein crystallization has attracted substantial interest; some studies have been performed in the past two decades. In this research field, the hardware is especially essential for successful studies because the environment is special and the design and utilization of the research apparatus in such an environment requires special considerations related to the magnetic field. This paper reviews the hardware for protein crystallization (including the magnet systems and the apparatus designed for use in a magnetic field) and progress in this area. Future prospects in this field will also be discussed.

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Composition of Trace Metals in Dust Samples Collected from Selected High Schools in Pretoria, South Africa

Potential health risks associated with trace metal pollution have necessitated the importance of monitoring their levels in the environment. The present study investigated the concentrations and compositions of trace metals in dust samples collected from classrooms and playing ground from the selected high schools In Pretoria. Schools were selected from Pretoria based on factors such as proximity to high traffic ways, industrial areas, and residential areas. Thirty-two dust samples were collected from inside and outside the classrooms, where learners often stay during recess period. The dust samples were analysed for trace metal concentrations using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The composition of the elements showed that the concentrations of Zn were more than all other elements except from one of the schools. There were significant differences in the concentrations of trace metals from the schools (). Regular cleaning, proximity to busy road, and well maintained gardens seem to have positive effects on the concentrations of trace metals recorded from the classrooms dust. The result further revealed a positive correlation for elements such as Pb, Cu, Zn, Mn, and Sb, indicating that the dust might have a common source.

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A Multiagent System for Dynamic Data Aggregation in Medical Research

The collection of medical data for research purposes is a challenging and long-lasting process. In an effort to accelerate and facilitate this process we propose a new framework for dynamic aggregation of medical data from distributed sources. We use agent-based coordination between medical and research institutions. Our system employs principles of peer-to-peer network organization and coordination models to search over already constructed distributed databases and to identify the potential contributors when a new database has to be built. Our framework takes into account both the requirements of a research study and current data availability. This leads to better definition of database characteristics such as schema, content, and privacy parameters. We show that this approach enables a more efficient way to collect data for medical research.

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Association of Endoscopic Features of Gastric Mucosa with Helicobacter pylori Infection in Chinese Patients

The aim of this study is to identify and consolidate reliable endoscopic features associated with H. pylori infection in gastric mucosa, which is one of the major causes of gastric cancer. A total of 256 Chinese patients with symptomatic stomach disturbances were enrolled. Pathological examination was conducted using a light microscope and biopsy specimens stained with hematoxylin-eosin. Endoscopic examination was performed using a high resolution video endoscope. The association between endoscopic features and pathological H. pylori diagnosis was compared, and endoscopic features significantly associated with H. pylori infection were identified. A total of 14 endoscopic features were observed. Six of the 14 endoscopic features, including mucus on the gastric mucosa, diffuse redness, spotty redness of fundic mucosa, enlarged fold, mucosal edema, and RAC (type D and type I), were highly associated with H. pylori infection and were significantly sensitive and specific predictors for H. pylori diagnosis. The type R RAC was not significantly associated with H. pylori diagnosis. Our results indicate that conventional endoscopy features can be used to diagnose H. pylori in Chinese patients and can help determine the risk factor for gastric cancer.

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Long Term Compression Strength of Mortars Produced Using Coarse Steel Slag as Aggregate

The paper reports on some experimental results obtained from the production of mortars prepared using a commercial cement, coarse steelmaking slag, superplasticizer, and water. The behaviour of this reference composition was compared to that of some others containing further additives in order to investigate materials compressive strength after long time ageing. It has been demonstrated that an optimized water/cement ratio coupled with slag particles of size lower than 2.5 mm and proper protocol of preparation leads to the production of materials with good mechanical properties after 28, 90, and 180 days of ageing. The resulting materials therefore appeared as good candidates for civil engineering applications. However, the present research also demonstrates that the mortar samples of all of the compositions prepared suffer from decay and compressive strength decrease after long time ageing in water. In the present paper the results are explained taking account of materials residual porosity and alkali silica reaction which occurs in the samples.

