Δευτέρα, 5 Ιουνίου 2017

Surprising Twist in the Plot – Sister Mary Joseph’s Nodule of Pancreatic Cancer Mimicking Wound Infection after Umbilical Hernia Repair



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Besonders abgerechnet

Im antiken Griechenland erhielt vor mehr als 2600 Jahren der Gesetzgeber Drakon den Auftrag, das athenische Gewohnheitsrecht zu ordnen. In BEMA und GOZ ist zum Glück nicht die Rede von Drakonischen Maßnahmen, sondern lediglich von „besonderen Maßnahmen". Doch trotz scheinbar ähnlicher Formulierung unterscheiden sich hier BEMA und GOZ im „Kleingedruckten" erheblich. Wie werden „besondere Maßnahmen beim Präparieren oder Füllen, bMF" in BEMA und GOZ richtig abgerechnet?



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Notfallendodontie — Behandlung nach der 3-D-Strategie

Endodontische Notfälle umfassen alle Situationen, in denen akute Schmerzen endodontischen Ursprungs zu einer Konsultation eines Zahnarztes führen und in denen eine sofortige zahnärztliche Intervention indiziert und notwendig ist. Tatsächlich hat die überwiegende Zahl der in der täglichen Praxis auftretenden Beschwerden eine endodontische Ursache. Dabei stehen symptomatische irreversible Pulpitiden und symptomatische apikale Parodontitiden im Vordergrund. Die Ursache dafür ist in der überwiegenden Zahl der Fälle Karies.



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Die Arbeitsgemeinschaft für Grundlagenforschung stellt sich vor



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Guadalupe, wir kommen wieder!

Die Stiftung Zahnärzte ohne Grenzen freut sich jederzeit über freiwillige Zahnärztinnen/Zahnärzte, die sich für Einsätze in verschiedenen Ländern auf der ganzen Welt interessieren. Ein Auslandseinsatz ist zugleich abenteuerlich, aber auch äußerst erfüllend. Er ermöglicht einen völlig neuen Blickwinkel auf unsere alltägliche Arbeit und erfordert ein gewisses Maß an Kreativität und Flexibilität, um sich den individuellen Bedingungen vor Ort anpassen zu können. Im Februar/März 2016 durfte ich für 4 Wochen in Guadalupe/Ecuador diese wunderbare Erfahrung machen und kann die Teilnahme an einem solchen Einsatz nur weiterempfehlen.



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FVDZ-Praxispool: Schnelle Suche über das Internet



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Hygiene in der Zahnarztpraxis

Politisch heiß diskutiert wird derzeit die Hygiene in der Zahnarztpraxis. Vielfältige Anforderungen sorgen nicht selten für Verwirrung. Sie stellen für die niedergelassenen Kolleginnen und Kollegen teilweise nahezu unüberwindbare Hürden dar. Hilfe bietet der von BZÄK und DAHZ erstellte Hygieneleitfaden (www.dahz.org). Kürzlich erschienene Studien liefern interessante Ergebnisse zu diesem wichtigen Gebiet.



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Einmal MKG-Chirurgie, bitte!

Nach meinem Medizinstudium und der Approbation fiel die Entscheidung: „Ich möchte Fachärztin für MKG-Chirurgie werden." Nun manage ich meinen Alltag zwischen Berufstätigkeit und Zweitstudium.



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Aligner: Eine unauffällige Therapie zur Zahnstellungskorrektur

Aligner haben sich in den letzten Jahren als fester Bestandteil des kieferorthopädischen Therapierepertoires etabliert. Bei korrekter Indikationsstellung unter Berücksichtigung der Limitationen und Sicherstellung einer guten Patientenmitarbeit können sie gegenüber herkömmlichen Therapieverfahren Vorteile für Patient und Behandler bieten. Insbesondere Patienten im Berufsalltag mit hohen ästhetischen Ansprüchen und dem Wunsch nach einer möglichst unauffälligen Therapie mit geringer funktioneller und phonetischer Beeinträchtigung können von einer Alignertherapie profitieren.



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Frühjahrsmeeting der young dentists: Implantologie in Abrechnung und Praxis

Das gut besuchte Frühjahrsmeeting der young dentists (yd2) in Bonn stand ganz im Zeichen der Implantologie. Zunächst ging es dabei um den im Studium immer noch sträflich vernachlässigten Bereich der privaten Abrechnung, ehe am zweiten Tag praktisches Arbeiten bei einer Einführung in die Implantologie — „Mein erstes Implantat" mit den „Tröltzsch-Brothers" — anstand.



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Schritt für Schritt erklärte



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Inhaltsverzeichnis



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Spaß am Schreiben und zeitliche Flexibilität

Schreibfeder oder Behandlungszimmer? Beim „alternativen" Berufsfeld Journalismus kann die Antwort auch lauten: Schreibfeder und Behandlungszimmer! Wie die ersten Schritte in Richtung Journalismus aussehen können und was der Reiz am Schreiben ist, haben uns zwei Kollegen erzählt, die diesen Weg auf unterschiedliche Weise gegangen sind.



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Liebe Kolleginnen, liebe Kollegen,



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Teleskopprothese — in 6 Sitzungen zur langfristigen Versorgung

Auch wenn sich der Trend für Zahnersatz immer weiter hin zur Implantatprothetik verschiebt, sollten bewährte herausnehmbare Alternativen nicht außer Acht gelassen werden. Als Meisterarbeit bei herausnehmbarem Zahnersatz gilt sowohl in zahntechnischer als auch zahnmedizinischer Hinsicht die Doppelkronenprothese.



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„Mit Hypnose lassen sich Kinder oft problemlos behandeln“



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Kurze Implantate vs. Augmentation

Zusammenfassung

Der Einsatz kurzer Implantate als Alternative zum präimplantologischen Knochenaufbau gewinnt zunehmend an Akzeptanz. Laut derzeitiger Definition handelt es sich hierbei um Implantate mit einer vorgesehenen Länge im Knochen ≤8 mm. Früher wurde unter anderem aufgrund der geringeren Knochen-Implantat-Kontaktfläche und des ungünstigen Kronen-Implantat-Längenverhältnisses bei kurzen Implantaten von geringeren Überlebensraten im Vergleich zu ihren längeren Gegenstücken berichtet. Allerdings scheint die Erfolgsrate moderner kurzer Implantatsysteme mit rauer Oberfläche bei korrekter Indikationsstellung annähernd denen mit Standardlängen zu gleichen. Insbesondere wird von einer Häufung prothetischer Komplikationen bei Kronen-Implantat-Längenverhältnissen >2 berichtet. Im Ergebnis scheinen kurze Implantate in ausgewählten Fällen bei entsprechender Expertise eine gute Alternative zu Augmentation und Insertion längerer Implantate darzustellen, gerade weil dieses Behandlungskonzept schneller und kostengünstiger sowie mit weniger Komplikationen behaftet ist. Allerdings liegen derzeit nur vereinzelte Langzeitstudien mit ausreichenden Fallzahlen und somit nur eine eingeschränkte wissenschaftliche Evidenz vor. Dies lässt eine abschließende Aussage noch nicht zu.



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IDS 2017: Wie war‘s?



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Comparative study of intralesional triamcinolone alone and in combination with 5-flurourouracil for the treatment of keloid and hypertrophic scars

Abstract

Background

Keloids and hypertrophic scars are benign growths of dermal collagen that can cause physical and psychological (cosmetic) problems for patients. Many modalities of treatment have been advocated for the treatment of keloids, without convincing results.

Methods

A randomised controlled trial was conducted in the Department of Surgery at Silchar Medical College and Hospital, Silchar, Assam for the period from January 2015 to June 2016. Keloids or hypertrophic scars (1cm to 5cm in size) having no history of treatment for the scars in preceding 6 months were included. The subjects were divided into two groups: Group A received intralesional triamcinolone acetonide alone and Group B received triamcinolone acetonide + 5 flourouracil. Eight injections were given at weekly interval. Scars were assessed at 4, 8 weeks during and 4 weeks after the completion of treatment on a five-point scale.

Results

50 patients were included in the study and were divided in two equal groups of 25 each. Good to excellent results were seen in 14 (56%) cases in Group A, compared to 20 (80%) in Group B (p value <0.05). Group B lesions showed better improvement than Group A lesions in pruritus, pain, tenderness, restriction of movements and cosmetic problem. Recurrence was seen in 16% and 4% in both groups respectively.

Conclusion

The combination of triamcinolone acetonide and 5 flourouracil is superior to triamcinolone acetonide alone in treatment of keloids and hypertrophied scars.



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Pyogenic liver abscess of a male patient with diabetes mellitus due to Escherichia coli with fever and chills as the only symptoms

Abstract

Pyogenic liver abscesses (PLAs) are the most frequent visceral abscesses with predominance in men. They are extremely rare and their mechanism of formation is extended to infection of an anatomically contiguous organ or hematogenous seeding. Diabetes mellitus is a major predisposing factor and if so, the mortality rate is high. The most common clinical presentation forms are fever with chills, abdominal pain and hepatomegaly. In the present report we present the case of a 65-year-old Greek male patient with history significant for diabetes mellitus, who attended the emergency department complaining of fever and chills for five days. The final diagnosis was pyogenic liver abscess of the right lobe. Blood cultures were positive for Escherichia coli. The patient was treated with broad spectrum antibiotics and percutaneous drainage of the abscess. To our knowledge, this is the first pyogenic liver abscess in a diabetic patient due to E. coli reported in Western Greece.



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Mucinous carcinoma of the anal canal arising from perianal fistula

Abstract

Background

Anal carcinomas account for 1.5% of all gastrointestinal carcinomas. They may occur in the anal canal, perianal region (up to 5 cm) and surrounding skin. Squamous cell carcinoma (SCC) is the most frequent type (80%), while adenocarcinoma of the anal canal (ACC) accounts for 10% of all anal carcinomas. The remaining 5% includes neuroendocrine neoplasms, mesenchymal tumours, lymphomas, melanocyte tumours and secondary tumours. ACCs arise from chronic fistula or anal glands and they are very rare.

Methods

We report one case of rare adenocarcinoma that originated from perianal fistula. There is not definitive strategy about cure.

