Πληροφορίες

Η φωτογραφία μου
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, https://plus.google.com/communities/115462130054650919641?sqinv=VFJWaER0c2NCRl9ERzRjZWhxQmhzY09kVV84cjRn , ,https://plus.google.com/u/0/+AlexandrosGSfakianakis , https://www.youtube.com/channel/UCQH21WX8Qn5YSTKrlJ3OrmQ , https://www.youtube.com/channel/UCTREJHxB6yt4Gaqs4-mLzDA , https://twitter.com/g_orl?lang=el, https://www.instagram.com/alexandrossfakianakis/,

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Σάββατο, 21 Ιανουαρίου 2017

Making inventors of us all

Youthful enthusiams is a big asset for any nation. Micro:bit is encouraging children to innovate

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US cancer mortality drops 25% since peak - The Japan News


US cancer mortality drops 25% since peak
The Japan News
The largest disparities between the two sexes are for cancers of the esophagus, larynx and bladder, for which incidence and mortality are around four times greater in men. Melanoma, an aggressive skin cancer, is also 60 percent more frequent among men ...

and more »


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Making inventors of us all

Youthful enthusiams is a big asset for any nation. Micro:bit is encouraging children to innovate

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In Situ Catalytic Pyrolysis of Low-Rank Coal for the Conversion of Heavy Oils into Light Oils

Lighter tars are largely useful in chemical industries but their quantity is quite little. Catalytic cracking is applied to improve the yield of light tars during pyrolysis. Consequently, in situ upgrading technique through a MoS2 catalyst has been explored in this research work. MoS2 catalyst is useful for the conversion of high energy cost into low energy cost. The variations in coal pyrolysis tar without and with catalyst were determined. Meanwhile, the obtained tar was analyzed using simulated distillation gas chromatograph and Elemental Analyzer. Consequently, the catalyst reduced the pitch contents and increased the fraction of light tar from 50 to 60 wt.% in coal pyrolysis tar. MoS2 catalyst increased the liquid yield from 18 to 33 (wt.%, db) and decreased gas yield from 27 to 12 (wt.%, db) compared to coal without catalyst. Moreover, it increased H content and hydrogen-to-carbon ratio by 7.9 and 3.3%, respectively, and reduced the contents of nitrogen, sulphur, and oxygen elements by 8.1%, 15.2%, and 23.9%, respectively, in their produced tars compared to coal without catalyst.

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CP family shares challenging 20-year journey against cancer - nwitimes.com


nwitimes.com

CP family shares challenging 20-year journey against cancer
nwitimes.com
... 23 years old and attending college, pursuing broadcasting along with other studies, Andrew has maintained an incredible outlook after being diagnosed with leukemia at age 3, and then facing three more bouts with cancers (including testicular and ...



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Thyroid Awareness Month promotes for those to check your neck - WMDT


WMDT

Thyroid Awareness Month promotes for those to check your neck
WMDT
47 ABC - January is Thyroid Awareness Month and the goal is to raise public awareness for those who may have thyroid conditions. About 59 million Americans are linked to thyroid diseases and even cancers. 47 ABC spoke to a PRMC endocrinologist who ...



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IoT in Action: Design and Implementation of a Building Evacuation Service

With the development of sensor technologies, various application areas have emerged. The usage of these technologies and exploitation of recent improvements have clear benefits on building applications. Such use-cases can improve smart functions of buildings and can increase the end-user comfort. As a similar notion, building automation systems (BAS) are smart systems that target to provide automated management of various control services and to improve resource usage efficiency. However, buildings generally contain hardware and control services from a diverse set of characteristics. The automated and central management of such functions can be challenging. In order to overcome such issues, an Emergency Evacuation Service is proposed for BAS, where requirements of such central management model are analyzed and model content and subservice definitions are prepared. A crucial scenario, which could be a necessity for future BAS, is defined and an approach for evacuation of people in the buildings at emergency situations is proposed. For real-life scenarios, the Evacuation Service is implemented by using a low-cost design, which is appropriate for Internet of Things (IoT) based BAS applications. As demonstrated, the proposed service model can provide effective performance in real-life deployments.

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Curcumin Suppresses Intestinal Fibrosis by Inhibition of PPARγ-Mediated Epithelial-Mesenchymal Transition

Intestinal fibrotic stricture is a major complication of Crohn’s disease (CD) and epithelial-to-mesenchymal transition (EMT) is considered as an important contributor to the formation of intestinal fibrosis by increasing extracellular matrix (ECM) proteins. Curcumin, a compound derived from rhizomes of Curcuma, has been demonstrated with a potent antifibrotic effect. However, its effect on intestinal fibrosis and the potential mechanism is not completely understood. Here we found that curcumin pretreatment significantly represses TGF-β1-induced Smad pathway and decreases its downstream α-smooth muscle actin (α-SMA) gene expression in intestinal epithelial cells (IEC-6); in contrast, curcumin increases expression of E-cadherin and peroxisome proliferator-activated receptor γ (PPARγ) in IEC-6. Moreover, curcumin promotes nuclear translocation of PPARγ and the inhibitory effect of curcumin on EMT could be reversed by PPARγ antagonist GW9662. Consistently, in the rat model of intestinal fibrosis induced by 2,4,5-trinitrobenzene sulphonic acid (TNBS), oral curcumin attenuates intestinal fibrosis by increasing the expression of PPARγ and E-cadherin and decreasing the expression of α-SMA, FN, and CTGF in colon tissue. Collectively, these results indicated that curcumin is able to prevent EMT progress in intestinal fibrosis by PPARγ-mediated repression of TGF-β1/Smad pathway.

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Experimental and Analytical Study on the Penetration of Corundum-Rubble Concrete Subjected to Projectile Impact

A new type of composite concrete which can be called corundum-rubble concrete (CRC) was presented to improve the resistance of protective structure to the projectile impact. Comparative experiments were conducted between CRC and reinforced concrete, and a modified Taylor model was proposed to predict the penetration depth of CRC targets. Experimental results show that CRC is much higher than reinforced concrete in both strength and hardness and shows excellent resistance to the 0.125 m-diameter projectile impact. Theoretical analyses demonstrated that the modified Taylor model’s predicted results were in good agreement with the measured values.

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Synthesis and Characterization of La-Doped Luminescent Multilayer Films

In this work, we have successfully designed ordered luminescent multilayer films based on La-doped nonmagnetic or magnetic inorganic nanostructure with electronic microenvironment (EM). The inorganic nanosheets with opposite charge can assemble EM between the interlayers. At the same time, their elements on nanosheets of layer double hydroxides (LDHs) are facile to be replaced so that we can introduce transition metal or lanthanide elements. Besides, ferromagnetic effect (FE) can be formed in this microenvironment due to introducing transition metal on LDHs nanosheets. As a result, we confirm that EM, FE, and doping La element in the LDHs can affect the vibration of backbone of chromophores and then prolong the luminescent lifetime, which suggests a new pathway for developing the novel light-emitting thin films.

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Seizure following the Use of the COX-2 Inhibitor Etoricoxib

We describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presentation and selecting appropriate treatment. This is, to the best of our knowledge, the first reported case of generalized seizures associated with the use of COX-2 inhibitors.

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Immunohistochemical Investigation of HER/AKT/mTOR Pathway and Cellular Adhesion Molecules in Urothelial Carcinomas

Background. Several investigators have suggested the possibility that the expression of both EGFR and HER2 could be utilized for molecularly targeted therapy in urinary bladder cancer. We tried to evaluate the expression of HER2 and EGFR and activation of the AKT/PTEN/mTOR pathway in urothelial carcinomas and if there is any association between them and cellular adhesion molecules (CAMs). Materials and Methods. Forty-one paraffin-embedded urothelial cancer tissue blocks were collected. Immunostains for HER2, EGFR, MIB1, phospho-AKT, PTEN, phospho-mTOR, e-cadherin, p-cadherin, and b-catenin were performed on tissue microarrays sections. The immunohistochemical results were correlated with clinicopathological parameters. Results. The overexpression of HER2 was found in 19.6% of the cases and it was associated with high grade tumors with a high mitotic index and phosphorylation of AKT and mTOR. Muscle-invasive tumors presented both cytoplasmic and nuclear losses of PTEN expression. There was no association between HER/AKT/mTOR pathway activation and CAM expression. Although cadherins were often coexpressed, only p-cadherin immunoreactivity was associated with tumor grade and high proliferative index. Conclusions. HER2 overexpression is found in a respective proportion of urothelial carcinomas. P-cadherin expression is associated with high grade UCs but it is not affected by HER2 overexpression or by activation of HER/AKT/mTOR pathway.