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The Association of Hepatitis C Serological Status with Several Risk Factors in Indonesia

Hepatitis is an inflammation of the liver commonly caused by viral infection such as hepatitis A, B, C, D, and E but it is also possible by other causes. Infection with hepatitis C virus is also referred to as a disguise because the early infection is often asymptomatic that often goes undetected. This study aims at determining the several associated risk factors with hepatitis C serological status. The study design is cross-sectional. The biomedical data collection was carried out in 33 provinces in Indonesia with a population in urban blocks, census in Indonesia, where the sample is all household members over the age of one year from selected households by signing the informed consent. Total block census in selected urban area is about 971-block census with a total sample of 15.536 households. The results showed that there is a correlation between hepatitis C serological statuses with demographic group and that the age and occupation groups showed significant value obtained at 0.001 (OR = 3.27, CI = 1.84–5.81) and 0.209 (OR = 0.23, CI = 0.59–0.94). In conclusion, there are risk factors such as age and occupation that have a correlation of being infected with hepatitis C serological status.

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Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis

Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management.

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Anomalous Origin of the Left Common Carotid Artery from the Main Pulmonary Artery: A Rare Association in an Infant with CHARGE Syndrome

Case Report. Isolated carotid artery originating from the pulmonary trunk is an exceedingly rare anomalous origin of head and neck vessels. We present this finding, along with a persistent embryonic trigeminal artery, in a male infant with multiple cardiac defects and other congenital anomalies associated with CHARGE syndrome. After extensive investigations, cardiac catheterization revealed the anomalous left common carotid artery arising from the cranial aspect of the main pulmonary artery. There was retrograde flow in this vessel, resulting from the lower pulmonary pressure, essentially stealing arterial supply from the left anterior cerebral circulation. The persistent left-sided trigeminal artery provided collateral flow from the posterior circulation to the left internal carotid artery territory, allowing for safe ligation of the anomalous origin of the left common carotid artery, thereby reversing the steal of arterial blood flow into the pulmonary circulation and resulting in a net improvement of cerebral perfusion. Conclusion. The possibility of this vascular anomaly should be considered in all infants with CHARGE syndrome. Surgical repair or ligation should be tailored to the specific patient circumstances, following a careful delineation of all sources of cerebral perfusion.

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Pediatric Heart Failure, Lagging, and Sagging of Care in Low Income Settings: A Hospital Based Review of Cases in Ethiopia

Introduction. Causes of acute heart failure in children range from simple myocarditis complicating chest infection to complex structural heart diseases. Objective. To describe patterns, predictors of mortality, and management outcomes of acute heart failure in children. Methods. In retrospective review, between February 2012 and October 2015 at a tertiary center, 106 admitted cases were selected consecutively from discharge records. Data were extracted from patients chart and analyzed using SPSS software package. -test and statistical significance at value

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The Needs of Current Implant Technology in Orthopaedic Prosthesis Biomaterials Application to Reduce Prosthesis Failure Rate

Today, orthopaedics is still in search for the most reliable biomaterial for prosthesis. The biomaterial needs to have good longevity and other supporting properties in order to maintain low implant failure. An ideal metallic biomaterial should be biocompatible, has similar elastic modulus to that of bone, has excellent resistance to fatigue, corrosion, aseptic loosening, and wear, and has good bone-bonding ability. The success of an implant depends on many factors. Good osseointegration is one of the factors required to reduce the rate of loosening of implants and in order to increase the chance of osseointegration, high stability of implants and early healing process encouragement are needed.

