Σάββατο, 24 Ιουνίου 2017

High-touch surfaces: microbial neighbours at hand

Abstract

Despite considerable efforts, healthcare-associated infections (HAIs) continue to be globally responsible for serious morbidity, increased costs and prolonged length of stay. Among potentially preventable sources of microbial pathogens causing HAIs, patient care items and environmental surfaces frequently touched play an important role in the chain of transmission. Microorganisms contaminating such high-touch surfaces include Gram-positive and Gram-negative bacteria, viruses, yeasts and parasites, with improved cleaning and disinfection effectively decreasing the rate of HAIs. Manual and automated surface cleaning strategies used in the control of infectious outbreaks are discussed and current trends concerning the prevention of contamination by the use of antimicrobial surfaces are taken into consideration in this manuscript.



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Development of rigid toughened photocurable epoxy foams

Abstract

This study present a fast and efficient method for preparing photocurable rigid epoxy foams. A system based on the anionic photopolymerization of diglycidyl ether of bisphenol A (DGEBA) combined with a thiol-ene photopolymerization, was used. A tertiary diamine curing agent functionalized with four allyl groups was used in conjunction with a multifunctional thiol. The presence of several basic species, like tertiary amines, thiolates, polythioethers and alkoxide groups induced the anionic ring opening polymerization of the epoxy groups. At the same time the double bonds of the curing agent reacted with the multifunctional thiol generating polythioethers. The flexibility of the polythioethers modified the properties of the epoxy polymers, improving their toughness. Benzenesulfonyl hydrazide as foaming agent and zinc oxide as activator were added to DGEBA to produce the epoxy foams. The photopolymerization kinetics showed that conversion of the epoxide groups reached 80% in 600 s. Thermal curing studies performed by DSC showed that the main curing exotherm were determined at 84–89 °C, which match the temperature at which the photocuring was carried out in the UV light chamber (85 °C). It was found that the viscosity of the formulations plays a key role in the pore size of the foamed polymer, the higher the viscosity the larger the pore sizes. It was also determined that the impact resistance of the produced foams increased with increasing concentration of the thiol-ene system, as a consequence of a greater amount of polythioethers present in the co-network.



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Novel approach to the maxillary sinusitis after sinus graft

Abstract

Background

Postoperative infection occurs when bone graft material is dislodged into the maxillary sinus cavity and most of the patients are often uncomfortable with the drainage and irrigation procedures to eradicate the infection. In this case report, we share a technique in treating patients with such condition.

Material and methods

A 47-year-old patient was referred after sinus elevation using the crestal socket osteotome, bone graft, and implant insertion at a local clinic. Clinical and radiographic findings confirmed the diagnosis of right maxillary sinusitis. A surgical and medical treatment regimen was applied.

Results

By using this technique for irrigation, we were able to achieve successful results, and the patient was satisfied due to less discomfort during the irrigation process.

Conclusion

This method is a patient-friendly technique for sinus irrigation. It is not only limited to sinus grafted patients, but also maxillary sinusitis patients in any other type of odontogenic infection.



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A simple technique for repositioning of the mandible by a surgical guide prepared using a three-dimensional model after segmental mandibulectomy

Abstract

Background

Mandibular reconstruction is performed after segmental mandibulectomy, and precise repositioning of the condylar head in the temporomandibular fossa is essential for maintaining preoperative occlusion.

Methods

In cases without involvement of soft tissue around the mandibular bone, the autopolymer resin in a soft state is pressed against the lower border of the mandible and buccal and lingual sides of the 3D model on the excised side. After hardening, it is shaved with a carbide bar to make the proximal and distal parts parallel to the resected surface in order to determine the direction of mandibular resection. On the other hand, in cases that require resection of soft tissue around the mandible such as cases of a malignant tumor, right and left mandibular rami of the 3D model are connected with the autopolymer resin to keep the preoperative position between proximal and distal segments before surgical simulation. The device is made to fit the lower border of the anterior mandible and the posterior border of the mandibular ramus. The device has a U-shaped handle so that adaptation of the device will not interfere with the soft tissue to be removed and has holes to be fixed on the mandible with screws.

Results

We successfully performed the planned accurate segmental mandibulectomy and the precise repositioning of the condylar head by the device.

Conclusions

The present technique and device that we developed proved to be simple and useful for restoring the preoperative condylar head positioning in the temporomandibular fossa and the precise resection of the mandible.