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Activity and Stability of Trypsin Immobilized onto Chitosan Magnetic Nanoparticles

The aim of this study was to develop a thermally and operationally stable trypsin through covalent immobilization onto chitosan magnetic nanoparticles (Fe3O4 @CTS). The successful preparation of the Fe3O4 @CTS nanoparticles was verified by Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), and transmission electron microscopy (TEM), which indicated that the prepared Fe3O4 @CTS nanoparticles have superparamagnetic properties, with an average size of approximately 17 nm. Then, trypsin was covalently immobilized onto the Fe3O4 @CTS nanoparticles at a high loading capacity (149.25 mg/g). The FTIR data demonstrated that the trypsin had undergone a conformational change compared with free trypsin, and the Michaelis constant () and the maximum hydrolysis reaction rate () showed that the trypsin immobilized on the Fe3O4 @CTS had a lower affinity for BAEE and lower activity compared with free trypsin. However, the immobilized trypsin showed higher activity than free trypsin at pH 6.0 and in alkaline conditions and retained more than 84% of its initial activity at 60°C after 8 h incubation. Its excellent performance across a broader pH range and high thermal stability, as well as its effective hydrolysis of bovine serum albumin (BSA) and its reusability, make it more attractive than free trypsin for application in protein digestion.

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RNA Sequencing Analysis Reveals Interactions between Breast Cancer or Melanoma Cells and the Tissue Microenvironment during Brain Metastasis

Metastasis is the main cause of treatment failure and death in cancer patients. Metastasis of tumor cells to the brain occurs frequently in individuals with breast cancer, non–small cell lung cancer, or melanoma. Despite recent advances in our understanding of the causes and in the treatment of primary tumors, the biological and molecular mechanisms underlying the metastasis of cancer cells to the brain have remained unclear. Metastasizing cancer cells interact with their microenvironment in the brain to establish metastases. We have now developed mouse models of brain metastasis based on intracardiac injection of human breast cancer or melanoma cell lines, and we have performed RNA sequencing analysis to identify genes in mouse brain tissue and the human cancer cells whose expression is associated specifically with metastasis. We found that the expressions of the mouse genes Tph2, Sspo, Ptprq, and Pole as well as those of the human genes CXCR4, PLLP, TNFSF4, VCAM1, SLC8A2, and SLC7A11 were upregulated in brain tissue harboring metastases. Further characterization of such genes that contribute to the establishment of brain metastases may provide a basis for the development of new therapeutic strategies and consequent improvement in the prognosis of cancer patients.

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Single-Operator Peroral Cholangioscopy for Extraction of Cystic Duct Stones in Postcholecystectomy Mirizzi Syndrome

Mirizzi syndrome is an exceptionally rare diagnosis with an annual incidence of less than 1% in developed countries. In this disease process, stone burden in the cystic duct or gallbladder neck leads to common hepatic duct obstruction, either by mechanical compression or secondary inflammation. Mirizzi syndrome is classified into one of four types based on the presence and severity of cholecystobiliary fistulization. Treatment is primarily surgical in nature and largely dictated by the type of Mirizzi syndrome encountered. It is typically diagnosed in the preoperative or operative setting of cholecystectomy; however, there have been rare occurrences of postcholecystectomy diagnosis. Factors thought to predispose to postcholecystectomy disease include low insertion of the cystic duct and long remnant duct length. Few case reports exist describing this phenomenon and its management, which is made exceptionally difficult due to the presence of inflammation and surgical adhesion. We present the case of a young female with postcholecystectomy Mirizzi syndrome who underwent successful endoscopic management using peroral cholangioscopy and electrohydraulic lithotripsy. We also provide a brief overview of both Mirizzi syndrome and peroral cholangioscopy.

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Two-Phase Image Encryption Scheme Based on FFCT and Fractals

This paper blends the ideas from recent researches into a simple, yet efficient image encryption scheme for colored images. It is based on the finite field cosine transform (FFCT) and symmetric-key cryptography. The FFCT is used to scramble the image yielding an image with a uniform histogram. The FFCT has been chosen as it works with integers modulo and hence avoids numerical inaccuracies inherent to other transforms. Fractals are used as a source of randomness to generate a one-time-pad keystream to be employed in enciphering step. The fractal images are scanned in zigzag manner to ensure decorrelation of adjacent pixels values in order to guarantee a strong key. The performance of the proposed algorithm is evaluated using standard statistical analysis techniques. Moreover, sensitivity analysis techniques such as resistance to differential attacks measures, mean square error, and one bit change in system key have been investigated. Furthermore, security of the proposed scheme against classical cryptographic attacks has been analyzed. The obtained results show great potential of the proposed scheme and competitiveness with other schemes in literature. Additionally, the algorithm lends itself to parallel processing adding to its computational efficiency.

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Novel Synthetic Monothiourea Aspirin Derivatives Bearing Alkylated Amines as Potential Antimicrobial Agents

A new series of aspirin bearing alkylated amines moieties 1–12 were synthesised by reacting isothiocyanate with a series of aniline derivatives in overall yield of 16–56%. The proposed structures of all the synthesised compounds were confirmed using elemental analysis, FTIR, and 1H and  13C NMR spectroscopy. All compounds were evaluated for antibacterial activities against E. coli and S. aureus via turbidimetric kinetic and Kirby Bauer disc diffusion method. Compound 5 bearing meta -CH3 substituent showed the highest relative inhibition zone diameter against tested bacteria compared to ortho and para substituent. Furthermore, aspirin derivatives bearing shorter chains exhibited better bacterial inhibition than longer alkyl chains.

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Fuzzy Modeling for Uncertainty Nonlinear Systems with Fuzzy Equations

The uncertain nonlinear systems can be modeled with fuzzy equations by incorporating the fuzzy set theory. In this paper, the fuzzy equations are applied as the models for the uncertain nonlinear systems. The nonlinear modeling process is to find the coefficients of the fuzzy equations. We use the neural networks to approximate the coefficients of the fuzzy equations. The approximation theory for crisp models is extended into the fuzzy equation model. The upper bounds of the modeling errors are estimated. Numerical experiments along with comparisons demonstrate the excellent behavior of the proposed method.

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Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle

Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies.

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Efficient High-Order Iterative Methods for Solving Nonlinear Systems and Their Application on Heat Conduction Problems

For solving nonlinear systems of big size, such as those obtained by applying finite differences for approximating the solution of diffusion problem and heat conduction equations, three-step iterative methods with eighth-order local convergence are presented. The computational efficiency of the new methods is compared with those of some known ones, obtaining good conclusions, due to the particular structure of the iterative expression of the proposed methods. Numerical comparisons are made with the same existing methods, on standard nonlinear systems and a nonlinear one-dimensional heat conduction equation by transforming it in a nonlinear system by using finite differences. From these numerical examples, we confirm the theoretical results and show the performance of the presented schemes.

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Comparative Study of Elastic Network Model and Protein Contact Network for Protein Complexes: The Hemoglobin Case

The overall topology and interfacial interactions play key roles in understanding structural and functional principles of protein complexes. Elastic Network Model (ENM) and Protein Contact Network (PCN) are two widely used methods for high throughput investigation of structures and interactions within protein complexes. In this work, the comparative analysis of ENM and PCN relative to hemoglobin (Hb) was taken as case study. We examine four types of structural and dynamical paradigms, namely, conformational change between different states of Hbs, modular analysis, allosteric mechanisms studies, and interface characterization of an Hb. The comparative study shows that ENM has an advantage in studying dynamical properties and protein-protein interfaces, while PCN is better for describing protein structures quantitatively both from local and from global levels. We suggest that the integration of ENM and PCN would give a potential but powerful tool in structural systems biology.

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Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms

Irritable bowel syndrome (IBS) is a gastrointestinal disorder linked to disturbances in the gut-brain axis. Visceral hypersensitivity and pain are hallmarks of IBS and linked to the physiological and psychological burden and to the nonadaptive coping with stress. Cognitive-behavioral therapy (CBT) for IBS has proven effective in reducing gastrointestinal and psychiatric symptoms in IBS by means of coping with stress. The present pilot study evaluated for the first time whether CBT for IBS affected visceral sensitivity and pain. Individual CBT was performed for 12 weeks in 18 subjects with IBS and evaluated in terms of visceral sensitivity and pain during rectal distensions using the barostat method and self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms. Visceral discomfort, urge, and pain induced by the barostat were not affected by CBT but were stable across the study. However, the level of self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms decreased after the intervention. Central working mechanisms and increased ability to cope with IBS-symptoms are suggested to play a key role in the alleviation of IBS symptoms produced by CBT.