Conclusion

Inflammatory perianal tumour often causes late diagnosis or misdiagnosis of ACC, which is due to frequent perianal abscesses at the external perianal fistula opening. The presence of mucin may increase the index of suspicion for malignancy.



http://ift.tt/2rYHdLR

Andrographolide Benefits Rheumatoid Arthritis via Inhibiting MAPK Pathways

Abstract

Andrographolide (AD) is the main compound distributed in medicinal herb Andrographis paniculata and exhibits anti-inflammatory activity. AD has been used for the treatment of multiple inflammatory diseases. However, the therapeutic value of AD on human rheumatoid arthritis (RA) remains unclear. In this study, we investigated the effects of AD on collagen-induced arthritis (CIA) and human RA synovial fibroblasts (RA-SFs). CIA mice were treated with AD (dissolved in 0.5% CMC-Na, 100 mg/kg per day) or vehicle (0.5% CMC-Na) daily by oral gavage for 2 weeks. The arthritis severity and joint destruction were assessed. Serum anti-collagen II antibody (anti-CII Abs) and cytokines were determined by ELISA. TNFα-stimulated human RA-SFs were treated with varying doses of AD for in vitro investigation. Results showed that AD significantly attenuated the arthritis severity and joint damage. AD treatment significantly reduced the production of serum anti-CII, TNFα, IL-1β, and IL-6. In vitro, AD decreased the secretion of IL-1β and IL-6 from TNFα-stimulated RA-SFs in a dose-dependent manner. AD treatment reduced the TNFα-induced phosphorylation of p38 MAPK and ERK1/2 in a dose-dependent manner. Thus, our findings suggest that AD confers protective effects on autoimmune arthritis through inhibiting MAPK pathways.



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Glycomic and glycoproteomic analysis of glycoproteins—a tutorial

Abstract

The structural analysis of glycoproteins is a challenging endeavor and is under steadily increasing demand, but only a very limited number of labs have the expertise required to accomplish this task. This tutorial is aimed at researchers from the fields of molecular biology and biochemistry that have discovered that glycoproteins are important in their biological research and are looking for the tools to elucidate their structure. It provides brief descriptions of the major and most common analytical techniques used in glycomics and glycoproteomics analysis, including explanations of the rationales for individual steps and references to published literature containing the experimental details necessary to carry out the analyses. Glycomics includes the comprehensive study of the structure and function of the glycans expressed in a given cell or organism along with identification of all the genes that encode glycoproteins and glycosyltransferases. Glycoproteomics which is subset of both glycomics and proteomics is the identification and characterization of proteins bearing carbohydrates as posttranslational modification. This tutorial is designed to ease entry into the glycomics and glycoproteomics field for those without prior carbohydrate analysis experience.



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Multiclass analytical method for the determination of natural/synthetic steroid hormones, phytoestrogens, and mycoestrogens in milk and yogurt

Abstract

Within this study, a new method enabling monitoring of various estrogenic substances potentially occurring in milk and dairy products was proposed. Groups of compounds fairly differing in physico-chemical properties and biological activity were analyzed: four natural estrogens, four synthetic estrogens, five mycoestrogens, and nine phytoestrogens. Since they may pass into milk mainly in glucuronated and sulfated forms, an enzymatic hydrolysis was involved prior to the extraction based on the QuEChERS methodology. For the purification of the organic extract, a dispersive solid-phase extraction (d-SPE) with sorbent C18 was applied. The final analysis was performed by ultra-high-performance liquid chromatography (UHPLC) coupled with triple quadrupole tandem mass spectrometry (MS/MS). Method recovery ranged from 70 to 120% with a relative standard deviation (RSD) value lower than 20% and limits of quantification (LOQs) in the range of 0.02–0.60 μg/L (0.2–6.0 μg/kg dry weight) and 0.02–0.90 μg/kg (0.2–6.0 μg/kg dry weight) for milk and yogurt, respectively. The new procedure was applied for the investigation of estrogenic compounds in 11 milk samples and 13 yogurt samples from a Czech retail market. Mainly phytoestrogens were found in the studied samples. The most abundant compounds were equol and enterolactone representing 40–90% of all estrogens. The total content of phytoestrogens (free and bound) was in the range of 149–3870 μg/kg dry weight. This amount is approximately 20 times higher compared to non-bound estrogens.



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Surface-enhanced Raman scattering (SERS) imaging-guided real-time photothermal ablation of target cancer cells using polydopamine-encapsulated gold nanorods as multifunctional agents

Abstract

In this study, we developed a novel "see-and-treat" theranostic system named "surface-enhanced Raman scattering (SERS) imaging-guided real-time photothermal therapy" for accurate cancer detection and real-time cancer cell ablation using the same Raman laser. Facilely synthesized polydopamine-encapsulated gold nanorods (AuNRs), which possess excellent biocompatibility and enhanced stability, were used as multifunctional agents. Under near-infrared (NIR) laser irradiation, polydopamine-encapsulated AuNRs show strong SERS effect and high photothermal conversion efficiency simultaneously. After immobilization of antibodies (anti-EpCAM), polydopamine-encapsulated gold nanorods show high specificity to target cancer cells. Tumor margins could be distinguished facilely by a quick SERS imaging process, which was confirmed by H&E staining results. By focusing the exciting light on detected cancer cells for a prolonged time, cancer cells could be ablated immediately without the need of other procedure. This "see-and-treat" theranostic strategy combining SERS imaging and real-time photothermal therapy using the same Raman laser is proposed for the first time. Experimental results confirmed the feasibility of our "SERS imaging-guided real-time photothermal therapy system." This novel theranostic strategy can significantly improve the efficiency of cancer therapy in clinical application, allowing the effective ablation of cancer cells with no effects on surrounding healthy tissues.

Graphical abstract



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A mechanistic study of geminal dicationic ionic liquids as mobile phase additives for improving the separation performance of high-performance liquid chromatography

Abstract

Due to the acidity and strong polarity of auxinic herbicides, separation of these compounds in food and environmental samples is a great challenge. In this study, 12 geminal dicationic ionic liquids (GDILs) were synthesized and used as mobile phase additives to separate six auxinic herbicides. The effects of the kind of dication, the length of linkage chain, the kind of anion, the concentration of GDILs, and the pH of mobile phase for the separation were investigated in detail. Compared with [C4MIm][BF4], GDILs ([C8(MIm)2][BF4]2) showed higher resolution, better peak shape, and lower retention factor. The separation performance of additives was in the order of [C8(MIm)2][BF4]2 > [C8(MPy)2][BF4]2, [(C4)2MPiz][BF4]2, [C8(MMo)2][BF4]2, [C4MIm][BF4], [C8(MPid)2][BF4]2 > [C8(HBOc)2][BF4]2 > TBAB. GDILs showed the best separation under the following conditions: cation: imidazolium; length of linkage chain: 8; anion: BF4; mobile phase pH: 3; concentration: 5 mmol L−1. The separation mechanism of GDILs may mainly be due to their symmetric structure and the abundance of positive charge sites which could help GDILs shield the residual silanol and interact with analytes more efficiently to improve the peak shapes, resolution, and retention. In addition, the GDILs in the mobile phase and anions adsorbed on the stationary phase also greatly affected the separation. GDILs used as mobile phase additives to separate auxinic herbicides showed high efficiency separation and low damage to HPLC columns, and the developed chromatographic method had excellent linearity, accuracy, precision, and repeatability. The application and mechanism study of GDILs in HPLC would be instructive to determine and separate acid herbicides in food and environmental samples.

Graphical abstract

As HPLC mobile phase additives, GDILs show high separation performance due to their unique symmetric structures.


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Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis

Abstract

Interstitial lung disease (ILD) is a severe rheumatoid arthritis (RA) manifestation. The worst survival has been associated with usual interstitial pneumonia (UIP) definitive pattern in high-resolution chest tomography (HRCT) scans. Moreover, the use of methotrexate in RA-ILD is controversial. Our aim was to evaluate prognostic factors including methotrexate in an RA-ILD cohort and their association with survival. RA-ILD patients referred for medical evaluation and treatment at a single center were included. At the baseline, pulmonary function tests were carried out and a HRCT was obtained. A radiologist evaluated the ILD tomographic pattern and the extent of lung disease. Patients were considered as receiving methotrexate therapy if this drug was specifically prescribed for the treatment of RA-ILD at the beginning of follow up. Seventy-eight patients were included. UIP definite pattern in HRCT was not associated to worse survival. Variables associated with mortality reflected the severity of lung disease. Treatment with methotrexate was associated with survival (HR 0.13, 95% CI 0.02–0.64); older patients had worse prognosis (HR 1.04, 95% CI 1.003–1.09). After adjusting for confounding variables, methotrexate was strongly associated with survival. Methotrexate treatment during follow up was associated with survival. The severity of lung disease and not the tomographic pattern is associated with mortality; older patients had worse prognosis.



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The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures—a systematic review of the literature

Abstract

Vertebral compression fracture (VCF) is a common fragility fracture and the starting point of a lasting, painful, disabling condition. The aim was to summarize evidence of person-centered/non-medical interventions supporting women with VCF. Results show small numbers of studies with only probable effect on function, pain, QoL, fear of falling, and psychological symptoms. The vertebral compression fracture (VCF) caused by osteoporosis is the third most common fragility fracture worldwide. Previously, it was believed that the pain caused by VCF was self-subsiding within weeks or a few months post-fracture. However, this positive prognosis has been refuted by studies showing that, for the great majority of patients, the VCF was the starting point of a long-lasting, severely painful, and disabling condition. The low number of studies focusing on the experience of the natural course of VCF, and what support is available and how it is perceived by those affected, calls for further investigation. Strengthening older patients' sense of security and increasing confidence in their own abilities are of great importance for successful rehabilitation following VCF. More research is needed to identify resources, possibilities, and strategies that can assist older patients to reach their goals to improve well-being. The purpose of this systematic review was to identify and summarize the current evidence of person-centered or other structured non-medical/non-surgical interventions supporting older women after experiencing an osteoporotic VCF. A systematic literature search was conducted on the MeSH terms encompassing osteoporosis and vertebral compression fractures in the PubMed-MEDLINE and Cumulative Index for Nursing and Allied Health Literature (CINAHL) databases during March through June 2015. The initial search identified 8789 articles, but only seven articles (six randomized controlled trials and one observational study with a control group) met the inclusion criteria. It became evident from the current study that the availability of evidence on the effects of non-medical interventions aiming to support older women with VCF is limited, to say the least. The trials included in this review have few limitations and were mainly considered to be of moderate quality. This systematic literature review suggests that non-medical interventions aiming to support older women with VCF might decrease levels of pain and use of analgesic as well as promote improved physical mobility and function. These interventions would probably result in an improved difference in experiences of fear of falling and perceived psychological symptoms, but would only slightly improve quality of life. However, given the nature of the seven studies, potential biases in patient selection, issues around precision with small cohorts, and failure to control for confounders, makes it difficult to draw a definitive conclusion about the significant effects of non-medical interventions. Incurring a VCF is a complex and diverse event, necessitating equally complex interventions to identify new ways forward. However, to date, interventions struggle with a risk of selection bias in that only the needs of the healthiest of the population are addressed and the voices of the remaining majority of the people affected by VCF are unheard.