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Book review for “Orthognathic Surgery: Principles, Planning and Practice”



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A correlation between secondary structure and rheological properties of low-density lipoproteins at air/water interfaces

Abstract

The secondary structure of apolipoprotein B-100 is studied within the bulk phase and at the air/water interface. In these "in viro" experiments, infrared reflection absorption spectroscopy (IRRAS) study was performed at the air/water interface while circular dichroism (CD) was conducted in the bulk phase. In the bulk phase, the conformational structure containing a significant amount of β–structure, whereas varying amount of α-helix, unordered structures, and β-sheet were observed at the air/water interface depending on the low-density lipoprotein (LDL) film interfacial pressure. The present IRRAS results demonstrate the importance of interfacial pressure-induced structural conformations on the apoB-100. A correlation between the secondary structure of the apoB-100 protein and the monomolecular film elasticity at the air/water interface was also established. The orientation of apoB-100 with respect to the LDL film-normal was found to depend on the interfacial pressure exhibited by the monomolecular film. These results may shed light on LDL's pivotal role in the progression of atherosclerotic coronary artery disease as demonstrated previously by clinical trials.



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Predictive Value of C-Reactive Protein for Complications Post-laparoscopic Roux-En-Y Gastric Bypass—Author Reply



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Assessing high impacts of climate change: spatial characteristics and relationships of hydrological ecosystem services in northern Japan (Teshio River watershed)

Abstract

Ecosystem services (ESs) provide information on the tendency of ecosystems to reach and form a state of equilibrium. The process of ES changes is important in order to identify the climate change-related causes that occur regionally to globally. ES-based management plays an important role in mitigation strategies for the negative impact of global climate change on ecosystem. Therefore, it is necessary to evaluate spatial characteristics and relationships among these multiple services from different spatial scales which could aid in multiple ES sustainable development from local to global scales. In this study, we developed a framework for analyzing the spatial characteristics and interactive relationships of multiple ESs. We analyzed the spatial distributions of six hydrological ESs that are important in the northernmost part of Japan (Teshio River watershed) by using hydrology and nutrient model (Soil and Water Assessment Tool, SWAT) under baseline climate conditions and climate change derived from the global circulation model (GCM). We then explored the spatial characteristic scales of ESs by multiscale analysis (lacunarity estimation) to reveal provision flow and spatial distribution characteristics for hydrological ESs. We observed a strong relationship between the spatial characteristics of land uses and ES provision. The spatial characteristics of individual hydrological ESs were totally different and had different spatial homogeneity and cluster (indicated by initial lacunarity index and lacunarity dimension). The results also showed trade-offs between inorganic nutrient retention (provision ESs) and organic nutrient and sediment retentions (regulating ESs), and synergies between organic nutrient retention and sediment retention under all climate change scenarios. The different stakeholders will take different mitigation programs (e.g., establishing riparian vegetation, planning nutrient management practices, and integrating climate change model into systematic conservation planning of ESs) to avoid negative impacts of climate change on ESs. Application of this proposed framework to study the spatial characteristics and relationships of hydrological ESs under climate change could provide understanding on the impact of climate change on ES changes and solutions to mitigate strategies to cope with those changes in the future.



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The effect of low- and high-power microwave irradiation on in vitro grown Sequoia plants and their recovery after cryostorage

Abstract

Two distinct microwave power levels and techniques have been studied in two cases: low-power microwave (LPM) irradiation on in vitro Sequoia plants and high-power microwave (HPM) exposure on recovery rates of cryostored (−196°C) Sequoia shoot apices. Experimental variants for LPM exposure included: (a) in vitro plants grown in regular conditions (at 24 ± 1°C during a 16-h light photoperiod with a light intensity of 39.06 μEm−2 s−1 photosynthetically active radiation), (b) in vitro plants grown in the anechoic chamber with controlled environment without microwave irradiation, and (c) in vitro plants grown in the anechoic chamber with LPM irradiation for various times (5, 15, 30, 40 days). In comparison to control plants, significant differences in shoot multiplication and growth parameters (length of shoots and roots) were observed after 40 days of LPM exposure. An opposite effect was achieved regarding the content of total soluble proteins, which decreased with increasing exposure time to LPM. HPM irradiation was tested as a novel rewarming method following storage in liquid nitrogen. To our knowledge, this is the first report using this type of rewarming method. Although, shoot tips subjected to HPM exposure showed 28% recovery following cryostorage compared to 44% for shoot tips rewarmed in liquid medium at 22 ± 1 °C, we consider that the method represent a basis and can be further improved. The results lead to the overall conclusion that LPM had a stimulating effect on growth and multiplication of in vitro Sequoia plants, while the HPM used for rewarming of cryopreserved apices was not effective to achieve high rates of regrowth after liquid nitrogen exposure.