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Physicochemical Properties of Epoxy Resin-Based and Bioceramic-Based Root Canal Sealers

Three bioceramic sealers (EndoSequence BC sealer, EndoSeal MTA, and MTA Fillapex) and three epoxy resin-based sealers (AH-Plus, AD Seal, and Radic-Sealer) were tested to evaluate the physicochemical properties: flow, final setting time, radiopacity, dimensional stability, and pH change. The one-way ANOVA and Tukey’s post hoc test were used to analyze the data (). The MTA Fillapex sealer had a highest flow and the BC Sealer presented a flow significantly lower than the others (). The BC Sealer and MTA Fillapex samples were not set in humid incubator condition even after one month. EndoSeal MTA had the longest setting time among the measurable materials and Radic-Sealer and AD Seal showed shorter setting time than the AH-Plus (). AH-Plus and EndoSeal MTA showed statistically higher values and MTA Fillapex showed statistically lower radiopacity (). BC Sealer showed the highest alkaline pH in all evaluation periods. Set samples of 3 epoxy resin-based sealers and EndoSeal MTA presented a significant increase of pH over experimental time for 4 weeks. In conclusion, the bioceramic sealer and epoxy resin-based sealers showed clinical acceptable physicochemical properties, but BC Sealer and MTA Fillapex were not set completely.

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Establishing Concurrent Validity of the Role Checklist Version 2 with the OCAIRS in Measurement of Participation: A Pilot Study

Persons experiencing problems with adaptation following disease, disability, or overwhelming life circumstances are often referred by their physicians to occupational therapists. Given time constraints, therapists may skip administration of a client-centered participation focused assessment and instead use an impairment or limitation focused assessment. This approach assumes that skill remediation will naturally lead to return of participation in valued occupational roles because most participation measures take 30 minutes or longer. In response to the need for an efficient measure of desired role participation, this study establishes concurrent validity of the 10–15-minute Role Checklist Version 2 (RCV2: QP) with the 50 minute Occupational Circumstances Assessment And Rating Scale (OCAIRS) in measuring occupational participation in individuals recovering from surgery following liver transplantation. 20 subjects (mean age of 55 and a mean time-since-transplant of 5.2 months) completed both instruments. The hypothesis was supported (), showing concurrent validity between the OCAIRS and the RCV2: QP. This provides therapists with an efficient, client-centered measure of occupational participation for a client-centered treatment plan. Using the RCV2: QP in place of the OCAIRS provides a more efficient assessment tool for occupational therapists to set treatment goals and monitor client progress over time.

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Test-Retest Reliability of a Measure of Independence in Everyday Activities: The ADL Profile

Background. Very few performance-based measures used in occupational therapy have established test-retest reliability coefficients. Objectives of Study. This study presents the test-retest reliability of the task and operation scores of a performance-based measure of independence in everyday activities called the ADL Profile. Methods. 20 adults with severe traumatic brain injury (mean age 28.4 years; SD 9.9) were tested on two occasions with the 17 tasks (personal care, home, and community) of the ADL Profile. Kappa coefficients were calculated on both task and operation scores (formulating goal, planning, executing, and goal attainment). Findings. Test-retest reliability was moderate to almost perfect on task and operation scores of all 17 tasks. The three tasks with only moderate agreement were more novel and complex (e.g., making a budget) for the participants. Relevance to Clinical Practice. Use of measures that are stable over time is essential for treatment planning and research. Repeat testing is crucial with clients that require long periods of treatment (acute care, rehabilitation, and community integration) and multiple measurements of ADL independence. Limitations. The small sample size is a limit of the study. Recommendations for Further Research. Alternate versions of the three tasks with only moderate agreement would need to be developed and other psychometric properties established.

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Comparison of Maximum Stretch Forces between Femtosecond Laser-Assisted Capsulotomy and Continuous Curvilinear Capsulorhexis

The current study reports comparing the postoperative mechanical properties of the anterior capsule between femtosecond laser capsulotomy (FLC) and continuous curvilinear capsulorhexis (CCC) of variable size and shape in porcine eyes. All CCCs were created using capsule forceps. Irregular or eccentric CCCs were also created to simulate real cataract surgery. For FLC, capsulotomies 5.3 mm in diameter were created using the LenSx® (Alcon) platform. Fresh porcine eyes were used in all experiments. The edges of the capsule openings were pulled at a constant speed using two L-shaped jigs. Stretch force and distance were recorded over time, and the maximum values in this regard were defined as those that were recorded when the capsule broke. There was no difference in maximum stretch force between CCC and FLC. There were no differences in circularity between FLC and same-sized CCC. However, same-sized CCC did show significantly higher maximum stretch forces than FLC. Teardrop-shaped CCC showed lower maximum stretch forces than same-sized CCC and FLC. Heart-shaped CCC showed lower maximum stretch forces than same-sized CCC. Conclusively, while capsule edge strength after CCC varied depending on size or irregularities, FLC had the advantage of stable maximum stretch forces.

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Bone natural autofluorescence and confocal laser scanning microscopy: preliminary results of a novel useful tool to distinguish between forensic and ancient human skeletal remains

The analysis of skeletal remains is a highly specialized field in the medico-legal science. A forensic anthropologist is usually tasked with determining the biological profile of skeletal remains (e.g., ancestry, sex, age and stature) that have been identified as human. Morphometrical features of bones and teeth can help to answer these questions [1–3]. A more difficult parameter to estimate is the time since death (TSD). As quoted from Nagy et al. [4], “dating human skeletal remains is one of the most important and yet unreliable aspects of forensic medicine.

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Distinguishing real from fake ivory products by elemental analyses: A Bayesian hybrid classification method

Illegal killing of African elephants (Loxodonta africana, Loxodonta cyclotis) for ivory has been ongoing for decades [1,2], but currently is escalating in accordance with the higher price of ivory in local black markets [3]. The African elephant is listed in Appendix I of CITES, except populations in Botswana, Namibia, South Africa and Zimbabwe, which are Appendix II because of larger population numbers. Most of Africa’s illegal ivory is exported as whole tusks to Asia, with China being the largest importer [4].

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Tackling the salinity-pollution nexus in coastal aquifers from arid regions using nitrate and boron isotopes

Abstract

Salinization and nitrate pollution are generally ascertained as the main issues affecting coastal aquifers worldwide. In arid zones, where agricultural activities also result in soil salinization, both phenomena tend to co-exist and synergically contribute to alter groundwater quality, with severe negative impacts on human populations and natural ecosystems’ wellbeing. It becomes therefore necessary to understand if and to what extent integrated hydrogeochemical tools can help in distinguishing among possible different salinization and nitrate contamination origins, in order to provide adequate science-based support to local development and environmental protection. The alluvial plain of Bou-Areg (North Morocco) extends over about 190 km2 and is separated from the Mediterranean Sea by the coastal Lagoon of Nador. Its surface is covered for more than 60% by agricultural activities, although the region has been recently concerned by urban population increase and tourism expansion. All these activities mainly rely on groundwater exploitation and at the same time are the main causes of both aquifer and lagoon water quality degradation. For this reason, it was chosen as a case study representative of the typical situation of coastal aquifers in arid zones worldwide, where a clear identification of salinization and pollution sources is fundamental for the implementation of locally oriented remedies and long-term management strategies. Results of a hydrogeochemical investigation performed between 2009 and 2011 show that the Bou-Areg aquifer presents high salinity (often exceeding 100 mg/L in TDS) due to both natural and anthropogenic processes. The area is also impacted by nitrate contamination, with concentrations generally exceeding the WHO statutory limits for drinking water (50 mg/L) and reaching up to about 300 mg/L, in both the rural and urban/peri-urban areas. The isotopic composition of dissolved nitrates (δ15NNO3 and δ18ONO) was used to constrain pollution drivers. The results indicate two main origins for human-induced pollution: (i) manure and septic effluents, especially in urban areas, and (ii) synthetic fertilizers in agricultural areas. In the latter, δ15N-enriched values highlight a mixture of those sources, possibly related to unbalanced fertilization and agricultural return flow. Boron isotopes (δ11B) were hence studied to further distinguish the nitrate origin in the presence of multiple sources and mixing processes. The results indicate that in the study area, the high geochemical background for B and Cl, associated to the complex water-rock interaction processes, limit the application of the coupled δ11B and δ15N isotopic systematics to the detection of sources of groundwater pollution. In fact, despite the exceedingly high nitrate contents, the depleted δ11B values that characterize synthetic fertilizers and sewage leakages could not be detected. Therefore, even if in saline groundwater the anthropogenic contribution has a negligible effect in terms of salinity input, with both sewage and irrigation water not very charged, the associated nitrate content fuels up water-rock interaction processes, eventually leading to a mineralization increase.