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Andrographolide Benefits Rheumatoid Arthritis via Inhibiting MAPK Pathways

Abstract

Andrographolide (AD) is the main compound distributed in medicinal herb Andrographis paniculata and exhibits anti-inflammatory activity. AD has been used for the treatment of multiple inflammatory diseases. However, the therapeutic value of AD on human rheumatoid arthritis (RA) remains unclear. In this study, we investigated the effects of AD on collagen-induced arthritis (CIA) and human RA synovial fibroblasts (RA-SFs). CIA mice were treated with AD (dissolved in 0.5% CMC-Na, 100 mg/kg per day) or vehicle (0.5% CMC-Na) daily by oral gavage for 2 weeks. The arthritis severity and joint destruction were assessed. Serum anti-collagen II antibody (anti-CII Abs) and cytokines were determined by ELISA. TNFα-stimulated human RA-SFs were treated with varying doses of AD for in vitro investigation. Results showed that AD significantly attenuated the arthritis severity and joint damage. AD treatment significantly reduced the production of serum anti-CII, TNFα, IL-1β, and IL-6. In vitro, AD decreased the secretion of IL-1β and IL-6 from TNFα-stimulated RA-SFs in a dose-dependent manner. AD treatment reduced the TNFα-induced phosphorylation of p38 MAPK and ERK1/2 in a dose-dependent manner. Thus, our findings suggest that AD confers protective effects on autoimmune arthritis through inhibiting MAPK pathways.



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Quality of life correlates with muscle strength in patients with dermato- or polymyositis

Abstract

The aim of this study was to compare health-related quality of life (HQoL) in adults with dermatomyositis (DM) or polymyositis (PM) with a healthy control group and to assess whether muscle strength was associated with HQoL in patients with DM or PM. A cross-sectional study was performed and included 75 patients with DM or PM and 48 healthy controls. HQoL was assessed by the Short Form 36 questionnaire (SF-36). Muscle strength of the patients was assessed using the Manual Muscle Test-8 (MMT8). Covariables and possible confounding factors were collected by validated tools. Associations were determined in multiple linear regression models. The patients had significantly lower HQoL than the control group in both the physical component summary score (PCS) and the mental component summary score (MCS). Thus, the PCS-difference between groups was 32% (p < 0.001), whereas the MCS-difference was 14% (p < 0.001). Muscle strength was associated with one domain in the patients; Physical Function (β = 1.2; 95% confidence interval 0.37 to 2.1). No statistically significant associations were found between muscle strength and HQoL in the remaining domains. Patients with DM or PM have reduced HQoL compared to healthy controls. Notably, muscle strength was associated with scores of the domain reflecting perceived physical function in patients. These findings corroborate the validity of including selected patient reported outcomes in the evaluation and monitoring of patients with DM or PM.



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Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis

Abstract

Purpose

Drug-induced sedation endoscopy (DISE) classification systems have been used to assess anatomical findings on upper airway obstruction, and decide and plan surgical treatments and act as a predictor for surgical treatment outcome for obstructive sleep apnoea management. The first objective is to identify if there is a universally accepted DISE grading and classification system for analysing DISE findings. The second objective is to identify if there is one DISE grading and classification treatment planning framework for deciding appropriate surgical treatment for obstructive sleep apnoea (OSA). The third objective is to identify if there is one DISE grading and classification treatment outcome framework for determining the likelihood of success for a given OSA surgical intervention.

Methods

A systematic review was performed to identify new and significantly modified DISE classification systems: concept, advantages and disadvantages.

Results

Fourteen studies proposing a new DISE classification system and three studies proposing a significantly modified DISE classification were identified. None of the studies were based on randomised control trials.

Conclusion

DISE is an objective method for visualising upper airway obstruction. The classification and assessment of clinical findings based on DISE is highly subjective due to the increasing number of DISE classification systems. Hence, this creates a growing divergence in surgical treatment planning and treatment outcome. Further research on a universally accepted objective DISE assessment is critically needed.



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The effect of sleep duration on exhaled nitric oxide levels in U.S. adults

Abstract

Purpose

Poor sleep quality and duration are associated with systemic endothelial dysfunction. However, an association between poor sleep and pulmonary endothelial dysfunction has not been elucidated. We sought to determine if there is a relationship between sleep duration and fractional exhaled nitric oxide (FeNO) concentrations as a surrogate for pulmonary endothelial function.

Methods

We used three National Health and Nutrition Examination Survey (NHANES) cycles (2007–2012). Linear regression models were built with and without adjustment for age, sex, race, BMI, asthma/bronchitis, CRP, smoking, folate, renal function, respiratory infections, and steroid use. To examine a non-linear relationship, we introduced a spline, with single knot at mean sleep duration (7 h).

Results

Of 13,173 participants (50.8% male, 44.2% Caucasian), 78% slept 6–8 hours (h). FeNO was significantly higher in the group sleeping 6–8 h (17.3 ± 14.9 ppb) than in the other two groups (16.0 ± 13.0 ppb, 15.9 ± 12.7 ppb for <6 and >8 h respectively; P < 0.001). In unadjusted linear regression, FeNO increased by 1.1 ppb for each hour increase in sleep up to 7 h (P < 0.001). Increased sleep duration beyond 7 h saw a 0.96 ppb decrease in FeNO (P < 0.001). After adjustment for confounders, FeNO increased by 1.09 ppb for each hour of sleep up to 7 h (P = 0.001) and decreased by 0.71 ppb for each hour after (P = 0.02).

Conclusion

Sleeping less or more than 7 h is associated with pulmonary endothelial dysfunction as measured by FeNO. Further study is needed to evaluate mechanism(s) of this association and validity of FeNO as a marker of endothelial function.



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Severity of desaturation events differs between hypopnea and obstructive apnea events and is modulated by their duration in obstructive sleep apnea

Abstract

Purpose

Frequency of apnea and hypopnea events is used to estimate the severity of obstructive sleep apnea (OSA). However, comprehensive information on whether apneas and hypopneas cause an equal biological effect is not available. The purpose of the present work was to evaluate the effect of the breathing cessation event type (i.e., obstructive apnea or hypopnea) and duration on the severity of related SpO2 desaturation events.

Methods

Type 1 polysomnographies of 395 patients (220 males and 175 females) examined for suspected OSA were analyzed. Desaturation severity related to hypopnea and obstructive apnea events were compared and comparison was controlled for gender, sleep stage, sleeping position, age, and body mass index. Hypopneas and obstructive apneas were further divided into eight different durational categories and related desaturation event characteristics were compared between the categories.

Results

SpO2 desaturation events caused by obstructive apneas were statistically significantly (p ≤ 0.004) longer, greater in area, and deeper compared to the SpO2 desaturations caused by hypopneas. The increase in the duration of hypopnea and obstructive apnea events led to increase in the duration and area of related SpO2 desaturations. The increase in the obstructive apnea event duration also led to increase in the depth of related desaturation event.

Conclusions

Obstructive apneas led to more severe SpO2 desaturation compared to hypopneas. Increased event duration led to increase in the severity of the related SpO2 desaturation. In addition to considering event duration, obstructive apneas should have more weight than hypopneas when estimating severity of OSA and associated long-term cardiovascular risk.



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A new species of Moniliformis from a Sigmodontinae rodent in Patagonia (Argentina)

Abstract

The majority of species of Acanthocephala known thus far from South America have been recorded mostly in fish and wild birds. In particular, rodents in Argentina have been poorly studied for acanthocephalans. The genus Abrothrix (Sigmodontinae-Cricetidae) ranges from the Altiplano of southern Peru through the highlands of Bolivia, northern Chile, and Argentina south through Tierra del Fuego. The purpose of this paper was to study Acanthocephala species parasitizing different populations of Abrothrix from Santa Cruz province (Patagonia Argentina). Specimens of Acanthocephala were found in the small intestine of Abrothrix olivaceus, showing values of P 14.7%, IM = 2.8, and AM = 0.41. All the rodents parasitized were collected in Punta Quilla, Santa Cruz, Argentina. The specimens of Abrothrix longipilis were not parasitized. Moniliformis amini n. sp. is described with features such as the long, cylindrical, and pseudo-segmented body; proboscis receptacle double walled, outer wall with muscle fibers usually arranged spirally, and a combination of several morphometric characters, mainly the very small size of the proboscis receptacle and length of the testes and lemnisci. A marked proportion of arthropods was found in the diet of A. olivaceus, characterizing it as arthropodivorous. Possibly, a larger sampling effort and specific projects dealing with the study of acanthocephalans will shed light on several questions of the rodent-Moniliformis relationship.



http://ift.tt/2qVOvzU

Associations between fasciolosis and milk production, and the impact of anthelmintic treatment in dairy herds