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From medicinal plant extracts to defined chemical compounds targeting the histamine H 4 receptor: Curcuma longa in the treatment of inflammation

Abstract

Objectives

The aim was to evaluate the activity of seven medicinal, anti-inflammatory plants at the hH4R with focus on defined chemical compounds from Curcuma longa.

Materials

Activities were analyzed with membrane preparations from Sf9 cells, transiently expressing the hH4R, Gαi2 and Gβ1γ2 subunits.

Methods

From the methanolic extract of C. longa curcumin (1), demethoxycurcumin (2) and bis(4-hydroxy-cinnamoyl)methane (3) were isolated, purified with HPLC (elution-time 10.20, 9.66, 9.20 min, respectively) and together with six additional extracts, were characterized via radioligand binding studies at the hH4R.

Results

Compounds from C. longa were the most potent ligands at the hH4R. They exhibited estimated K i values of 4.26–6.26 µM (1.57–2.31 µg/mL) (1); 6.66––8.97 µM (2.26–3.04 µg/mL) (2) and 10.24–14.57 µM (3.16–4.49 µg/mL) (3) (95% CI). The estimated K i value of the crude extract of curcuma was 0.50–0.81 µg/mL. Fractionated curcumin and the crude extract surpassed the effect of pure curcumin with a K i value of 5.54 µM or 2.04 µg/mL [95% CI (4.47–6.86 µM), (1.65–2.53 µg/mL)].

Conclusion

Within this study, defined compounds of C. longa were recognized as potential ligands and reasonable lead structures at the hH4R. The mode of anti-inflammatory action of curcumin was further elucidated and the role of extracts in traditional phytomedicine was strengthened.



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Preoperative nutritional status and its impact on cholangitis after Kasai portoenterostomy in biliary atresia patients

Abstract

Objective

To explore the preoperative nutrition status in patients with biliary atresia (BA) and its effect on the cholangitis of Kasai portoenterostomy (KPE).

Methods

106 patients who had been diagnosed with BA type III and were undergoing KPE were divided into two groups according to the score obtained using STRONGkids. Preoperative and postoperative data were collected to compare general characteristics and postoperative outcomes between the different groups.

Results

Forty-nine (46.2%) patients were at moderate nutritional risk (MNR) and fifty-seven (53.8%) patients were at high nutritional risk (HNR) preoperatively. The MNR group had shorter postoperative hospitalization times than the HNR group (P = 0.023). The initial postoperative cholangitis occurred later (P = 0.002) and the incidence of early cholangitis was lower (P = 0.029) in patients at MNR than in those at HNR. The ratio of jaundice clearance (P = 0.02) and 2-year native liver survival (P = 0.0109) were significantly higher in MNR group than in HNR group.

Conclusions

Patients with BA presented the greatest nutritional deficiencies and patients at HNR are more vulnerable to the early cholangitis and the rate of jaundice clearance is lower than those at MNR. The occurrence of initial postoperative cholangitis in MNR group was later than in HNR group.



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A Comprehensive Health Profile of Guyanese Immigrants Aged 18–64 in Schenectady, New York

Abstract

Guyanese immigrants are the 5th largest foreign-born group in NY State, but sparse literature is available on their health status and health needs. A community-based health interview survey of Schenectady NY residents aged 18–64 (N = 1861) was analyzed. Bivariate comparisons between Guyanese respondents and White, Black, and Hispanic respondents were made for each variable to identify disparities. As predominantly low SES immigrants, Guyanese adults were less likely to be covered by health insurance, have a usual place for care, and receive cancer screenings. They were more likely to engage in alcohol binge drinking, but generally in good overall physical and mental health and less likely to smoke or report disability. Stable family structure and supportive interpersonal relationships are major assets of this group. Improved access to affordable health insurance, linkages to primary care, targeted cancer screening programs, and culturally-sensitive behavioral health services are recommended for Guyanese immigrants.



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Quantum transition and decoherence of levitating polaron on helium film thickness under an electromagnetic field

Abstract

We have studied the transition probability and decoherence time of levitating polaron in helium film thickness. By using a variational method of Pekar type, the ground and the first excited states of polaron are calculated above the liquid-helium film placed on the polar substrate. It is shown that the polaron transits from the ground to the excited state in the presence of an external electromagnetic field in the plane. We have seen that, in the helium film, the effects of the magnetic and electric fields on the polaron are opposite. It is also shown that the energy, transition probability and decoherence time of the polaron depend sensitively on the helium film thickness. We found that decoherence time decreases as a function of increasing electron–phonon coupling strength and the helium film thickness. It is seen that the film thickness can be considered as a new confinement in our system and can be adjusted in order to reduce decoherence.