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Influence of environmental and anthropogenic factors at the bottom sediments in a Doce River tributary in Brazil

Abstract

In developing countries, it is uncommon to find watersheds that have been the object of detailed environmental studies. It makes the assessment of the magnitude of environmental impacts and pollution of these sites difficult. This research demonstrated ways to understand the dynamics of river bottom sediments contamination, even for watersheds with a lack of environmental data. Based on geochemical affinity, we conducted a comprehensive study on the concentration of metals and metalloids. Then, we discussed the probable origin of the concentration of these elements at the bottom sediment along the Matipó River. The Matipó River is an important tributary of the Doce River, which stood out in international headlines because of the mining tailing dam disaster in Mariana, Minas Gerais, in 2015. The bottom sediment samples were taken in 25 stations located along the basin in different seasonal periods. The results showed that copper ( \( \overline{x} \) = 464.7 mg kg−1) and zinc ( \( \overline{x} \) = 287.7 mg kg−1) probably have natural origin, despite of the high concentrations. Lead ( \( \overline{x} \) = 28.0 mg kg−1), chromium ( \( \overline{x} \) = 153.2 mg kg−1), and nickel ( \( \overline{x} \) = 41.8 mg kg−1) also had high concentrations at some collecting stations, and this probably reflected the local natural conditions. The bedrock of the studying basin is dominantly composed of metabasalts and metatonalites interlayered with calcitic and dolomitic metalimestone. On the other hand, the concentration was worrisome in stations near human activities, possibly due to impacts caused by unsustainably agriculture and livestock.



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Niki Bezzant: A turmeric latte won't prevent cancer - Northern Star


Northern Star

Niki Bezzant: A turmeric latte won't prevent cancer
Northern Star
That doesn't mean these things are not good, healthy foods. Blueberries and quinoa are well worth including in our super diet. And, if you like the spicy taste of a tongue-staining turmeric latte, there's no reason not to enjoy it. If you have it with ...

and more »


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Bone natural autofluorescence and confocal laser scanning microscopy: preliminary results of a novel useful tool to distinguish between forensic and ancient human skeletal remains

The analysis of skeletal remains is a highly specialized field in the medico-legal science. A forensic anthropologist is usually tasked with determining the biological profile of skeletal remains (e.g., ancestry, sex, age and stature) that have been identified as human. Morphometrical features of bones and teeth can help to answer these questions [1–3]. A more difficult parameter to estimate is the time since death (TSD). As quoted from Nagy et al. [4], “dating human skeletal remains is one of the most important and yet unreliable aspects of forensic medicine.

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Distinguishing real from fake ivory products by elemental analyses: A Bayesian hybrid classification method

Illegal killing of African elephants (Loxodonta africana, Loxodonta cyclotis) for ivory has been ongoing for decades [1,2], but currently is escalating in accordance with the higher price of ivory in local black markets [3]. The African elephant is listed in Appendix I of CITES, except populations in Botswana, Namibia, South Africa and Zimbabwe, which are Appendix II because of larger population numbers. Most of Africa’s illegal ivory is exported as whole tusks to Asia, with China being the largest importer [4].

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Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant

Abstract

Background

Postoperative delirium is common after extensive surgery, and is known to be associated with sleeping medications. In this study, we aimed to investigate the relationships between sleeping medications and postoperative delirium after pharyngolaryngectomy with esophagectomy.

Methods

We performed a retrospective analysis of 65 patients who underwent pharyngolaryngectomy with esophagectomy at Shizuoka Cancer Center Hospital between January 2012 and March 2016. All data were assessed by two psychiatrists, and univariate and multivariate analyses were performed.

Results

Postoperative delirium developed in 9 (13.8%) patients, with most cases (77.8%) occurring between postoperative day (POD) 1 and POD 3. Of the 24 patients taking a minor tranquilizer after surgery, 8 (33.3%) became delirious, but, of the remaining 41 patients taking ramelteon with or without suvorexant, only one (2.4%) became delirious after surgery. Moreover, of the 16 patients taking both ramelteon and suvorexant, no postoperative delirium was observed. Ramelteon with or without suvorexant was significantly associated with a decreased rate of postoperative delirium compared with minor tranquilizer use (p = 0.001). Multivariate analysis confirmed that the use of ramelteon with or without suvorexant was the only significant preventive factor of postoperative delirium (odds ratio 0.060, p = 0.013).

Conclusion

The use of ramelteon with or without suvorexant was the only significant preventive factor of postoperative delirium after pharyngolaryngectomy with esophagectomy. However, using minor tranquilizers was associated with postoperative delirium. We recommend ramelteon with or without suvorexant for preventing postoperative delirium after pharyngolaryngectomy with esophagectomy.



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It is important to measure changes in the bone-conduction threshold when evaluating whether FGF-2 can be used to repair blast-induced total or near-total tympanic membrane perforations

We would like to comment on the manuscript entitled “Utility of basic fibroblast growth factor in the repair of blast-induced total or near-total tympanic membrane perforations: A pilot study” by Lou et al. [1]. The authors investigated whether basic fibroblast growth factor (bFGF) could be used to repair blast-induced total or near-total tympanic membrane perforations (TMPs) [1]. The authors concluded that direct application of bFGF was a promising minimally invasive alternative to conventional tympanoplasty, affording a comparable success rate.

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Cochlear duct length–one size fits all?

Recent studies demonstrated the utility of high-resolution computed tomography (HRCT) scans in measuring basal cochlear length and cochlear insertion depths. These studies showed significant variations in the anatomy of the cochlea amongst humans. The aim of our study was to investigate for gender and racial variations in the basal turn length of the human cochlea in an Asian population.

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Hemispheric lateralization of resting-state functional connectivity of the ventral striatum: an exploratory study

Abstract

Resting-state functional connectivity (rsFC) is widely used to examine cerebral functional organization. The ventral striatum (VS) is critical to motivated behavior, with extant studies suggesting functional hemispheric asymmetry. The current work investigated differences in rsFC between the left (L) and right (R) VS and explored gender differences in the extent of functional lateralization. In 106 adults, we computed a laterality index (fcLI) to query whether a target region shows greater or less connectivity to the L vs R VS. A total of 45 target regions with hemispheric masks were examined from the Automated Anatomic Labeling atlas. One-sample t test was performed to explore significant laterality in the whole sample and in men and women separately. Two-sample t test was performed to examine gender differences in fcLI. At a corrected threshold (p < 0.05/45 = 0.0011), the dorsomedial prefrontal cortex (dmPFC) and posterior cingulate cortex (pCC) showed L lateralization and the intraparietal sulcus (IPS) and supramarginal gyrus (SMG) showed R lateralization in VS connectivity. Except for the pCC, these findings were replicated in a different data set (n = 97) from the Human Connectome Project. Furthermore, the fcLI of VS—pCC was negatively correlated with a novelty seeking trait in women but not in men. Together, the findings may suggest a more important role of the L VS in linking saliency response to self control and other internally directed processes. Right lateralization of VS connectivity to the SMG and IPS may support attention and action directed to external behavioral contingencies.



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Surrogate Endpoints Useful in Study of Treatments for Prostate Cancer

In prostate cancer patients, a PSA nadir value of> 0.5 ng/mL after radiation therapy and androgen deprivation therapy can identify patients at a high risk of death. (Source: CancerNetwork)

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AspiriN To Inhibit SEPSIS (ANTISEPSIS) randomised controlled trial protocol

Introduction

Sepsis is a leading global cause of morbidity and mortality, and is more common at the extremes of age. Moreover, the cost of in-hospital care for elderly patients with sepsis is significant. There are indications from experimental and observational studies that aspirin may reduce inflammation associated with infection. This paper describes the rationale and design of the AspiriN To Inhibit SEPSIS (ANTISEPSIS) trial, a substudy of ASPirin in Reducing Events in the Elderly (ASPREE). ANTISEPSIS primarily aims to determine whether low-dose aspirin reduces sepsis-related deaths in older people. Additionally, it will assess whether low-dose aspirin reduces sepsis-related hospitalisations and sepsis-related Intensive Care Unit (ICU) admissions.

Methods and analysis

ASPREE is a double-blinded, randomised, placebo-controlled primary prevention trial that will determine whether daily low-dose aspirin extends disability-free longevity in 19 000 healthy older people recruited in Australia and the USA. The ANTISEPSIS substudy involves additional ASPREE trial data collection to assess the impact of daily low-dose aspirin on sepsis-related events in the 16 703 ASPREE participants aged 70 years and over, recruited in Australia. The intervention is a daily 100 mg dose of enteric-coated aspirin versus matching placebo, with 1:1 randomisation. The primary outcome for the ANTISEPSIS substudy is the incidence of sepsis-related death in eligible patients. The incidence of sepsis-related hospital and ICU admissions are secondary outcomes. ANTISEPSIS is to be conducted between 2012 and 2018.

Discussion

This substudy will determine whether aspirin, an inexpensive and accessible therapy, safely reduces sepsis-related deaths and hospitalisations in older Australians. If shown to be the case, this would have profound effects on the health of older Australians.

Trial registration number

Pre-results, ACTRN12613000349741.