Abstract

Liver fluke is a ubiquitous parasite that causes extensive production losses in cattle and is a zoonosis. The aims of this study were to determine the prevalence of fasciolosis in 178 dairy cattle herds in Styria (federal state of Austria) and its influence on production, to detect the risk factors for infection, and to explore effective strategies in management and control. A questionnaire on farm management, prophylaxis, and therapy was developed and applied. Furthermore, production parameters (milk yield, milk protein content, butter fat content, non-return rate 90, calving to conception interval, service period) were recorded for 2014 and 2015, and a commercial ELISA for detection of Fasciola hepatica antibodies was applied in bulk tank milk in March 2014 and March 2015. Analysis of bulk tank milk samples showed a prevalence of 61.3% in 2014 and 45.5% in 2015. No associations could be found between F. hepatica exposure and farm structure or pasture management. Farms with highly positive (optical density ratio (ODR) ≥ 0.6 and lying above the upper interquartile range) antibody levels had a significantly lower annual milk yield of 438 kg per cow per year (p = 0.045), butterfat content of 0.091% (p = 0.004), and milk protein content of 0.046% (p = 0.024). However, fertility parameters were not significantly associated with liver fluke exposure. Anthelmintic treatment led to significantly lower antibody levels in the subsequent year (p = 0.042) and had a significant influence on protein content in milk (p = 0.003). This study highlighted the importance of fasciolosis in Austria and its influence on milk production and the need for veterinary advice regarding prophylactic measures to reduce economic losses.



http://ift.tt/2rFa6JZ

A comparative study of CO catalytic oxidation on Au/YPO 4 -prisms and Au/YPO 4 -rods

Abstract

YPO4 nanoprisms and nanorods were synthesized by hydrothermal and co-precipitation processes. Au/YPO4 catalysts were obtained by a deposition-precipitation method. The as-prepared YPO4 and Au/YPO4 were characterized by N2 adsorption-desorption, XRD, TEM, XPS, ICP, UV-Vis DRS, and FT-IR. The XRD results revealed that YPO4 nanoprisms and nanorods were hexagonal phase. The TEM observations demonstrated that the gold nanoparticles with the size of <4 nm uniformly dispersed on the surface of the support. The XPS spectra revealed that gold was in the metallic state. The catalysis results demonstrated that Au/YPO4-rods performed higher catalytic activity than Au/YPO4-prisms for CO oxidation. 1.0% Au/YPO4-rods catalyst could achieve complete CO conversion at 20 °C. Au/YPO4-prisms exhibited higher sintering-resistant property than Au/YPO4-rods. After continuous operation for 10 h, Au/YPO4-rods showed better stability at low reaction temperature than Au/YPO4-prisms, and both of them showed good stability at the reaction temperature of 220 °C.



http://ift.tt/2qVGQ4H

Study of the Effect of Bisphenol A on Oxidative Stress in Children with Autism Spectrum Disorders

Abstract

The role of bisphenol A (BPA) in autism was investigated in 49 children (mean age = 5.950 ± 1.911 years) with autism spectrum disorders (ASDs) and 40 comparable age and sex matched children used as controls (mean age = 5.333 ± 2.279 years). In addition, 8-Hydroxydeoxyguanosine (8-oxodG) was also studied as a biomarker of oxidative stress in the same set of two selected groups. The results showed that both BPA and 8-oxodG were significantly higher in children with autism than those of control children (p values = 0.025 and 0.0001, respectively). There were positive correlations between both BPA and 8-oxodG with ASDs severity (r = 0.400 and 0.805, respectively), these correlations were highly significant (p values = 0.004 and 0.001, respectively). There was a significance positive correlation between BMI and BPA, but the correlation between BMI and 8-oxodG was not significant in children with autism. The observed results revealed that BPA may increase oxidative stress resulting in mitochondrial dysfunction that affecting the behavior and functioning of ASDs children.



http://ift.tt/2qZXECI

Quality of life correlates with muscle strength in patients with dermato- or polymyositis

Abstract

The aim of this study was to compare health-related quality of life (HQoL) in adults with dermatomyositis (DM) or polymyositis (PM) with a healthy control group and to assess whether muscle strength was associated with HQoL in patients with DM or PM. A cross-sectional study was performed and included 75 patients with DM or PM and 48 healthy controls. HQoL was assessed by the Short Form 36 questionnaire (SF-36). Muscle strength of the patients was assessed using the Manual Muscle Test-8 (MMT8). Covariables and possible confounding factors were collected by validated tools. Associations were determined in multiple linear regression models. The patients had significantly lower HQoL than the control group in both the physical component summary score (PCS) and the mental component summary score (MCS). Thus, the PCS-difference between groups was 32% (p < 0.001), whereas the MCS-difference was 14% (p < 0.001). Muscle strength was associated with one domain in the patients; Physical Function (β = 1.2; 95% confidence interval 0.37 to 2.1). No statistically significant associations were found between muscle strength and HQoL in the remaining domains. Patients with DM or PM have reduced HQoL compared to healthy controls. Notably, muscle strength was associated with scores of the domain reflecting perceived physical function in patients. These findings corroborate the validity of including selected patient reported outcomes in the evaluation and monitoring of patients with DM or PM.



http://ift.tt/2r0831n

Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis

Abstract

Interstitial lung disease (ILD) is a severe rheumatoid arthritis (RA) manifestation. The worst survival has been associated with usual interstitial pneumonia (UIP) definitive pattern in high-resolution chest tomography (HRCT) scans. Moreover, the use of methotrexate in RA-ILD is controversial. Our aim was to evaluate prognostic factors including methotrexate in an RA-ILD cohort and their association with survival. RA-ILD patients referred for medical evaluation and treatment at a single center were included. At the baseline, pulmonary function tests were carried out and a HRCT was obtained. A radiologist evaluated the ILD tomographic pattern and the extent of lung disease. Patients were considered as receiving methotrexate therapy if this drug was specifically prescribed for the treatment of RA-ILD at the beginning of follow up. Seventy-eight patients were included. UIP definite pattern in HRCT was not associated to worse survival. Variables associated with mortality reflected the severity of lung disease. Treatment with methotrexate was associated with survival (HR 0.13, 95% CI 0.02–0.64); older patients had worse prognosis (HR 1.04, 95% CI 1.003–1.09). After adjusting for confounding variables, methotrexate was strongly associated with survival. Methotrexate treatment during follow up was associated with survival. The severity of lung disease and not the tomographic pattern is associated with mortality; older patients had worse prognosis.



http://ift.tt/2rvcEMu

Gene Overexpression in Streptomyces hygroscopicus Associated with DNA Amplification

Abstract

The genetics of the Streptomyces hygroscopicus strain 10–22 is of interest due to the ability of this strain to produce antifungal compounds. Strain T110 was obtained through insertional mutagenesis of strain 10–22 and was found to have undergone DNA amplification, as determined by both conventional and pulsed-field gel electrophoresis (PFGE). pIJ702, the vector used for insertional mutagenesis, was shown to have integrated into and co-amplified with the chromosomal DNA sequence of T110, as pIJ702 hybridized predominantly with two of the three amplified BamHI fragments. The amplified DNA sequence in T110 is 10.8 kb in length and consists of 5.18 kb of Streptomyces chromosomal DNA and the entire 5.62 kb pIJ702 sequence. Sequence analysis of the 5.18 kb chromosomal sequence revealed two open reading frames, one encoding a putative IS5 family transposase and the other encoding a putative dihydroxy-acid dehydratase. Real-time PCR analysis showed that expression of the putative dehydratase gene in T110 is about 50 times greater than in the wild-type strain, consistent with the high level of amplification of this DNA region, and therefore this system has the potential for producing economically or clinically important molecules.



http://ift.tt/2rEYzKR

Aquichromatium aeriopus gen. nov., sp. nov., A Non-phototrophic Aerobic Chemoheterotrophic Bacterium, and Proposal of Aquichromatiaceae fam. nov. in the Order Chromatiales

Abstract

A gram-staining negative, non-motile, aerobic chemoheterotrophic, ovoid or short rod-shaped bacterium, designated as J89T, was isolated from a seawater sample collected from the coast of Yellow Sea in Qingdao, China. The strain grew at salinities of 1.0–6.0% (w/v) NaCl (optimum, 3.0%). Growth occurred at pH 6.0–9.0 (optimum, pH 7.0) and at 10–35 °C (optimum, 25–30 °C). The genomic DNA G+C content was determined to be 59.3 mol%. Q-8 was detected as the respiratory quinone. The major fatty acids (>10%) were summed feature 3 (C16:1ω7c and/or C16:1ω6c), summed feature 8 (C18:1ω7c and/or C18:1ω6c), and C16:0. The polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylcholine, two unidentified phospholipids, and an unidentified polar lipid. Comparison of the 16S rRNA gene sequence indicated that the strain was most closely related (<91%) to members of the order Chromatiales in the class Gammaproteobacteria. Phylogenetic analyses showed that this strain represented a distinct phylogenetic lineage in the order Chromatiales and could not be assigned to any of the defined families in the order. On the basis of low sequence similarities and differential characteristics of strain J89T from the genera of neighboring families, the strain is proposed to be a representative of a novel genus Aquichromatium gen. nov. A new family Aquichromatiaceae with the type genus Aquichromatium is proposed. Strain J89T (=MCCC 1K03281T=CMRC C2017206T) is the type strain of the type species Aquichromatium aeriopus sp. nov.



http://ift.tt/2qVutFR

Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review

Abstract

Roux-en-Y gastric bypass (RYGB) is traditionally classified as a combined restrictive and malabsorptive operation. This notion of the operation influences its technical variations and revisions for patients who do not achieve significant weight loss after this surgery. There is an increasing body of literature suggesting a role for appetite suppression mediated by neuro-hormonal signals after RYGB. The purpose of this paper was to systematically review published English language scientific literature to determine the role of malabsorption towards weight loss achieved with RYGB. This review finds that there is little or no malabsorption of carbohydrates or protein after RYGB but there is some fat malabsorption. Overall, malabsorption makes a little (approximately 11.0% in the early period) overall contribution to weight loss after RYGB.



http://ift.tt/2sLORpg

Extended endoscopic endonasal approach for pituitary adenoma: a single-center experience of 171 patients

Abstract

Background

Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to treat increasing numbers of patients with PA in recent years. We conducted this study to evaluate the safety and efficacy of this approach for PA resection.

Methods

We performed a retrospective analysis of all patients who underwent an EEEA to remove PA by a binostril, four-handed technique between October 2013 and April 2016 in our department. The medical information of the patients including gender, age, tumor size, hormone level, clinical outcome, and complications were collected and analyzed.