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The Comprehension of Syntactic and Affective Prosody by Adults with Autism Spectrum Disorder Without Accompanying Cognitive Deficits

Abstract

The present study investigates the comprehension of syntactic and affective prosody in adults with autism spectrum disorder without accompanying cognitive deficits (ASD w/o cognitive deficits) as well as age-, education- and gender-matched unimpaired adults, while processing orally presented sentences. Two experiments were conducted: (a) an on-line sentence completion task containing local subject/object ambiguities and (b) an affective prosody task exploring the comprehension of six emotions. The syntactic prosody task revealed that the experimental group performed similar to the control group on the fillers and the object condition. On the other hand, the ASD w/o cognitive deficits group manifested lower accuracy compared to the unimpaired controls in the subject reading condition, as well as slower reaction times in all conditions. In the affective prosody task, the experimental group performed significantly worse than the controls in the recognition of the emotion of surprise, whereas no differences between the experimental and the control group were attested in the recognition of all other emotions. A positive correlation was found between the two tasks in the ASD w/o cognitive deficits group. Thus, individuals with ASD w/o cognitive deficits face slight difficulties with the decoding of prosody, both the syntactic and the affective one. More specifically, these difficulties are attested in the most difficult conditions, i.e. the subject reading and the emotion of surprise.



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Alzheimer’s disease related genes during primate evolution

Abstract

During primate evolution, the neuronal and cognition-related genes have evolved rapidly. These genes seem to induce neurological illnesses such as Alzheimer's disease (AD). In this study, we analyzed genes APOE, TOMM40, and PICALM known as the risk factors of AD. We performed bioinformatics analyses in relation to evolution, phylogeny, and protein structure for those genes in humans, Neanderthals, chimpanzees, bonobos, gorillas, orangutans, crab-eating monkeys, and rhesus monkeys. Cholesterol-related genes showed relatively rapid evolution toward a lower risk of AD. Neanderthals showed relatively higher polymorphism in genes APOE, TOMM40, and PICALM than humans did. Phylogeny indicated different topologies in the trichotomy of humans, chimpanzees, and gorillas in terms of genes APOE, TOMM40, and PICALM. These results provide to hominin-specific patterns in three genes, and give clues to the modern human-specific traits of AD and shed light on further functional research helping to understand AD.



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Improving the construction of ORB through FPGA-based acceleration

Abstract

Binary descriptors have won their place as efficient and effective visual descriptors in several vision tasks. In this context, one of the most widely used binary descriptors to date is the ORB descriptor. ORB is robust against rotation changes, and it uses a learning procedure to generate sampling pairwise tests to construct the descriptor. However, this construction involves a sequential memory access of as many steps as the binary string size. From the latter and motivated by the fact that modern computer vision tasks may require the construction of thousands, if not millions of binary descriptors, we propose to accelerate the construction process of the ORB descriptor via an FPGA-based hardware architecture. The latter is leveraged with a novel arrangement of pairwise tests, which takes advantage of a dual random access memory scheme achieving an acceleration of up to 17 times when compared against the sequential way. The empirical assessment indicates that ORB descriptors obtained from the proposed approach keep a similar performance to that of the original ORB.



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A rigorous analysis of the intermodal delay in few-mode fibers

Abstract

The intermodal delay is one of the fundamental issues in the mode of transmission which limits the propagation distance of mode division multiplexing. In this paper the theoretical background and a numerical analysis of intermodal group velocity dispersion in step-index of few-mode fiber are given. The numerical analysis is based on the general solution of the characteristic equation for step-index few mode fiber in order to compute normalized propagation constant, group delay and finally the group delay difference between fundamental LP01 mode and three selected higher modes. It was found that the material dispersion is not a negligible part of the total intermodal delay and so it should be included.



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Variation of magnetoimpedance of electrodeposited NiFe/Cu with deposition current density

Abstract

An investigation about influence of deposition current density on electrodeposited magnetic film is reported in this paper. Ferromagnetic NiFe thin films were electrodeposited on copper wires of 100 μm diameter for various electrdepostion current densities ranging from 10 to 60 mA/cm2 maintaining equal thickness in all films. The composition of deposited film varied with deposition current density and in particular, a composition of Ni79Fe21 was achieved for a current density of 20 mA/cm2. The surface microstructure of the film deposited at the current density of 20 mA/cm2 was found to have excellent smoothness. The coercivity of the film was lowest and highest value of magnetoimpedance was measured for this film. The influence of current density on film composition and hence magnetic properties was attributed to the change of deposition mechanism.