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Validation of a clinical screening instrument for tumour predisposition syndromes in patients with childhood cancer (TuPS): protocol for a prospective, observational, multicentre study

Introduction

Recognising a tumour predisposition syndrome (TPS) in patients with childhood cancer is of significant clinical relevance, as it affects treatment, prognosis and facilitates genetic counselling. Previous studies revealed that only half of the known TPSs are recognised during standard paediatric cancer care. In current medical practice it is impossible to refer every patient with childhood cancer to a clinical geneticist, due to limited capacity for routine genetic consultation. Therefore, we have developed a screening instrument to identify patients with childhood cancer with a high probability of having a TPS. The aim of this study is to validate the clinical screening instrument for TPS in patients with childhood cancer.

Methods and analysis

This study is a prospective nationwide cohort study including all newly diagnosed patients with childhood cancer in the Netherlands. The screening instrument consists of a checklist, two- and three-dimensional photographic series of the patient. 2 independent clinical geneticists will assess the content of the screening instrument. If a TPS is suspected based on the instrument data and thus further evaluation is indicated, the patient will be invited for full genetic consultation. A negative control group consists of 20% of the patients in whom a TPS is not suspected based on the instrument; they will be randomly invited for full genetic consultation. Primary outcome measurement will be sensitivity of the instrument.

Ethics and dissemination

The Medical Ethical Committee of the Academic Medical Centre stated that the Medical Research Involving Human Subjects Act does not apply to this study and that official approval of this study by the Committee was not required. The results will be offered for publication in peer-reviewed journals and presented at International Conferences on Oncology and Clinical Genetics. The clinical data gathered in this study will be available for all participating centres.

Trial registration number

NTR5605.



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Socioeconomic disparities in birth weight and body mass index during infancy through age 7 years: a study within the Danish National Birth Cohort

Background

Socioeconomic inequalities in birth weight and in body mass index (BMI) later in childhood are in opposite directions, which raises questions about when during childhood the change in direction happens. We examined how maternal and paternal education and household income were associated with birthweight z-scores and with BMI z-scores at age 5 and 12 months and 7 years, and we examined the socioeconomic differences in the tracking of these z-scores across infancy and childhood.

Methods

The associations were studied in a cohort of children in the Danish National Birth Cohort, single born between 1997 and 2003, for whom information on body size from at least 1 of 4 time points (n=85 062) was recorded. We examined the associations using linear mixed-effects modelling.

Results

Children from families with a low maternal and paternal educational level changed their body size z-scores upwards between birth and age 7 years. At age 5 and 12 months, there were no educational gradient. A low maternal educational level was associated with lower birth weight for gestational age z-scores at birth for boys (–0.199; 95% CI –0.230 to –0.169) and girls (–0.198; 95% CI –0.229 to –0.167) and higher BMI z-scores at age 7 for boys (0.198; 95% CI 0.154 to 0.242) and girls (0.218; 95% CI 0.173 to 0.264). There was not a similarly clear pattern in the tracking between different household income groups. However, a low household income level was associated with higher z-scores of both birth weight and BMI at age 7 years, but with a much weaker gradient at 5 and 12 months.

Conclusions

The educational gradient shifts from positive with birth weight, to none during infancy to inverse with BMI at age 7 years. In contrast, the income gradient was positive at birth and at 7 years and much weaker during infancy.



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Injuries caused by pets in Asian urban households: a cross-sectional telephone survey

Objectives

Little is known about pet-related injuries in Asian populations. This study primarily aimed to investigate the incidence rate of pet-related household injuries in Hong Kong, an urban Chinese setting.

Setting

Cantonese-speaking non-institutionalised population of all ages in Hong Kong accessible by telephone land-line.

Participants

A total of 43 542 telephone numbers were dialled and 6570 residents successfully completed the interviews.

Primary and secondary outcome measures

Data of pet-related household injuries in the previous 12 months, pet ownership and socio-demographic characteristics were collected with a questionnaire. Direct standardisation of the incidence rates of pet-related household injuries by gender and age to the 2009 Hong Kong Population Census was estimated. Univariate and multivariate analyses were performed to estimate risks of socio-demographic factors and pet ownership for the injury.

Results

A total of 84 participants experienced pet-related household injuries in the past 12 months, with an overall person-based incidence rate of 1.28%. The majority of the victims were injured once (69.6%). Cats (51.6%) were the most common pets involved. Pet owners were at an extremely higher risk after controlling for other factors (adjusted OR: 52.0, 95% CI 22.1 to 98.7). Females, the unmarried, those with higher monthly household income and those living in lower-density housing were more likely to be injured by pets.

Conclusions

We project a pet-related household injury incidence rate of 1.24% in the general Hong Kong population, with 86 334 residents sustaining pet-related injuries every year. Pet ownership puts people at extremely high risk, especially the unmarried. Further studies should focus on educating pet owners to reduce pet-related injuries in urban Greater China.



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Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis

Objectives

The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs.

Setting

This research was carried out in a non-clinical research setting using secondary data.

Participants

There were no human participants in the study. Four drugs were selected for the study: bortezomib, dasatinib, everolimus and gefitinib. These medications were selected according to their clinical importance, novel pharmaceutical actions and the availability of generic price data.

Primary and secondary outcome measures

Target costs for treatment were to be generated for each indication for each treatment. The primary outcome measure was the target cost according to a production cost calculation algorithm. The secondary outcome measure was the target cost as the lowest available generic price; this was necessary where export data were not available to generate an estimate from our cost calculation algorithm. Other outcomes included patent expiry dates and total eligible treatment populations.

Results

Target prices were £411 per cycle for bortezomib, £9 per month for dasatinib, £852 per month for everolimus and £10 per month for gefitinib. Compared with current list prices in England, these target prices would represent reductions of 74–99.6%. Patent expiry dates were bortezomib 2014–22, dasatinib 2020–26, everolimus 2019–25 and gefitinib 2017. The total global eligible treatment population in 1 year is 769 736.

Conclusions

Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research.



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Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective

To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development.

Design

Multicentre prospective cohort study.

Setting

UK hospital and community settings.

Participants inclusion

Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU).

Exclusion

Patients too unwell, unable to report pain, 2 or more category ≥2 PUs.

Follow-up

Twice weekly for 30 days.

Primary and secondary outcome measures

Development and time to development of one or more category ≥2 PUs.

Results

Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001).

Conclusions

This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development.



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Screening for seemingly healthy newborns with congenital cytomegalovirus infection by quantitative real-time polymerase chain reaction using newborn urine: an observational study

Objective

Approximately 8–10% of newborns with asymptomatic congenital cytomegalovirus (cCMV) infection develop sensorineural hearing loss (SNHL). However, the relationship between CMV load, SNHL and central nervous system (CNS) damage in cCMV infection remains unclear. This study aimed to examine the relationship between urinary CMV load, SNHL and CNS damage in newborns with cCMV infection.

Study design

The study included 23 368 newborns from two maternity hospitals in Saitama Prefecture, Japan. Urine screening for cCMV infection (quantitative real-time PCR) and newborn hearing screening (automated auditory brainstem response (AABR) testing) were conducted within 5 days of birth to examine the incidence of cCMV infection and SNHL, respectively. CNS damage was assessed by MRI of cCMV-infected newborns.

Results

The incidence of cCMV infection was 60/23 368 (0.257%; 95% CI 0.192% to 0.322%). The geometric mean urinary CMV DNA copy number in newborns with cCMV was 1.79x106 copies/mL (95% CI 7.97x105 to 4.02x106). AABR testing revealed abnormalities in 171 of the 22 229 (0.769%) newborns whose parents approved hearing screening. Of these 171 newborns, 22 had SNHL (12.9%), and 5 of these 22 were infected with cCMV (22.7%). Newborns with both cCMV and SNHL had a higher urinary CMV DNA copy number than newborns with cCMV without SNHL (p=0.036). MRI revealed CNS damage, including white matter abnormalities, in 83.0% of newborns with cCMV. Moreover, newborns with CNS damage had a significantly greater urinary CMV load than newborns without CNS damage (p=0.013).

Conclusions

We determined the incidence of cCMV infection and urinary CMV DNA copy number in seemingly healthy newborns from two hospitals in Saitama Prefecture. SNHL and CNS damage were associated with urinary CMV DNA copy number. Quantification of urinary CMV load may effectively predict the incidence of late-onset SNHL and neurodevelopmental disorders.



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Associations of apolipoprotein B/apolipoprotein A-I ratio with pre-diabetes and diabetes risks: a cross-sectional study in Chinese adults

Background

Apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) ratio is a useful predictor of cardiovascular risk. However, the association between the ApoB/ApoA-I ratio and the risk of type 2 diabetes mellitus (T2DM) is still obscure.

Aims

To investigate the associations between the ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes in a Chinese population, and to assess the role of gender in these associations.

Methods

A stratified random sampling design was used in this cross-sectional study which included 264 men and 465 women with normal glucose tolerance (NGT), pre-diabetes or T2DM. Serum ApoB, ApoA-I and other lipid and glycaemic traits were measured. Pearson's partial correlation and multivariable logistic analysis were used to evaluate the associations between ApoB/ApoA-I ratio and the risk of T2DM and pre-diabetes.