Results

From a total of 593 pituitary adenoma surgeries, 171 patients (101 male and 70 female, mean age 47.4 ± 12.8 years) underwent EEEA, including 96 with functional adenomas (56.14%) and 75 with nonfunctional adenomas (43.86%). The most common symptoms were headache and vision change. Gross total resection was achieved in 126 patients (73.68%). Common complications were hyposmia or anosmia, diabetes insipidus, hypopituitarism, postoperative cerebrospinal fluid leak, cerebral hemorrhage, and epistaxis. The mean duration of follow-up was 14.6 months (range: 6–31 months).

Conclusions

The application of EEEA for PA resection by a binostril, four-handed technique provided great surgical freedom with minimal invasion, and resulted in few complications. EEEA is a secure and effective surgical method that could be used for the majority of PAs.



http://ift.tt/2sy7gH5

Pathobiology of the Hepatic Glycogen Storage Diseases

Abstract

Purpose of the Review

The purpose of this study is to review the pathobiology of the hepatic glycogen storage diseases (GSD) and recent developments in their management.

Recent Findings

Increasingly, noninvasive mutation detection has replaced biological and tissue samples as the first line diagnostic method. For type 1 GSD, continuous subcutaneous monitoring has transformed patient monitoring. There is evidence that improved metabolic control can prevent complications such as adenoma formation and renal dysfunction. Improved understanding of the pathophysiology of hepatic adenomata may allow rationalization of their management. Hepatocellular carcinoma only develops in established adenomata, offering an option for prevention. For type 111 GSD, intrinsic liver disease and myopathy become the major clinical concerns after childhood. Type IV GSD is a heterogenous multisystemic disorder which often results in progressive liver and cardiac failure. Recombinant acid α-glucosidase may have a disease-modifying role, but experience remains limited. Types VI and IX GSD are milder diseases where supportive treatment usually results in an excellent long-term outcome.

Summary

Current management of the hepatic GSDs has significantly improved their outcome and improved metabolic control can prevent many long-term complications.



http://ift.tt/2rYwlO5

Gap dynamics in the Western Carpathian mixed beech old-growth forests affected by spruce bark beetle outbreak

Abstract

Understanding how species-specific disturbances affect the dynamics of mixed forests is becoming increasingly important due to rapidly changing disturbance regimes. This study estimated the effect of Norway spruce (Picea abies (L.) Karst.) mortality on the disturbance processes in two mixed beech stands of the Western Carpathians that were affected by a bark beetle outbreak. We evaluated the size distribution, fraction of canopy and expanded gaps, the characteristics of gapmakers and the contribution of different species to gap size. The measured canopy gap fraction was <5%, and most canopy gaps were small (<100 m2). Spruce was the most abundant gapmaker, and its share among gapmakers was 3–6 times higher than its share in the canopy. We found that the increase in spruce mortality due to the outbreak resulted in a fine-scale mortality pattern. However, spruce gapmakers did not contribute much to gap area size, as shown by a weak correlation between the number of spruce gapmakers and the area of expanded gaps. Diameter distribution of living versus recently dead trees showed that beech mortality occurred disproportionately in large size classes. However, dead spruce trees were equally frequent in all diameter classes, which means beetles did not exclusively attack larger trees in these stands during the outbreak. We conclude that spruce mortality may have influenced successional processes by giving a competitive advantage to two other species that were not affected by the outbreak, provided that a high deer browsing intensity does not hinder the regeneration of new seedlings.



http://ift.tt/2sL9P7C

Differences of Heart Rate Variability Between Happiness and Sadness Emotion States: A Pilot Study

Abstract

This pilot study investigated the differences of heart rate variability (HRV) indices between two opposite emotion states: happiness and sadness, to reveal the differences of autonomic nervous system activity under different emotional states. Forty-eight healthy volunteers were enrolled for this study. Electrocardiography (ECG) signals were recorded under both emotion states with a random measurement order (first happiness emotion measurement then sadness or reverse). RR interval (RRI) time series were extracted from ECGs and multiple HRV indices, including time-domain (MEAN, SDNN, RMSSD and PNN50), frequency-domain (LFn, HFn and LF/HF) and nonlinear indices (SampEn and FuzzyMEn) were calculated. In addition, the effects of heart rate (HR) and mean artery pressure (MAP) on the aforementioned HRV indices were analyzed for both emotion states. The results showed that experimental order had no significant effect on all HRV indices from both happiness and sadness emotions (all P > 0.05). The key result was that among all nine HRV indices, six indices were identified having significant differences between happiness and sadness emotion states: MEAN (P = 0.028), SDNN (P = 0.002), three frequency-domain indices (all P < 0.0001) and FuzzyMEn (P = 0.047), whereas RMSSD, PNN50 and SampEn had no significant differences between the two emotion states. All indices, except for SampEn, had significant positive correlations (all P < 0.01) for the two emotion states. Four time-domain indices decreased with the increase of HR (all P < 0.01), while frequency-domain and nonlinear indices demonstrated no HR-related changes for each emotional state. In addition, all indices (time-domain, frequency-domain and nonlinear) showed no MAP-related changes. It concluded that HRV indices showed significant differences between happiness and sadness emotion states and the findings could help to better understand the inherent differences of cardiovascular time series between different emotion states in clinical practice.



http://ift.tt/2sxEGp7

Circulating levels of dickkopf-1, osteoprotegerin and sclerostin are higher in old compared with young men and women and positively associated with whole-body bone mineral density in older adults

Abstract

Summary

Bone mineral density declines with increasing older age. We examined the levels of circulating factors known to regulate bone metabolism in healthy young and older adults. The circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin were positively associated with whole-body bone mineral density (WBMD) in older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young.

Introduction

This study aims to investigate the relationship between whole-body bone mineral density (WBMD) and levels of circulating factors with known roles in bone remodelling during 'healthy' ageing.

Methods

WBMD and fasting plasma concentrations of dickkopf-1, fibroblast growth factor-23, osteocalcin, osteoprotegerin, osteopontin and sclerostin were measured in 272 older subjects (69 to 81 years; 52% female) and 171 younger subjects (18–30 years; 53% female).

Results

WBMD was lower in old than young. Circulating osteocalcin was lower in old compared with young, while dickkopf-1, osteoprotegerin and sclerostin were higher in old compared with young. These circulating factors were each positively associated with WBMD in the older adults and the relationships remained after adjustment for covariates (r values ranging from 0.174 to 0.254, all p < 0.01). In multivariate regression, the body mass index, circulating sclerostin and whole-body lean mass together accounted for 13.8% of the variation with WBMD in the older adults. In young adults, dickkopf-1 and body mass index together accounted for 7.7% of variation in WBMD.

Conclusion

Circulating levels of dickkopf-1, osteocalcin, osteoprotegerin and sclerostin are positively associated with WBMD in community-dwelling older adults, despite the average WBMD being lower and circulating dickkopf-1, osteoprotegerin and sclerostin being higher in old than young.



http://ift.tt/2qUWw89

Morphometry and microsurgical anatomy of Bochdalek’s flower basket and the related structures of the cerebellopontine angle

Abstract

Background

Bochdalek's flower basket (Bfb) is the distal part of the horizontal segment of the fourth ventricle's choroid plexus protruding through the lateral aperture (foramen of Luschka). The microsurgical anatomy of the cerebellopontine angle, fourth ventricle and its inner choroid plexus is well described in the literature, but only one radiological study has investigated the Bfb so far. The goal of the present study was to give an extensive morphometric analysis of the Bfb for the first time and discuss the surgically relevant anatomical aspects.

Method

Forty-two formalin-fixed human brains (84 cerebellopontine angles) were involved in this study. Photomicrographs with scale bars were taken in every step of dissection to perform further measurements with Fiji software. The lengths and widths of the Bfb, rhomboid lip and lateral aperture of the fourth ventricle as well as the related neurovascular and arachnoid structures were measured. The areas of two sides were compared with paired t-tests using R software. Significance level was set at p < 0.05.

Results

Protruding choroid plexus was present in 77 cases (91.66%). In 6 cases (7.14%), the Bfb was totally covered by the rhomboid lip, and in one case (1.19%), it was absent. The mean width of the Bfb was 6.618 mm (2–14 mm), the mean height 5.658 mm (1.5–14 mm) and mean area 25.80 mm2 (3.07–109.83 mm2). There was no statistically significant difference between the two sides (p = 0.1744). The Bfb was in contact with 20 AICAs (23.80%), 6 PICAs (7.14%) and 39 vestibulocochlear nerves (46.42%). Arachnoid trabecules, connecting the lower cranial nerves to the Bfb or rhomboid lip, were found in 57 cases (67.85%).

Conclusions

The Bfb is an important landmark during various surgical procedures. Detailed morphology, dimensions and relations to the surrounding neurovascular structures are described in this study. These data are essential for surgeons operating in this region.



http://ift.tt/2sxCNsE

Preventing Tuberculosis in a Low Incidence Setting: Evaluation of a Multi-lingual, Online, Educational Video on Latent Tuberculosis

Abstract

Treating latent tuberculosis infection (LTBI) in those at risk is an important yet challenging cornerstone of TB elimination. We evaluated a culturally-tailored, multi-lingual, 4.5-min, health promotional video on LTBI. Mixed methods study assessed use of the video with web-analytics, acceptability of content through interviews and survey questions, and compared knowledge scores in viewers and non-viewers using a survey. The video was viewed 6999 times in six languages over 1 year. Of 1598 survey respondents, 193 viewers had a mean knowledge score of 59%, compared to 38% in non-viewers. Eighty-four percent of viewers rated the video as helpful. When controlling for other factors, viewing the video was associated with a 1.04 (95% CI 0.85–1.26) or a 21% increase in a knowledge score. Qualitative data suggested the video was acceptable and may facilitate behavior change. This online, educational video shows promise as a tool to supplement clinical care.



http://ift.tt/2rtox5K

Health of International Marriage Immigrant Women in South Korea: A Systematic Review