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An Iterative, Mixed Usability Approach Applied to the Telekit System from the Danish TeleCare North Trial

Objective. The aim of the present study is to evaluate the usability of the telehealth system, coined Telekit, by using an iterative, mixed usability approach. Materials and Methods. Ten double experts participated in two heuristic evaluations (HE1, HE2), and 11 COPD patients attended two think-aloud tests. The double experts identified usability violations and classified them into Jakob Nielsen’s heuristics. These violations were then translated into measurable values on a scale of 0 to 4 indicating degree of severity. In the think-aloud tests, COPD participants were invited to verbalise their thoughts. Results. The double experts identified 86 usability violations in HE1 and 101 usability violations in HE2. The majority of the violations were rated in the 0–2 range. The findings from the think-aloud tests resulted in 12 themes and associated examples regarding the usability of the Telekit system. The use of the iterative, mixed usability approach produced both quantitative and qualitative results. Conclusion. The iterative, mixed usability approach yields a strong result owing to the high number of problems identified in the tests because the double experts and the COPD participants focus on different aspects of Telekit’s usability. This trial is registered with Clinicaltrials.gov, NCT01984840, November 14, 2013.

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Total CAD/CAM Supported Method for Manufacturing Removable Complete Dentures

The incorporation of computer-aided design/computer-aided manufacturing (CAD/CAM) technology into complete denture fabrication brings about several advantages to the fabrication process, providing better predictability of the desired outcomes and high accuracy of denture fit, mainly because the milling of prepolymerized acrylic resin eliminates the shrinkage of the acrylic base. Also, there is a decrease in the porosity when compared to a conventionally processed denture, and consequently there is a decrease in the retention of Candida albicans on the denture base. The presented workflow for complete denture fabrication presents a totally wax-free manufacturing process, combining rapid prototyping (RP) and rapid milling. With the presented technique, the maxillomandibular relation (MMR) and the ideal setup of the tooth arrangement are developed by using occlusion rims and trial setup made with RP. For the definitive final denture, the denture base and the basal surfaces of the conventional denture teeth were milled according to the individual clinical situation. Posteriorly, the teeth were adapted and bonded into the milled sockets of the milled base.

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The Economist explains: Environmental policy under Donald Trump

Main image:  “THE Trump Administration is firmly committed to conserving our wonderful natural resources and beautiful natural habitats,” claims a new website which sets out the policy priorities of Donald Trump, America’s president-elect. Greens are not convinced. Mr Trump promised on the campaign trail to rip up the Paris Agreement on climate change, which aims to limit global warming to “well below” 2°C above pre-industrial temperatures. He wants to kill America’s Clean Power Plan, which would regulate emissions from power plants. And he would promote coal-burning once more. Can America’s next president keep his campaign promises?The Paris Agreement came into effect on November 4th, less than a year after more than 190 countries adopted it in December 2015. Barack Obama committed America to the plan using his executive authority, which gives Mr Trump the power to abandon it without seeking congressional approval. The process to withdraw, as mandated by international law, would take at least four years. But the way the agreement is structured means that while each country is obliged to curb warming, they maintain authority over how to do so. Mr Trump could therefore wilfully ignore America’s obligations to cut emissions—although it is more than halfway to meeting its own target of cutting emissions ...

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A New Method to Solve Numeric Solution of Nonlinear Dynamic System

It is well known that the cubic spline function has advantages of simple forms, good convergence, approximation, and second-order smoothness. A particular class of cubic spline function is constructed and an effective method to solve the numerical solution of nonlinear dynamic system is proposed based on the cubic spline function. Compared with existing methods, this method not only has high approximation precision, but also avoids the Runge phenomenon. The error analysis of several methods is given via two numeric examples, which turned out that the proposed method is a much more feasible tool applied to the engineering practice.

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Ultraviolet Spectroscopy Used to Fingerprint Five Wild-Grown Edible Mushrooms (Boletaceae) Collected from Yunnan, China

Nowadays, wild-grown edible mushrooms which are natural, nutritious, and healthy get more and more popular by large consumers. In this paper, UV spectra of different Boletaceae mushrooms with the aid of partial least squares discriminant analysis (PLS-DA) and hierarchical cluster analysis (HCA) were shown to be a practical and rapid method for discrimination purpose. The specimens of Boletus edulis, Boletus ferrugineus, Boletus tomentipes, Leccinum rugosiceps, and Xerocomus sp. were described based on the UV spectra. From the results, all the specimens were characterized by strong absorption at the wavelengths of 274 and 284 nm and showed the shoulder at 296 nm. However, changes could be seen in the peak heights at the same wavelength for different samples. After analyzing by chemometrics, visual discrimination among samples was presented and the relationships among them were also obtained. This study showed that UV spectroscopy combined with chemometrics methods could be used successfully as a simple and effective approach for characterization of these five wild-grown edible mushrooms at species and genus levels. Meanwhile, this rapid and simple methodology could also provide reference for the discrimination of edible mushrooms.