Results

The ApoB/ApoA-I ratios were significantly increased across the spectrum of NGT, pre-diabetes and T2DM. Women showed higher levels of ApoB/ApoA-I ratio and ApoB than men in the pre-diabetic and T2DM groups, but not in the NGT group. The ApoB/ApoA-I ratio was closely related with triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other glycaemic traits. Moreover, in women, the risk of diabetes and pre-diabetes in the top and middle tertiles of the ApoB/ApoA-I ratio were 3.65-fold (95% CI 1.69 to 6.10) and 2.19-fold (95% CI 1.38 to 2.84) higher than in the bottom tertile, respectively, after adjusting for potential confounding factors. However, the associations disappeared in men after adjusting for other factors.

Conclusions

The ApoB/ApoA-I ratio showed positive associations with the risk of diabetes and pre-diabetes in Chinese women.



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Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

Introduction

Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages.

Methods and analysis

A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners.

Ethics and dissemination

The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations.

Trial registration number

Pre-results, NTR5712.



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Incidence, risk factors and risk prediction of hospital-acquired suspected adverse drug reactions: a prospective cohort of Ugandan inpatients

Objectives

To determine the incidence and risk factors of hospital-acquired suspected adverse drug reactions (ADRs) among Ugandan inpatients. We also constructed risk scores to predict and qualitatively assess for peculiarities between low-risk and high-risk ADR patients.

Methods

Prospective cohort of consented adults admitted on medical and gynaecological wards of the 1790-bed Mulago National Referral Hospital. Hospital-acquired suspected ADRs were dichotomised as possible (possible/probable/definite) or not and probable (probable/definite) or not, using the Naranjo scale. Risk scores were generated from coefficients of ADR risk-factor logistic regression models.

Results

The incidence of possible hospital-acquired suspected ADRs was 25% (194/762, 95% CI: 22% to 29%): 44% (85/194) experienced serious possible ADRs. The risk of probable ADRs was 11% (87/762, 95% CI 9% to 14%): 46% (40/87) had serious probable ADRs. Antibacterials-only (51/194), uterotonics-only (21/194), cardiovascular drugs-only (16/194), antimalarials-only (12/194) and analgesics-only (10/194) were the most frequently implicated. Treatment with six or more conventional medicines during hospitalisation (OR=2.31, 95% CI 1.29 to 4.15) and self-reported herbal medicine use during the 4 weeks preadmission (OR=1.96, 95% CI 1.22 to 3.13) were the risk factors for probable hospital-acquired ADRs. Risk factors for possible hospital-acquired ADRs were: treatment with six or more conventional medicines (OR=2.72, 95% CI 1.79 to 4.13), herbal medicine use during the 4 weeks preadmission (OR=1.68, 95% CI 1.16 to 2.43), prior 3 months hospitalisation (OR=1.57, 95% CI 1.09 to 2.26) and being on gynaecological ward (OR=2.16, 95% CI 1.36 to 3.44). More drug classes were implicated among high-risk ADR-patients, with cardiovascular drugs being the most frequently linked to possible ADRs.

Conclusions

The risk of hospital-acquired suspected ADRs was higher with preadmission herbal medicine use and treatment with six or more conventional medicines during hospitalisation. Our risk scores should be validated in large-scale studies and tested in routine clinical care.



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Spectra Optia ® for Automated Red Blood Cell Exchange in Patients with Sickle Cell Disease: A NICE Medical Technology Guidance

Abstract

The Spectra Optia® automated apheresis system, indicated for red blood cell exchange in people with sickle cell disease, underwent evaluation by the National Institute for Health and Care Excellence, which uses its Medical Technologies Advisory Committee to make recommendations. The company (Terumo Medical Corporation) produced a submission making a case for adoption of its technology, which was critiqued by the Newcastle and York external assessment centre. Thirty retrospective observational studies were identified in their clinical submission. The external assessment centre considered these were of low methodological and reporting quality. Most were single-armed studies, with only six studies providing comparative data. The available data showed that, compared with manual red blood cell exchange, Spectra Optia reduces the frequency of exchange procedures as well as their duration, but increases the requirement for donor blood. However, other clinical and patient benefits were equivocal because of an absence of robust clinical evidence. The company provided a de novo model to support the economic proposition of the technology, and reported that in most scenarios Spectra Optia was cost saving, primarily through reduced requirement of chelation therapy to manage iron overload. The external assessment centre considered that although the cost-saving potential of Spectra Optia was plausible, the model and its clinical inputs were not sufficiently robust to demonstrate this. However, taking the evidence together with expert and patient advice, the Medical Technologies Advisory Committee considered Spectra Optia was likely to save costs, provide important patient benefits, and reduce inequality, and gave the technology a positive recommendation in Medical Technology Guidance 28.



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Physicists Cool Microscopic Drum to Near Absolute Zero

According to a paper recently published in Nature, researchers at the National Institute of Standards and Technology (NIST) have cooled a vibrating drum to an unprecedented one-fifth of a quantum of energy, approaching the previously perceived limit of absolute zero (1). Scientists use temperature to measure the thermal motion of […]

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NJ's Ciattarelli to 'Scale Back' Gubernatorial Campaign During Cancer Treatment - Observer


Observer

NJ's Ciattarelli to 'Scale Back' Gubernatorial Campaign During Cancer Treatment
Observer
TRENTON — One of the leading contenders on the Republican side of New Jersey's 2017 gubernatorial election will be “scaling back” his campaign as he undergoes radiation treatment for cancer affecting his throat and tonsils. Speaking from the State ...
GOP candidate for N.J. governor discloses cancerPhilly.com
Ciattarelli: Cancer won't stop his gubernatorial runMyCentralJersey.com
Ciattarelli says he has cancer, will continue campaign for N.J. governorNJ.com
Packet Online -Patch.com -New Jersey 101.5 FM Radio
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Contribution of inducible and neuronal nitric oxide synthases to mitochondrial damage and melatonin rescue in LPS-treated mice

Abstract

NOS isoform activation is related to liver failure during sepsis, but the mechanisms driving mitochondrial impairment remain unclear. We induced sepsis by LPS administration to inducible nitric oxide synthase (iNOS−/−) and neuronal nitric oxide synthase (nNOS−/−) mice and their respective wild-type controls to examine the contribution of iNOS to mitochondrial failure in the absence of nNOS. To achieve this goal, the determination of messenger RNA (mRNA) expression and protein content of iNOS in cytosol and mitochondria, the mitochondrial respiratory complex content, and the levels of nitrosative and oxidative stress (by measuring 3-nitrotyrosine residues and carbonyl groups, respectively) were examined in the liver of control and septic mice. We detected strongly elevated iNOS mRNA expression and protein levels in liver cytosol and mitochondria of septic mice, which were related to enhanced oxidative and nitrosative stress, and with fewer changes in respiratory complexes. The absence of the iNOS, but not nNOS, gene absolutely prevented mitochondrial impairment during sepsis. Moreover, the nNOS gene did not modify the expression and the effects of iNOS here shown. Melatonin administration counteracted iNOS activation and mitochondrial damage and enhanced the expression of the respiratory complexes above the control values. These effects were unrelated to the presence or absence of nNOS. iNOS is a main target to prevent liver mitochondrial impairment during sepsis, and melatonin represents an efficient antagonist of these iNOS-dependent effects whereas it may boost mitochondrial respiration to enhance liver survival.



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Early Cardioversion in Atrial Fibrillation: Earlier Is Better, but Not Always and (Maybe) Not Immediately

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia in humans. One of its important features is the tendency to become more persistent over time, even in the absence of underlying progressive heart disease. Conversion and maintenance of sinus rhythm by pharmacological or electrical methods become increasingly difficult the longer the arrhythmia persists. Electrical, mechanical, structural, and autonomic remodeling processes have been implicated in the mechanisms of AF initiation, perpetuation, and progression. Prevention or reversal of these remodeling processes can halt the progression of the disease. Cardioversion is a powerful tool and rhythm control is a widely used strategy in the management of AF. However, important questions remain unanswered regarding not only if, but also when to perform cardioversion. There are observations from past trials and clinical situations that support attempting to restore sinus rhythm, but further prospective randomized clinical trials are needed. Optimal timing of cardioversion remains somewhat uncertain, but it appears to be some time after the first few hours and before the first few months: the earlier, the better, but not always, and maybe not immediately, and it has to be tailored to the clinical situation and its many variables. This review is intended to summarize the evidence supporting early intervention for the prevention of remodeling in patients with AF.



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Editorial Board

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Publication date: February 2017
Source:Free Radical Biology and Medicine, Volume 103





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Niki Bezzant: A tumeric latte won't prevent cancer - Health ... - New Zealand Herald


Niki Bezzant: A tumeric latte won't prevent cancer - Health ...
New Zealand Herald
Have you tried a turmeric latte yet? - New Zealand Herald.