Abstract

International marriage migration is now one of the most prominent forms of migration in Asia, and the number of women migrating to South Korea for marriage has increased dramatically in the last two decades. In this article, we provide a systematic review regarding the health status and health-related issues of international marriage immigrant women. The literature search identified 620 articles, of which 53 studies are presented in the article. Three overarching categories including six subcategories were identified according to the research focus; 'Environmental factors of health' including social support and barriers, 'Health status' including physical, psychological and social health, and quality of life as 'Outcome of health'. Overall women immigrants by marriage showed relatively poor health outcomes. Social support was an important factor affecting the health status and quality of life in this population. We offer recommendations to develop and implement culturally and linguistically appropriate health promoting programs for international marriage immigrant women in South Korea.



http://ift.tt/2qTWihz

Qualitative Study of Latino Cancer Patient Perspectives on Care Access and Continuity in a Rural, U.S.-Mexico Border Region

Abstract

Access to quality cancer care for cancer patients living in the rural U.S.-Mexico border region is complex due to common binational health care-seeking behaviors and regional socio-economic and cultural characteristics. But little is known about the challenges border dwelling residents face when navigating their cancer care systems. In-depth interviews were conducted with 22 cancer patients in Southern California. Thematic analysis was applied to identify patterns of meaning in the data. Emerging themes were: (1) delays in cancer care coordination: (a) poor coordination of cancer care (b) U.S. and cross-border discordance in cancer diagnosis; (2) regional shortage of cancer specialists; and (3) financial hardship. Findings revealed that care needs distinctly involved care coordination in/outside of the patient's community and bi-national care coordination. In addition to local solutions to improve cancer coordination through community-based partnerships, efforts to bridge care in a two-nation context are also imperative.



http://ift.tt/2qYdzkX

Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients

Abstract

Background

National rates of lateral epicondylitis and surgical treatment are poorly defined. Disease burden of lateral epicondylitis (LE) continues to increase annually. Further study is necessary to optimize treatment algorithms to reduce associated health-care expenditures.

Questions/Purposes

The purpose of this study is to review the annual incidence of LE, surgical rates, and associated health-care costs in a population setting.

Methods

A national database was queried for LE from 2007 to 2014. Surgical cases were identified and annual rates were recorded. Demographic and epidemiologic data were reported with descriptive statistics, while trends over time were analyzed using linear regression.

Results

Eighty-five thousand three hundred eighteen cases of LE were identified. The annual incidence per 10,000 patients remained constant (p = 0.304). The proportion of diagnoses in patients <65 years decreased (p ≤ 0.002) and ≥65 years increased (p < 0.001) over the study period. One thousand six hundred ninety-four patients (2%) required operative treatment. The annual rate of surgical intervention remained constant (p = 0.623). The proportion of patients <40 years requiring surgery decreased (p < 0.001) as the proportion of patients ≥65 years needing surgery increased (p = 0.003). Total reimbursement for LE procedures during the study period was $7,220,912. Average per-patient reimbursement was $4263. Both annual total reimbursement (p = 0.006) and per-patient reimbursement rates (p = 0.002) significantly increased.

Conclusion

The annual incidence of LE and rate of surgical intervention have remained constant from 2007 to 2014. The proportion of patients over >65 years diagnosed with, and receiving surgical treatment for, LE has significantly increased in recent years. Total reimbursement and average per-patient reimbursement have steadily risen, demonstrating the increasing burden of cost on the health-care system.



http://ift.tt/2qQNGEF

Binding object features to locations: Does the “spatial congruency bias” update with object movement?

Abstract

One of the fundamental challenges of visual cognition is how our visual systems combine information about an object's features with its spatial location. A recent phenomenon related to object–location binding, the "spatial congruency bias," revealed that two objects are more likely to be perceived as having the same identity or features if they appear in the same spatial location, versus if the second object appears in a different location. The spatial congruency bias suggests that irrelevant location information is automatically encoded with and bound to other object properties, biasing perceptual judgments. Here we further explored this new phenomenon and its role in object–location binding by asking what happens when an object moves to a new location: Is the spatial congruency bias sensitive to spatiotemporal contiguity cues, or does it remain linked to the original object location? Across four experiments, we found that the spatial congruency bias remained strongly linked to the original object location. However, under certain circumstances—for instance, when the first object paused and remained visible for a brief time after the movement—the congruency bias was found at both the original location and the updated location. These data suggest that the spatial congruency bias is based more on low-level visual information than on spatiotemporal contiguity cues, and reflects a type of object–location binding that is primarily tied to the original object location and that may only update to the object's new location if there is time for the features to be re-encoded and rebound following the movement.



http://ift.tt/2rumxKm

Natural scenes can be identified as rapidly as individual features

Abstract

Can observers determine the gist of a natural scene in a purely feedforward manner, or does this process require deliberation and feedback? Observers can recognise images that are presented for very brief periods of time before being masked. It is unclear whether this recognition process occurs in a purely feedforward manner or whether feedback from higher cortical areas to lower cortical areas is necessary. The current study revealed that the minimum presentation time required to identify or to determine the gist of a natural scene was no different from that required to determine the orientation or colour of an isolated line. Conversely, a visual task that would be expected to necessitate feedback (determining whether an image contained exactly six lines) required a significantly greater minimum presentation time. Assuming that the orientation or colour of an isolated line can be determined in a purely feedforward manner, these results indicate that the identification and the determination of the gist of a natural scene can also be performed in a purely feedforward manner. These results challenge a number of theories of visual recognition that require feedback.



http://ift.tt/2qZdXzK

The Use of the Mirror Tracing Persistence Task as a Measure of Distress Tolerance in Generalized Anxiety Disorder

Abstract

Behavioral tasks offer an objective index of processes associated with psychopathology. The mirror tracing persistence task (MTPT) has been used as a measure of distress tolerance, or the ability to endure negative internal states. In generalized anxiety disorder (GAD), a poor ability to tolerate aversive internal states may relate to the inability to adaptively regulate emotion. This study examined if those with GAD exhibit lower distress tolerance compared to controls as evidenced by length of time persisting on the MTPT. Participants underwent diagnostic interviews to determine the presence of absence of GAD and following group assignment, completed the MTPT. Results demonstrated that the groups differed significantly in time spent persisting on the task, with controls persisting longer than those with GAD, supporting the hypothesis that individuals with GAD exhibit lower distress tolerance than controls. These results provide support for the use of behavioral assessments as potential markers of distress tolerance.



http://ift.tt/2qUQsNf

The impact of category structure and training methodology on learning and generalizing within-category representations

Abstract

When interacting with categories, representations focused on within-category relationships are often learned, but the conditions promoting within-category representations and their generalizability are unclear. We report the results of three experiments investigating the impact of category structure and training methodology on the learning and generalization of within-category representations (i.e., correlational structure). Participants were trained on either rule-based or information-integration structures using classification (Is the stimulus a member of Category A or Category B?), concept (e.g., Is the stimulus a member of Category A, Yes or No?), or inference (infer the missing component of the stimulus from a given category) and then tested on either an inference task (Experiments 1 and 2) or a classification task (Experiment 3). For the information-integration structure, within-category representations were consistently learned, could be generalized to novel stimuli, and could be generalized to support inference at test. For the rule-based structure, extended inference training resulted in generalization to novel stimuli (Experiment 2) and inference training resulted in generalization to classification (Experiment 3). These data help to clarify the conditions under which within-category representations can be learned. Moreover, these results make an important contribution in highlighting the impact of category structure and training methodology on the generalization of categorical knowledge.



http://ift.tt/2qUmQQ3

Identity and semantic negative priming in rapid serial visual presentation streams

Abstract

In selective attention tasks, the efficiency of processing concurrently presented target and distractor stimuli in a given display is often influenced by the relationship these stimuli have with those in the previous display. When a to-be-attended target on a current trial (the probe trial) matches the ignored, non-target distractor on a previous trial (the prime trial), a response to the target is typically delayed compared with when the two stimuli are not associated. This negative priming (NP) phenomenon has been observed in numerous studies with traditional NP tasks presenting the target and distractor simultaneously in both the prime and probe trial couplets. Here, however, in four experiments using a mixture of stimulus types (letters, digits, English number words, and logographic Chinese number words), target and distractor stimuli were temporally separated in two rapid serial visual presentation (RSVP) streams instead of concurrently presented. The findings provide a conceptual replication and substantial extension of a recent study by Wong (Plos One, 7, e37023, 2012), and suggest that active suppression of irrelevant distracting information is a more ubiquitous form of cognitive control than previously thought.



http://ift.tt/2rE79cS

Miss it and miss out: Counterproductive nonspatial attentional capture by task-irrelevant, value-related stimuli

Abstract

Recent studies of visual search suggest that learning about valued outcomes (rewards and punishments) influences the likelihood that distractors will capture spatial attention and slow search for a target, even when those value-related distractors have never themselves been the targets of search. In the present study, we demonstrated a related effect in the context of temporal, rather than spatial, selection. Participants were presented with a temporal stream of pictures in a fixed central location and had to identify the orientation of a rotated target picture. Response accuracy was reduced if the rotated target was preceded by a "valued" distractor picture that signaled that a correct response to the target would be rewarded (and an incorrect response punished), relative to a distractor picture that did not signal reward or punishment. This effect of signal value on response accuracy was short-lived, being most prominent with a short lag between distractor and target. Impairment caused by a valued distractor was observed if participants were explicitly instructed regarding its relation to reward/punishment (Exps. 1, 3, and 4), or if they could learn this relationship only via trial-by-trial experience (Exp. 2). These findings show that the influence of signal value on attentional capture extends to temporal selection, and also demonstrate that value-related distractors can interfere with the conscious perception of subsequent target information.



http://ift.tt/2qUoYXL

Studying visual attention using the multiple object tracking paradigm: A tutorial review

Abstract

Human observers are capable of tracking multiple objects among identical distractors based only on their spatiotemporal information. Since the first report of this ability in the seminal work of Pylyshyn and Storm (1988, Spatial Vision, 3, 179–197), multiple object tracking has attracted many researchers. A reason for this is that it is commonly argued that the attentional processes studied with the multiple object paradigm apparently match the attentional processing during real-world tasks such as driving or team sports. We argue that multiple object tracking provides a good mean to study the broader topic of continuous and dynamic visual attention. Indeed, several (partially contradicting) theories of attentive tracking have been proposed within the almost 30 years since its first report, and a large body of research has been conducted to test these theories. With regard to the richness and diversity of this literature, the aim of this tutorial review is to provide researchers who are new in the field of multiple object tracking with an overview over the multiple object tracking paradigm, its basic manipulations, as well as links to other paradigms investigating visual attention and working memory. Further, we aim at reviewing current theories of tracking as well as their empirical evidence. Finally, we review the state of the art in the most prominent research fields of multiple object tracking and how this research has helped to understand visual attention in dynamic settings.