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Clinical Significance of Molecular Diagnostic Tools for Bacterial Bloodstream Infections: A Systematic Review

Bacterial bloodstream infection (bBSI) represents any form of invasiveness of the blood circulatory system caused by bacteria and can lead to death among critically ill patients. Thus, there is a need for rapid and accurate diagnosis and treatment of patients with septicemia. So far, different molecular diagnostic tools have been developed. The majority of these tools focus on amplification based techniques such as polymerase chain reaction (PCR) which allows the detection of nucleic acids (both DNA and small RNAs) that are specific to bacterial species and sequencing or nucleic acid hybridization that allows the detection of bacteria in order to reduce delay of appropriate antibiotic therapy. However, there is still a need to improve sensitivity of most molecular techniques to enhance their accuracy and allow exact and on time antibiotic therapy treatment. In this regard, we conducted a systematic review of the existing studies conducted in molecular diagnosis of bBSIs, with the main aim of reporting on clinical significance and benefits of molecular diagnosis to patients. We searched both Google Scholar and PubMed. In total, eighteen reviewed papers indicate that shift from conventional diagnostic methods to molecular tools is needed and would lead to accurate diagnosis and treatment of bBSI.

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Serum Vitamin D Levels and Vitamin D Supplement in Adult Patients with Asthma Exacerbation

Introduction. Vitamin D deficiency has been linked to an increased risk of asthma exacerbations. Objective. This study aimed to compare vitamin D status during the period of severe asthma exacerbations and investigate if vitamin D supplementation improves asthma control. Methods. A total of 47 asthmatic patients and 40 healthy subjects participated in this study. Serum 25-hydroxyvitamin D (25(OH)D), asthma control test (ACT) score, and % predicted peak expiratory flow rate were evaluated in the period with and without severe asthma exacerbations. After that, we provided vitamin D2 supplements to the patients with low vitamin D levels for 3 months. Results. At the period of asthma exacerbation, the prevalence of vitamin D deficiency and insufficiency was 38.29% and 34.04%. There was no significant difference in the levels of serum 25(OH)D with and without asthma exacerbations but the levels were significantly higher in the healthy group. Serum 25(OH)D levels significantly correlated with ACT score. Moreover, vitamin D2 supplementation improved asthma control in uncontrolled asthma group. Conclusions. Hypovitaminosis D was common in asthmatic patients but was not the leading cause of asthma exacerbations. Serum 25(OH)D levels correlated with the ability to control asthma. Improving vitamin D status might be a benefit in uncontrolled asthmatic patients.

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Histopathological Evaluation of Contrast-Induced Acute Kidney Injury Rodent Models

Contrast-induced acute kidney injury (CI-AKI) can occur in 3–25% of patients receiving radiocontrast material (RCM) despite appropriate preventive measures. Often patients with an atherosclerotic vasculature have to receive large doses of RCM. Thus, animal studies to uncover the exact pathomechanism of CI-AKI are needed. Sensitive and specific histologic end-points are lacking; thus in the present review we summarize the histologic appearance of different rodent models of CI-AKI. Single injection of RCM causes overt renal damage only in rabbits. Rats and mice need an additional insult to the kidney to establish a clinically manifest CI-AKI. In this review we demonstrate that the concentrating ability of the kidney may be responsible for species differences in sensitivity to CI-AKI. The most commonly held theory about the pathomechanism of CI-AKI is tubular cell injury due to medullary hypoxia. Thus, the most common additional insult in rats and mice is some kind of ischemia. The histologic appearance is tubular epithelial cell (TEC) damage; however severe TEC damage is only seen if RCM is combined by additional ischemia. TEC vacuolization is the first sign of CI-AKI, as it is a consequence of RCM pinocytosis and lysosomal fusion; however it is not sensitive as it does not correlate with renal function and is not specific as other forms of TEC damage also cause vacuolization. In conclusion, histopathology alone is insufficient and functional parameters and molecular biomarkers are needed to closely monitor CI-AKI in rodent experiments.