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Aerobic Endurance Training Does Not Protect Bone Against Poorly Controlled Type 1 Diabetes in Young Adult Rats

Abstract

Streptozotocin (STZ)-induced type 1 diabetes mellitus (T1DM) decreases trabecular bone volume and bone strength in rodents. The current study investigated the potential protective effects of aerobic endurance training (AET) on bone in STZ-induced T1DM young adult rats. Sixty-four 8-week-old male Sprague–Dawley rats were randomly divided into 4 groups of 16: control non-T1DM sedentary (CS) and exercised (CX), T1DM sedentary (DS) and exercised (DX). Blood glucose was maintained at 9–15 mmol/L using subcutaneously implanted insulin pellets (Linplant, Linshin Canada, Inc.). AET was performed at ~75–85% VO2max for 1 h/day, 5 day/week for 10 weeks. Areal and volumetric bone mineral density (aBMD and vBMD; excised femur) were measured using dual-energy X-ray absorptiometry (DXA; QDR 4500A) and micro computed tomography (μCT; Aloka). Bone strength was tested using a 3-point bending test (Instron 5544 Load Frame). Two-way ANOVA was used to test for T1DM and exercise differences followed by Tukey’s HSD tests for interaction effects; significance was set at P < 0.05. T1DM had lower body weight (18.0%), aBMD (8.6%), cortical vBMD (1.6%), trabecular vBMD (2.1%), maximum load at break (22.2%), and increased elastic modulus (11.3%) vs. control (P < 0.001). Exercise in T1DM further decreased body weight (4.7%) vs. sedentary (P = 0.043) and maximum extension during the bending test that demonstrated DX was increased (7.3%) vs. CX (P = 0.033). There were no other beneficial effects of exercise on bone. These results suggest that 10 weeks of AET in rats do not have protective effects on bone in the short term and that T1DM rats have compromised bone health.



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HPV vaccine could save your child's life - KCTV Kansas City


KCTV Kansas City

HPV vaccine could save your child's life
KCTV Kansas City
It's being seen by head and neck surgeons much later in life.” HPV typically leads to cancer of the female genitals, throat, tonsils or tongue. Tina Hillhouse contracted HPV through her work in the medical field. She inhaled it, which lead to cancer in ...



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Changes in fMRI activation in anterior hippocampus and motor cortex during memory retrieval after an intense exercise intervention

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Publication date: Available online 21 January 2017
Source:Biological Psychology
Author(s): Gerd Wagner, Marco Herbsleb, Feliberto de la Cruz, Andy Schumann, Stefanie Köhler, Christian Puta, Holger W. Gabriel, Jürgen R. Reichenbach, Karl-Jürgen Bär
Strong evidence indicates that regular aerobic training induces beneficial effects on cognitive functions. The present controlled fMRI study was designed to investigate the impact of a short-term intense aerobic exercise on the pattern of functional activation during the retrieval of learned pair-associates in 17 young and healthy male adults compared to 17 matched control subjects. We further aimed to relate putative changes in hippocampal activation to postulated changes in the exercised-induced brain derived neurotrophic factor (BDNF). The supervised exercise program was performed on a bicycle ergometer and lasted six weeks, with three aerobic sessions per week.We found profound improvement of physical fitness in most subjects indicated by the target parameter ‘individual anaerobic threshold’. Significant improvements in the cognitive performance were detected in the exercise group, but also in the control group. We observed significant differences in the activation pattern of the left anterior hippocampus during the pair-associates task after the intervention. We could also show a significant positive correlation between changes in exercise-induced BDNF and left anterior as well as right hippocampal activation. Moreover, we observed the brain’s motor network to be significantly stronger activated after the exercise intervention. Thus, our results suggest BDNF dependent activation changes of the hippocampus in addition to previously described structural changes after exercise.



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The new issue is now available.Chikyukagaku

Vol.39 No.3

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The new issue is now available.Transactions of the Society of Instrument and Control Engineers

Vol.53 No.1

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Succinate in the cancer–immune cycle

Publication date: 1 April 2017
Source:Cancer Letters, Volume 390
Author(s): Shuai Jiang, Wei Yan
Succinate is an important intermediate of the tricarboxylic acid (TCA) cycle. In mitochondria, it plays a crucial role in generating adenosine triphosphate. Succinate metabolism is also intertwined with the metabolism of other metabolites and with the “GABA shunt” of the glutamine pathway. Recently, it has become increasingly apparent that the roles of succinate extend into the realms of immunity and cancer. Succinate is a key modulator of the hypoxic response, an important player in tumorigenesis; succinate is also involved in protein succinylation, a novel posttranslational modification pathway. This expanding repertoire of succinate functions suggests that it has broad roles in cellular contexts. Mutations in enzymes such as succinate dehydrogenase (SDH) that participate in succinate-related pathways lead to various pathologies, including tumor formation and innate inflammatory processes. Succinate can have both pro- or anti-tumor effectiveness. Therefore, investigation of succinate as an inflammatory signal may increase our understanding of the cancer–immunity cycle involved in both inflammatory diseases and cancer. Here, we briefly review the emerging roles of succinate, extending beyond metabolism, into anti-cancer immunity. This expansion of succinate roles suggests that it may represent a novel class of regulators in inflammation, which act as key signals in human cancers.



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Which Personality Traits Are Most Predictive of Well-Being?

The real link between personality and well-being.

-- Read more on ScientificAmerican.com
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Chronic Wound Healing: A Review of Current Management and Treatments

Abstract

Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.



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Safinamide: A Review in Parkinson’s Disease

Abstract

Safinamide (Xadago®) is an orally active, selective, reversible monoamine oxidase-B inhibitor with both dopaminergic and non-dopaminergic (glutamatergic) properties. In the EU, safinamide is approved for the treatment of mid- to late-stage fluctuating Parkinson’s disease (PD) as add-on therapy to a stable dose of levodopa alone or in combination with other PD medications. Safinamide 50–100 mg/day administered as a fixed or flexible dose significantly increased daily ‘on’ time without dyskinesia (primary endpoint) in patients with mid- to late-stage PD with motor fluctuations in 24-week, placebo-controlled clinical trials. Other outcomes, including motor function, overall clinical status and health-related quality of life, were also generally improved with safinamide. Furthermore, in an 18-month extension of one study, although dyskinesia (primary endpoint) was not significantly improved with safinamide relative to placebo, treatment benefits in other outcomes were generally sustained over 24 months of treatment. Safinamide was generally well tolerated in clinical trials; dyskinesia was the most common adverse event. Although further studies are needed, including comparative and long-term studies, current evidence indicates that safinamide extends the treatment options available for use as add-on therapy to levodopa and other PD medications in patients with mid- to late-stage PD experiencing motor fluctuations.



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Niki Bezzant: A tumeric latte won't prevent cancer - New Zealand Herald


Niki Bezzant: A tumeric latte won't prevent cancer
New Zealand Herald
That doesn't mean these things are not good, healthy foods. Blueberries and quinoa are well worth including in our super diet. And, if you like the spicy taste of a tongue-staining turmeric latte, there's no reason not to enjoy it. If you have it with ...

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6th ESSD Congress Milan 2016 Abstract Book



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Knowledge, attitudes and practices in tamarind (Tamarindus indica L) use and conservation in Eastern Uganda

Tamarindus indica L is one of the indigenous fruit tree species that traditionally contributes to food security and ecosystem stability in sub-Saharan Africa. We hypothesized that the ...

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Traditional use and perception of snakes by the Nahuas from Cuetzalan del Progreso, Puebla, Mexico

Indigenous cultures are the result of their adaptation to the natural surroundings, in such a way that, amongst their main features is a set of knowledge, technologies and strategies for the appropriation of n...

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Medical pluralism and livestock health: ethnomedical and biomedical veterinary knowledge among East African agropastoralists

Human and animal health are deeply intertwined in livestock dependent areas. Livestock health contributes to food security and can influence human health through the transmission of zoonotic diseases. In low-i...

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C yanotoxins: producing organisms, occurrence, toxicity, mechanism of action and human health toxicological risk evaluation

Abstract

Cyanobacteria were present on the earth 3.5 billion years ago; since then they have colonized almost all terrestrial and aquatic ecosystems. They produce a high number of bioactive molecules, among which some are cyanotoxins. Cyanobacterial growth at high densities, forming blooms, is increasing in extension and frequency, following anthropogenic activities and climate changes, giving rise to some concern for human health and animal life exposed to cyanotoxins. Numerous cases of lethal poisonings have been associated with cyanotoxins ingestion in wild animal and livestock. In humans few episodes of lethal or severe human poisonings have been recorded after acute or short-term exposure, but the repeated/chronic exposure to low cyanotoxin levels remains a critical issue. The properties of the most frequently detected cyanotoxins (namely, microcystins, nodularins, cylindrospermopsin and neurotoxins) are here critically reviewed, describing for each toxin the available information on producing organisms, biosynthesis/genetic and occurrence, with a focus on the toxicological profile (including kinetics, acute systemic toxicity, mechanism and mode of action, local effects, repeated toxicity, genotoxicity, carcinogenicity, reproductive toxicity; human health effects and epidemiological studies; animal poisoning) with the derivation of health-based values and considerations on the risks for human health.