http://ift.tt/2rDVSch

Re-operative Surgery for Pheochromocytoma-Paraganglioma: Analysis of 13 Cases from a Single Institution

Abstract

Re-operative adrenal surgery for recurrent pheochromocytoma/paraganglioma (PCC/PGL) is a therapeutic situation not commonly encountered. The recurrence rate of pheochromocytoma is estimated to be 6.1–16.5% of patients from published retrospective series; there are no reports from the Asian continent. A retrospective analysis of the departmental database was performed on patients who had undergone surgery for PCC/PGL from January 2004 to December 2014 at the Christian Medical College Hospital, Vellore, India. Among 99 patients identified during the study period, there were 14 recurrent tumours and 13 patients underwent re-operative surgery. We located eight recurrences on the right side, three on the left side and three in the midline. All 14 recurrences were functioning, and the biochemical analysis as well as imaging studies were positive in 13 of them. The mean duration to recurrence from the time of the primary surgery was 76.3 months (range 6–180 months). Of the 89 patients who underwent their first operation at our centre, 67.4% reported for follow-up for a mean period of 25 months (range 4–132 months). Four of these required re-operation with a recurrence rate of 4.5% (4/89). The open approach was used for all but one of the recurrent tumours. Recurrence following surgery for PCC/PGL is a rarely studied though significant problem. Right adrenal tumour recurrences were most common, and all these recurrences were in the retrocaval region; this typical phenomenon may be dubbed the 'right retrocaval trap'. The reason for this was presumably due to difficult access and inadequate exposure of this area in open and laparoscopic surgery, resulting in incomplete dissection.



http://ift.tt/2rMsByn

A Technique to Define Extrahepatic Biliary Anatomy Using Robotic Near-Infrared Fluorescent Cholangiography

Abstract

Background

Bile duct injury is a rare but serious complication of minimally invasive cholecystectomy. Traditionally, intraoperative cholangiogram has been used in difficult cases to help delineate anatomical structures, however, new imaging modalities are currently available to aid in the identification of extrahepatic biliary anatomy, including near-infrared fluorescent cholangiography (NIFC) using indocyanine green (ICG).15 The objective of the study was to evaluate if this technique may aid in safe dissection to obtain the critical view.

Methods

Thirty-five consecutive multiport robotic cholecystectomies using NIFC with ICG were performed using the da Vinci Firefly Fluorescence Imaging System. All patients received 2.5 mg ICG intravenously at the time of intubation, followed by patient positioning, draping, and establishment of pneumoperitoneum. No structures were divided until the critical view of safety was achieved. Real-time toggling between NIFC and bright-light illumination was utilized throughout the case to define the extrahepatic biliary anatomy.

Results

ICG was successfully administered to all patients without complication, and in all cases the extrahepatic biliary anatomy was able to be identified in real-time 3D. All procedures were completed without biliary injury, conversion to an open procedure, or need for traditional cholangiography to obtain the critical view. Specific examples of cases where x-ray cholangiography or conversion to open was avoided and NIFC aided in safe dissection leading to the critical view are demonstrated, including (1) evaluation for aberrant biliary anatomy, (2) confirmation of non-biliary structures, and (3) use in cases where the infundibulum is fused to the common bile duct.

Conclusion

NIFC using ICG is demonstrated as a useful technique to rapidly identify and aid in the visualization of extrahepatic biliary anatomy. Techniques that selectively utilize this technology specifically in difficult cases where the anatomy is unclear are demonstrated in order to obtain the critical view of safety.



http://ift.tt/2sKqkAP

Portal Vein Embolization Reduces Postoperative Hepatic Insufficiency Associated with Postchemotherapy Hepatic Atrophy

Abstract

Background

The risk of postoperative hepatic insufficiency (PHI) is increased among patients with significant postchemotherapy hepatic atrophy. The primary aim of this study was to evaluate whether the liver regeneration stimulated by portal vein embolization (PVE) can protect against PHI.

Methods

Clinicopathological features of 177 patients treated with preoperative chemotherapy followed by PVE and hepatectomy were reviewed. Degree of atrophy was defined as the ratio of percentage difference in total liver volume (estimated by manual volumetry) to standardized liver volume. Kinetic growth rate (KGR, degree of hypertrophy [absolute % change in future liver remnant volume] divided by the number of weeks after PVE) and PHI events were compared between patients with degree of atrophy <10 vs ≥10%. Risk factors for the PHI were assessed using logistic regression.

Results

Seventy patients (40%) experienced significant hepatic atrophy ≥10% following preoperative chemotherapy. PHI rates were not significantly increased in patients who experienced significant hepatic atrophy (5.6 vs 8.6%, P = 0.443). KGR <2%/week (odds ratio, 8.10, P = 0.037) was the sole independent preoperative predictor of PHI. KGR ≥2% was associated with decreased PHI in both patients with <10% atrophy (0 vs 9.5%, P = 0.035) and ≥10% atrophy (2.6 vs 16.0%, P = 0.044).

Conclusions

Even in high-risk patients with ≥10% degree of atrophy from preoperative chemotherapy, KGR ≥2% mitigates the deleterious effects of hepatic atrophy and significantly reduces PHI to almost zero. In these high-risk patients, PVE with KGR calculation remains the most important preoperative technique to reduce liver failure after major hepatectomy.



http://ift.tt/2rMllTe

Co-culture of dedifferentiated and primary human chondrocytes obtained from cadaveric donor enhance the histological quality of repair tissue: an in-vivo animal study

Abstract

To compare the quality of the repair tissue in three-dimensional co-culture of human chondrocytes implanted in an in vivo model. Six cadaveric and five live human donors were included. Osteochondral biopsies from the donor knees were harvested for chondrocyte isolation. Fifty percent of cadaveric chondrocytes were expanded until passage-2 (P2) while the remaining cells were cryopreserved in passage-0 (P0). Fresh primary chondrocytes (P0f) obtained from live human donors were co-cultured. Three-dimensional constructs were prepared with a monolayer of passage-2 chondrocytes, collagen membrane (Geistlich Bio-Gide®), and pellet of non-co-cultured (P2) or co-cultured chondrocytes (P2 + P0c, P2 + P0f). Constructs were implanted in the subcutaneous tissue of athymic mice and left for 3 months growth. Safranin-O and Alcian blue staining were used to glycosaminoglycan content assessment. Aggrecan and type-II collagen were evaluated by immunohistochemistry. New-formed tissue quality was evaluated with an adaptation of the modified O'Driscoll score. Histological quality of non-co-cultured group was 4.37 (SD ±4.71), while co-cultured groups had a mean score of 8.71 (SD ±3.98) for the fresh primary chondrocytes and 9.57 (SD ±1.27) in the cryopreserved chondrocytes. In immunohistochemistry, Co-culture groups were strongly stained for type-II and aggrecan not seen in the non-co-cultured group. It is possible to isolate viable chondrocytes from cadaveric human donors in samples processed in the first 48-h of dead. There is non-significant difference between the numbers of chondrocytes isolated from live or cadaveric donors. Cryopreservation of cadaveric primary chondrocytes does not alter the capability to form cartilage like tissue. Co-culture of primary and passaged chondrocytes enhances the histological quality of new-formed tissue compared to non-co-cultured cells.



http://ift.tt/2swAAh0

Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients

Abstract

Background

National rates of lateral epicondylitis and surgical treatment are poorly defined. Disease burden of lateral epicondylitis (LE) continues to increase annually. Further study is necessary to optimize treatment algorithms to reduce associated health-care expenditures.

Questions/Purposes

The purpose of this study is to review the annual incidence of LE, surgical rates, and associated health-care costs in a population setting.

Methods

A national database was queried for LE from 2007 to 2014. Surgical cases were identified and annual rates were recorded. Demographic and epidemiologic data were reported with descriptive statistics, while trends over time were analyzed using linear regression.

Results

Eighty-five thousand three hundred eighteen cases of LE were identified. The annual incidence per 10,000 patients remained constant (p = 0.304). The proportion of diagnoses in patients <65 years decreased (p ≤ 0.002) and ≥65 years increased (p < 0.001) over the study period. One thousand six hundred ninety-four patients (2%) required operative treatment. The annual rate of surgical intervention remained constant (p = 0.623). The proportion of patients <40 years requiring surgery decreased (p < 0.001) as the proportion of patients ≥65 years needing surgery increased (p = 0.003). Total reimbursement for LE procedures during the study period was $7,220,912. Average per-patient reimbursement was $4263. Both annual total reimbursement (p = 0.006) and per-patient reimbursement rates (p = 0.002) significantly increased.

Conclusion

The annual incidence of LE and rate of surgical intervention have remained constant from 2007 to 2014. The proportion of patients over >65 years diagnosed with, and receiving surgical treatment for, LE has significantly increased in recent years. Total reimbursement and average per-patient reimbursement have steadily risen, demonstrating the increasing burden of cost on the health-care system.



http://ift.tt/2qQNGEF

Charge Mediated Compaction and Rearrangement of Gas-Phase Proteins: A Case Study Considering Two Proteins at Opposing Ends of the Structure-Disorder Continuum

Abstract

Charge reduction in the gas phase provides a direct means of manipulating protein charge state, and when coupled to ion mobility mass spectrometry (IM-MS), it is possible to monitor the effect of charge on protein conformation in the absence of solution. Use of the electron transfer reagent 1,3-dicyanobenzene, coupled with IM-MS, allows us to monitor the effect of charge reduction on the conformation of two proteins deliberately chosen from opposite sides of the order to disorder continuum: bovine pancreatic trypsin inhibitor (BPTI) and beta casein. The ordered BPTI presents compact conformers for each of three charge states accompanied by narrow collision cross-section distributions (TWCCSDN2→He). Upon reduction of BPTI, irrespective of precursor charge state, the TWCCSN2→He decreases to a similar distribution as found for the nESI generated ion of identical charge. The behavior of beta casein upon charge reduction is more complex. It presents over a wide charge state range (9–28), and intermediate charge states (13–18) have broad TWCCSDN2→He with multiple conformations, where both compaction and rearrangement are seen. Further, we see that the TWCCSDN2→He of the latter charge states are even affected by the presence of radical anions. Overall, we conclude that the flexible nature of some proteins result in broad conformational distributions comprised of many families, even for single charge states, and the barrier between different states can be easily overcome by an alteration of the net charge.