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Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (), followed by pulmonary disease (). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.

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Hyperlactatemia and the Outcome of Type 2 Diabetic Patients Suffering Acute Myocardial Infarction

Background. Increased lactate production is frequent in unregulated/complicated diabetes mellitus. Methods. Three groups, each consisting of 40 patients (type 2 diabetics with myocardial infarction, DM+AMI, nondiabetics suffering myocardial infarction, MI, and diabetics with no apparent cardiovascular pathology, DM group), were tested for pH, serum bicarbonate and electrolytes, blood lactate, and CK-MB. Results. Blood lactate levels were markedly higher in AMI+DM compared to MI group ( versus  mmol/L, ); they correlated with the incidence of heart failure , cardiac rhythm disorders , oxygen saturation , CK-MB levels , and poor short-term outcome. Lactic acidosis in DM+AMI group was not always related to lethal outcome. Discussion. The lactate cutoff value associated with grave prognosis depends on the specific disease. While some authors proposed cutoff values ranging from 0.76 to 4 mmol/L, others argued that only occurrence of lactic acidosis may be truly predictive of lethal outcome. Conclusion. Both defective glucose metabolism and low tissue oxygenation may contribute to the lactate production in diabetic patients with acute myocardial infarction; high lactate levels indicate increased risk for poor outcome in this population comparing to nondiabetic patients. The rise in blood lactate concentration in diabetics with AMI was associated with increased incidence of heart failure, severe arrhythmias, cardiogenic shock, and high mortality rate.

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Statin as a Combined Therapy for Advanced-Stage Ovarian Cancer: A Propensity Score Matched Analysis

Background. Despite the great achievements in the treatment of advanced-stage ovarian cancer, it is still a severe condition with an unfavorable 5-year survival rate. Statins have been suggested to reduce the risk of several cancers beyond their cholesterol-lowing effects. However, the prognostic significance of statins in patients with advanced-stage ovarian cancer remains controversial. Methods. A retrospective study was performed to evaluate the association between statin intake and overall survival (OS) among patients with advanced-stage ovarian cancer. Patients who underwent cytoreductive surgery followed by courses of intravenous chemotherapy were matched through a propensity score analysis. Results. A total of 60 propensity-matched patients were included. Women in statin group showed a similar OS than the nonstatin counterparts (), whereas residual tumor was significantly associated with better OS () and was an independent factor that associated with OS (, hazard ratio = 5.460, and 95% confidence interval: 1.894 to 15.742) in multivariable analysis. Conclusions. Our results suggested that statin usage was not associated with improved OS in patients with advanced-stage ovarian cancer undergoing surgery and chemotherapy. Considering the retrospective nature and the relative small sample size of the study, further prospective studies and random control trials are needed.

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Automatic Approach for Lung Segmentation with Juxta-Pleural Nodules from Thoracic CT Based on Contour Tracing and Correction

This paper presents a fully automatic framework for lung segmentation, in which juxta-pleural nodule problem is brought into strong focus. The proposed scheme consists of three phases: skin boundary detection, rough segmentation of lung contour, and pulmonary parenchyma refinement. Firstly, chest skin boundary is extracted through image aligning, morphology operation, and connective region analysis. Secondly, diagonal-based border tracing is implemented for lung contour segmentation, with maximum cost path algorithm used for separating the left and right lungs. Finally, by arc-based border smoothing and concave-based border correction, the refined pulmonary parenchyma is obtained. The proposed scheme is evaluated on 45 volumes of chest scans, with volume difference (VD)  cm3, volume overlap error (VOE) %, average surface distance (ASD)  mm, root mean square distance (RMSD)  mm, maximum symmetric absolute surface distance (MSD)  mm, and average time-cost 2 seconds per image. The preliminary results on accuracy and complexity prove that our scheme is a promising tool for lung segmentation with juxta-pleural nodules.