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The surgical pathology laboratory in Mwanza, Tanzania: a survey on the reproducibility of diagnoses after the first years of autonomous activity

In 2000, an Italian non-governmental organisation (NGO) began a 9-year project to establish a surgical pathology laboratory at the Bugando Medical Centre (BMC) in Mwanza, Tanzania, a country with a low Human D...

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Accurate simultaneous quantification of liver steatosis and iron overload in diffuse liver diseases with MRI

Abstract

Purpose

To evaluate the diagnostic performances of 3 Tesla multi-echo chemical shift-encoded gradient echo magnetic resonance (MECSE-MR) imaging to simultaneously quantify liver steatosis and iron overload in a wide spectrum of diffuse liver diseases having biopsy as reference standard.

Methods

MECSE-MR-acquired images were used to calculate fat fraction and iron content in a single breath-hold in 109 adult patients. Proton density fat fraction (PDFF) was prospectively estimated using complex-based data reconstruction with multipeak fat modeling. Water R2* was used to estimate iron content. Biopsy was obtained in all cases, grading liver steatosis, siderosis, inflammation, and fibrosis. Differences in PDFF and R2* values across histopathological grades were analyzed, and ROC curves analyses evaluated the MR diagnostic performance.

Results

Calculated fat fraction measurements showed significant differences (p < 0.001) among steatosis grades, being unaffected by the presence of inflammation or fibrosis (p ≥ 0.05). A strong correlation was found between fat fraction and steatosis grade (R S = 0.718, p < 0.001). Iron deposits did not affect fat fraction quantitation (p ≥ 0.05), except in cases with severe iron overload (grade 4). A strong positive correlation was also observed between R2* measurements and iron grades (R S = 0.704, p < 0.001). Calculated R2* values were not different across grades of steatosis, inflammation, and fibrosis (p ≥ 0.05).

Conclusion

A MECSE-MR sequence simultaneously quantifies liver steatosis and siderosis, regardless coexisting liver inflammation or fibrosis, with high accuracy in a wide spectrum of diffuse liver disorders. This sequence can be acquired within a single breath-hold and can be implemented in the routine MR evaluation of the liver.



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Alexithymia in people with subjective cognitive decline, mild cognitive impairment, and mild Alzheimer’s disease

Abstract

Background

Behavioral and psychological symptoms are widely accepted as accelerator factors in progression to dementia. Although alexithymia is closely related to normal aging process and poor neurocognitive performance, alexithymia has not been included in these symptoms yet.

Aims

Here, we aimed to investigate alexithymia features in people with prominent clinical memory complaints.

Methods

The participants (n = 82) were classified into three groups as: subjective cognitive decline (n = 30), mild cognitive impairment (n = 27), and mild Alzheimer’s disease (n = 25) after Mini-Mental State Examination, Clinical Dementia Rating Scale, neuropsychological test battery, Geriatric Depression Scale, and Hachinski Ischemic Scale. All participants were assessed with 20-item Toronto Alexithymia Scale.

Results

The patients with mild Alzheimer’s disease and mild cognitive impairment have significantly greater alexithymia features than individuals with subjective cognitive decline in Toronto Alexithymia Scale (p < 0.05 for all). The alexithymia features in patients with mild Alzheimer’s disease and mild cognitive impairment did not significantly differ (p > 0.05, for all).

Discussion

People who have objective cognitive decline seem to have more alexithymia features than people with subjective cognitive decline. Moreover, alexithymia features seem to be similar in people mild Alzheimer’s disease and in mild cognitive impairment.

Conclusion

Alexithymia might be an important searching domain of behavioral–psychological symptoms in people with cognitive problems beyond aging.



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In vivo magnetic resonance imaging investigating the development of experimental brain metastases due to triple negative breast cancer

Abstract

Triple negative breast cancer (TNBC), when associated with poor outcome, is aggressive in nature with a high incidence of brain metastasis and the shortest median overall patient survival after brain metastasis development compared to all other breast cancer subtypes. As therapies that control primary cancer and extracranial metastatic sites improve, the incidence of brain metastases is increasing and the management of patients with breast cancer brain metastases continues to be a significant clinical challenge. Mouse models have been developed to permit in depth evaluation of breast cancer metastasis to the brain. In this study, we compare the efficiency and metastatic potential of two experimental mouse models of TNBC. Longitudinal MRI analysis and end point histology were used to quantify initial cell arrest as well as the number and volume of metastases that developed in mouse brain over time. We showed significant differences in MRI appearance, tumor progression and model efficiency between the syngeneic 4T1-BR5 model and the xenogeneic 231-BR model. Since TNBC does not respond to many standard breast cancer treatments and TNBC brain metastases lack effective targeted therapies, these preclinical TNBC models represent invaluable tools for the assessment of novel systemic therapeutic approaches. Further pursuits of therapeutics designed to bypass the blood tumor barrier and permit access to the brain parenchyma and metastatic cells within the brain will be paramount in the fight to control and treat lethal metastatic cancer.



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Parents’ and peers’ normative influence on adolescents’ smoking: results from a Swiss-Italian sample of middle schools students

Adolescents observe and imitate people to whom they are associated in their social context, and the normative factors sent out by reference groups are crucial determinants of their decision to smoke. The aim o...

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Second-Line Regorafenib Extends Survival in Sorafenib-Tolerant HCC Patients

This video examines an exploratory analysis of the RESORCE trial, which tested regorafenib vs placebo in hepatocellular carcinoma patients following radiographic progression on sorafenib. (Source: CancerNetwork)

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A clinical decision rule for the use of ultrasound in children presenting with acute inflammatory neck masses

Abstract

Objective

To identify the association between clinical and ultrasound findings and surgical drainage in children with inflammatory neck masses and to create a clinical decision rule that allows for reduction of unnecessary use of ultrasound in inflammatory neck masses.

Materials and methods

We reviewed data on patients ≤18 years who visited our emergency department between 2012 and 2014 with inflammatory neck swelling and who underwent ultrasound examinations of the neck. We used multivariate logistic regression to identify factors associated with drainage within 24 h of ultrasound study (early drainage). Recursive partitioning was used for risk stratification.

Results

Of 341 consecutive patients included in this study, 37 patients underwent early drainage and all had purulent material drained. All patients but one with non-suppurative adenitis and 95% (97/102) of those with suppurative adenitis or early/suspicious abscess on ultrasound were initially treated medically. Of those with a definite diagnosis of abscess/fluid collection, 89% (32/36) underwent early drainage. Patients who underwent drainage were more likely to be younger, female and have a longer duration of neck swelling, with fluctuance and erythema on exam. Recursive partitioning analysis revealed that among children with neck swelling >3 days and ≤3 days, the rate of early drainage was 24.3% and 4.4%, respectively. None of the children >7 months with neck swelling ≤3 days underwent early drainage.

Conclusion

Children older than 1 year with inflammatory neck swelling ≤3 days are at low risk of having ultrasound findings that require drainage. In this subgroup of patients, ultrasound could be avoided unless the patient fails to improve after a trial of antibiotic therapy.



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Diagnostic utility of intravenous contrast for MR imaging in pediatric appendicitis

Abstract

Background

Magnetic resonance imaging (MRI) is increasingly employed as a diagnostic modality for suspected appendicitis in children. However, there is uncertainty as to which MRI sequences are sufficient for safe, timely and accurate diagnosis. Several recent studies have described different MRI protocols, including exams both with and without the use of intravenous contrast.

Objective

We hypothesized that intravenous contrast may be useful in some patients but could be safely omitted in others.

Materials and methods

All MRI examinations (n=112) performed at our institution for evaluating appendicitis in children were retrospectively reevaluated. Exams were reread by pediatric radiologists under three conditions: With postcontrast images, Without postcontrast images, and Without/With – selective use of postcontrast sequences only when needed for diagnostic certainty. Samples were scored as positive, negative or equivocal for appendicitis. Findings were compared to pathological or clinical follow-up in the medical record.

Results

Without the use of intravenous contrast yielded more equivocal results (12.4%) compared to With contrast (3.4%). By selectively using postcontrast sequences, the Without/With group yielded fewer equivocal results (1.1%) compared to Without while also reducing contrast use 79.8% compared to the With contrast group. No significant differences in conditional sensitivity or conditional specificity were detected among the three groups.

Conclusion

MRI diagnosis of acute appendicitis can be performed without contrast for most patients; injection of contrast can be reserved for only those patients with equivocal non-contrast imaging.



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