Graphical Abstract



http://ift.tt/2qU9Iu5

Erosion from a Cross-Country Natural Gas Pipeline Corridor: The Critical First Year

Abstract

Sediment losses as concentrations and yields were measured for a year from 12 segments of a newly constructed (buried) natural gas pipeline on the US Forest Service's Fernow Experimental Forest in West Virginia. Pipeline segments were separated by waterbars which served as drainage features. Six segments were northwest-facing, and six were southeast-facing. Three segments on each aspect were seeded with warm season native herbaceous species at rates used by the Forest Service (1×). All remaining segments received seeding at three times that rate (3×). Forest Service-established rates of fertilizer, lime, and straw mulch were applied to all segments. Sediment concentrations and yields generally were highest at the start of the study, respectively, averaging approximately 1660 mg L−1 and 340 kg ha−1 during the first 3 months following completion of corridor reclamation, but they were less than from nearby less-steep forest road corridors. Concentrations and yields fell significantly after the first 3 months; declines were attributed to revegetation on the ROW. At the end of the first growing season, vegetative cover on all segments ranged from 55 to 79%, with no differences between seeding rates. Mean runoff was significantly higher on the northwest-facing segments than on the southeast-facing segments, but runoff volumes did not decrease on either aspect in concert with loadings or concentrations. Higher runoff on the northwest-facing segments may have been due to clay-skinned peds in subsurface soil that limited vertical drainage. Even with a heavy straw mulch cover on the right-of-way, the timing of the highest sediment losses immediately following pipeline construction suggests that implementation of additional surface-protection best management practices could be beneficial until vegetation is reestablished.



http://ift.tt/2rXeVS2

Is 18 F-FDG-PET useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma?

Abstract

Objective

Induction therapy followed by surgery is a promising strategy for esophageal cancer patients with invasion of the trachea/bronchus or aorta. However, no diagnostic criteria have been established to diagnose whether R0 resection can be performed. We investigated whether 18F-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) and other modalities are useful for predicting R0 resection.

Methods

Fifty-seven patients with esophageal cancer invading the trachea/bronchus or aorta who underwent induction therapy followed by surgery were enrolled. We divided the participants into two groups, an R0 resection group (n = 43) and a non-R0 resection group (n = 14), and then compared the between-group results of three modalities, including computed tomography (CT), endoscopy and 18F-FDG-PET, before and after induction therapy.

Results

The post-maximal standardized uptake value (SUVmax) after induction therapy in the R0 resection group was significantly lower than that in the non-R0 resection group (4.4 vs. 6.6, p = 0.005). The receiver operating characteristic curve analysis showed that the cut-off value for the post-SUVmax based on 18F-FDG-PET prediction of R0 resection was 4.7. Furthermore, a tumor reduction rate of ≥44% on CT, no residual stenosis, and no deep ulcer on endoscopy were associated with R0 resection after induction therapy (p = 0.002, p = 0.091, and p = 0.059, respectively). Multivariate logistic analyses revealed that the tumor reduction rate on CT and post-SUVmax <4.7 in 18F-FDG-PET were independent factors for R0 resection.

Conclusions

The post-SUVmax determined by 18F-FDG-PET and the volume reduction rate based on CT scans were useful for predicting R0 resection after induction therapy for initially unresectable locally advanced esophageal carcinoma.



http://ift.tt/2rXob8H

Analysis of Promoters of Arabidopsis thaliana Divergent Gene Pair SERAT3;2 and IDH - III Shows SERAT3;2 Promoter is Nested Within the IDH - III Promoter

Abstract

Intergenic regions of divergent gene pairs show bidirectional promoter activity but whether regulatory sequences for gene expression in opposite directions are shared is not established. In this study, promoters of divergently arranged gene pair At4g35640At4g35650 (SERAT3;2-IDH-III) of Arabidopsis thaliana were analyzed to identify overlapping regulatory regions. Both genes showed the highest expression in flower buds and flowers. 5′ RACE experiments extended the intergenic region from 161 bp shown in TAIR annotation to 512 bp. GUS analysis of transgenic A. thaliana plants carrying the 691 bp fragment (512 bp intergenic region plus 5′ UTR of both the genes) linked to uidA gene revealed that SERAT3;2 promoter drives gene expression in the tapetum, whereas IDH-III promoter functions specifically in microspores/pollen. Serial 5′ deletion of the 691 bp fragment showed SERAT3;2 promoter extends up to −355 position, whereas IDH-III promoter encompasses the 512 bp intergenic region. In transgenics, uidA transcript levels were lower than native SERAT3;2 and IDH-III transcripts indicating presence of additional cis regulatory elements beyond the 691 bp fragment. The present study demonstrated for the first time occurrence of a nested promoter in plants and identified a novel bidirectional promoter capable of driving gene expression in tapetum and microspores/pollen.



http://ift.tt/2swJStf

Secondary breast carcinoma after completely remitted chronic myeloid leukemia following targeted tyrosine kinase inhibitor therapy

Abstract

We describe a rare case of secondary breast carcinoma after chronic myeloid leukemia (CML) in a 56-year-old woman. The patient was treated with hydroxyurea and imatinib for CML and achieved complete remission (she has since been taking imatinib as the maintenance therapy). Four years later, the patient noticed a firm and painless lump in the left breast, which was diagnosed as ductal carcinoma in situ based on a percutaneous biopsy of the mass. Simple resection and sentinel lymph node biopsy of the left breast were then performed. Pathological studies revealed a medium-grade intraductal carcinoma, with local infiltration associated with invasive micropapillary carcinoma. She received adjuvant endocrine therapy with imatinib after surgery. Breast cancer secondary to CML (treated with imatinib and completely remitted) is extremely rare. This report provides evidence to assist in the diagnosis and treatment for this rare manifestation.



http://ift.tt/2rM2ozW

New cryptotanshinone derivatives with anti-influenza A virus activities obtained via biotransformation by Mucor rouxii

Abstract

This paper provides an efficient platform to diversify the structure and pharmaceutical potentials of known natural products. Seven metabolites were obtained via the biotransformation of cryptotanshinone by the fungus Mucor rouxii AS 3.3447, and assigned as 13R-14R-hydroxy-anhydride of 16R-cryptotanshinone (1), 1S-hydroxy-anhydride of 16R-cryptotanshinone (2), 1R-hydroxy-anhydride of 16R-cryptotanshinone (3), 3S-hydroxy-epicryptoacetalide (4), 3S-hydroxy-cryptoacetalide (5), epicryptoacetalide (6), and cryptoacetalide (7). Among these compounds, 15 are novel. The ortho-naphthoquinone chromophore of cryptotanshinone was degraded and rearranged by M. rouxii. 1 and 3 showed good anti-influenza A virus activities with the reduced cytotoxic activities compared to the parent substrate cryptotanshinone (8). The structures of all the new compounds were determined on the basis of HRESIMS (high-resolution electrospray ionization mass spectroscopy) spectrometry, NMR (nuclear magnetic resonance) spectroscopy, ECD (electronic circular dichroism) calculations, and the CD (circular dichroism) of "in situ" method with [Rh2(OCOCF3)4].



http://ift.tt/2rXA5j1

The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study

Abstract

Background

Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia.

Methods

Retrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index.

Results

We identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3–6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0–22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35–1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50–79 years). The excess risk was more pronounced among men than women.

Conclusions

By the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.



http://ift.tt/2rDKjC9

Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review

Abstract

Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections.



http://ift.tt/2qU4ONM

Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases

Abstract

Objective

Intussusception secondary to pathologic lead points (PLPs) is a challenging condition for pediatric surgeons, and few studies have been published on this subject. The aim of this study was to review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in children.

Methods

Between 2002 and 2016, a total of 65 pediatric patients with a diagnosis of intussusception secondary to PLPs were retrospectively reviewed.

Results

The series comprised 47 males and 18 females. The average age of the patients was 4.9 years old. All patients had typical clinical manifestations, and intussusception was proven by ultrasound. Fifty-one patients had recurrent intussusception, of whom 21 had one, 14 had two, 10 had three, and 6 had more than three. There were 20 episodes of recurrence within 24 h (39.2%), 15 episodes were found between 24 and 72 h (29.4%), and the remaining 31.4% (16/51) of recurrences occurred after 72 h. All patients received surgical intussusception reduction. Meanwhile, enterectomy was the procedure of choice in 55 patients, polypectomy in 5 patients, and cystectomy in 3 patients. The types of intussusception secondary to PLPs included small intestinal (n = 25), ileocolic (n = 19), ileocecal (n = 11), ileo–ileocolic (n = 9) and cecalcolic (n = 1). The types of PLPs included Meckel diverticulum (n = 32), intestinal duplication (n = 14), benign polyps (n = 5), malignant lymphoma (n = 4), Peutz–Jeghers syndrome (n = 3), mesenteric cyst (n = 3), intestinal wall hematoma of hemophilia (n = 2), allergic purpura (n = 1), and hamartoma (n = 1). All patients recovered well with no relapse during follow-up, except for one patient who had an intestinal obstruction from adhesions that occurred approximately 3 months after discharge and who was curable after conservative treatment.

Conclusions

Intussusception secondary to PLPs tends to exhibit recurrence. There are various types of intussusception secondary to PLPs. It is necessary to improve auxiliary examinations to identify the etiology and avoid intraoperative omission. Surgical reduction of intussusception secondary to PLPs is the preferred clinical management.



http://ift.tt/2rMh5Dl

The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study

Abstract

Background

Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia.

Methods

Retrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index.

Results

We identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3–6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0–22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35–1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50–79 years). The excess risk was more pronounced among men than women.

Conclusions

By the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.



http://ift.tt/2rDKjC9

Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review

Abstract

Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections.



http://ift.tt/2qU4ONM

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