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Solid-State 13C NMR Spectroscopy Applied to the Study of Carbon Blacks and Carbon Deposits Obtained by Plasma Pyrolysis of Natural Gas

Solid-state 13C nuclear magnetic resonance (NMR) spectroscopy was used in this work to analyze the physical and chemical properties of plasma blacks and carbon deposits produced by thermal cracking of natural gas using different types of plasma reactors. In a typical configuration with a double-chamber reactor, N2 or Ar was injected as plasma working gas in the first chamber and natural gas was injected in the second chamber, inside the arc column. The solid residue was collected at different points throughout the plasma apparatus and analyzed by 13C solid-state NMR spectroscopy, using either cross polarization (CP) or direct polarization (DP), combined with magic angle spinning (MAS). The 13C CP/MAS NMR spectra of a number of plasma blacks produced in the N2 plasma reactor showed two resonance bands, broadly identified as associated with aromatic and aliphatic groups, with indication of the presence of oxygen- and nitrogen-containing groups in the aliphatic region of the spectrum. In contrast to DP experiments, only a small fraction of 13C nuclei in the plasma blacks are effectively cross-polarized from nearby 1H nuclei and are thus observed in spectra recorded with CP. 13C NMR spectra are thus useful to distinguish between different types of carbon species in plasma blacks and allow a selective study of groups spatially close to hydrogen in the material.

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Surgical Management of Giant Genital Condyloma Acuminata by Using Double Keystone Flaps

Condyloma acuminata in the external genitalia (genital warts) is a sexually transmitted disease that is often caused by human papillomavirus (HPV). We report a case of giant genital condyloma acuminata in a 35-year-old male patient with HIV comorbidity treated by wide surgical excision. Excision defect was covered with split thickness skin graft (STSG) and double keystone flaps. There was no complication after surgery. Ten months following surgery, there was no new condyloma lesion and the patient had normal voiding and erectile functions.

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Laparoscopic Treatment of Adrenal Tumors: A Single-Center Experience with 58 Patients

Background. The aim of this study is to discuss the laparoscopic approach and assess the immunohistochemical expression profiles of synaptophysin, Ki-67, and inhibin and patient outcomes in adrenal masses through a series of cases treated at our institution. Method. The study was conducted on 58 patients who were diagnosed with adrenal masses. All cases were operated on laparoscopically for adrenal masses. Results. Both inhibin and synaptophysin were found positive in 45 patients (77,6%). Ki-67 was negative in 11 patients, whereas it was found positive in 42 with a rate of 1%. The size of the masses ranged from 1 up to 9 cm (mean 4,3 ± 1,5). Urine hormone excretion was measured within normal ranges in 47 out of 58 patients (81%). Most of the diagnosed patients were harboring Cortical Adenoma (: 38; 65,5%). All of the masses were successfully resected without complication except 3 patients. Because of complications of bleeding, the operation was converted to open surgery for 2 patients. Conclusion. Morbidity, mortality, and healing were comparable, regardless of tumor size, yet involvement in both laparoscopic and adrenal surgery was required. Our results suggested that laparoscopic adrenalectomy should replace open surgery as the standard treatment for most adrenal masses.

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Viruses, Vol. 8, Pages 308: Host–Pathogen Interactions in Measles Virus Replication and Anti-Viral Immunity

The measles virus (MeV) is a contagious pathogenic RNA virus of the family Paramyxoviridae, genus Morbillivirus, that can cause serious symptoms and even fetal complications. Here, we summarize current molecular advances in MeV research, and emphasize the connection between host cells and MeV replication. Although measles has reemerged recently, the potential for its eradication is promising with significant progress in our understanding of the molecular mechanisms of its replication and host-pathogen interactions.

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