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Effect of exercising at minimum recommendations of the multiple sclerosis exercise guideline combined with structured education or attention control education – secondary results of the step it up randomised controlled trial

Abstract

Background

Recent exercise guidelines for people with multiple sclerosis (MS) recommend a minimum of 30 min moderate intensity aerobic exercise and resistance exercise twice per week. This trial compared the secondary outcomes of a combined 10-week guideline based intervention and a Social Cognitive Theory (SCT) education programme with the same exercise intervention involving an attention control education.

Methods

Physically inactive people with MS, scoring 0–3 on Patient Determined Disease Steps Scale, with no MS relapse or change in MS medication, were randomised to 10-week exercise plus SCT education or exercise plus attention control education conditions. Outcomes included fatigue, depression, anxiety, strength, physical activity, SCT constructs and impact of MS and were measured by a blinded assessor pre and post-intervention and 3 and 6 month follow up.

Results

One hundred and seventy-four expressed interest, 92 were eligible and 65 enrolled. Using linear mixed effects models, the differences between groups on all secondary measures post-intervention and at follow-up were not significant. Post-hoc, exploratory, within group analysis identified improvements in both groups post intervention in fatigue (mean ∆(95% CI) SCT -4.99(−9.87, −0.21), p = 0.04, Control −7.68(−12.13, −3.23), p = 0.00), strength (SCT -1.51(−2.41, −0.60), p < 0.01, Control −1.55(−2.30, −0.79), p < 0.01), physical activity (SCT 9.85(5.45, 14.23), p < 0.01, Control 12.92(4.69, 20.89), goal setting (SCT 7.30(4.19, 10.4), p < 0.01, Control 5.96(2.92, 9.01), p < 0.01) and exercise planning (SCT 5.88(3.37, 8.39), p < 0.01, Control 3.76(1.27, 6.25), p < 0.01) that were maintained above baseline at 3 and 6 month follow up (all p < 0.05). Only the SCT group improved at 3 and 6 month follow up in physical impact of MS(−4.45(−8.68, −0.22), −4.12(−8.25, 0.01), anxiety(−1.76(−3.20, −0.31), −1.99(−3.28, −0.71), depression(−1.51(−2.89, −0.13), −1.02(−2.05, 0.01)) and cognition(5.04(2.51, 7.57), 3.05(0.81, 5.28), with a medium effect for cognition and fitness (Hedges' g 0.75(0.24, 1.25), 0.51(0.01, 1.00) at 3 month follow up.

Conclusions

There were no statistically significant differences between groups for the secondary outcomes once age, gender, time since diagnosis and type of MS were accounted for. However, within the SCT group only there were improvements in anxiety, depression, cognition and physical impact of MS. Exercising at the minimum guideline amount has a positive effect on fatigue, strength and PA that is sustained at 3 and 6 months following the cessation of the program.

Trial registration

ClinicalTrials.gov, NCT02301442, retrospectively registered on November 13th 2014.



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Editorial



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Autophagy and multidrug resistance in cancer

Abstract

Multidrug resistance (MDR) occurs frequently after long-term chemotherapy, resulting in refractory cancer and tumor recurrence. Therefore, combatting MDR is an important issue. Autophagy, a self-degradative system, universally arises during the treatment of sensitive and MDR cancer. Autophagy can be a double-edged sword for MDR tumors: it participates in the development of MDR and protects cancer cells from chemotherapeutics but can also kill MDR cancer cells in which apoptosis pathways are inactive. Autophagy induced by anticancer drugs could also activate apoptosis signaling pathways in MDR cells, facilitating MDR reversal. Therefore, research on the regulation of autophagy to combat MDR is expanding and is becoming increasingly important. We summarize advanced studies of autophagy in MDR tumors, including the variable role of autophagy in MDR cancer cells.



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Immunoproteasome deficiency alters microglial cytokine response and improves cognitive deficits in Alzheimer’s disease-like APPPS1 mice

Abstract

The immunoproteasome (iP) represents a specialized type of proteasomes, which plays an important role in the clearance of oxidant-damaged proteins under inflammatory and pathological conditions determining the outcome of various diseases. In Alzheimer's disease (AD)-like APPPS1 mice Aβ-deposition is paralleled by iP upregulation, most likely mediated through type I interferon induction. To define the impact of increased iP expression we crossed APPPS1 mice with mice deficient in the iP subunit LMP7 resulting in impaired iP function. While LMP7 deficient APPPS1 mice showed no major change in cerebral Aβ-pathology, we observed an altered cytokine response in microglia isolated from LMP7 deficient APPPS1 mice compared to LMP7 expressing APPPS1 control mice. The altered microglial cytokine profile upon iP deficiency in the presence of extracellular Aβ-pathology was associated with an improvement of Aβ-associated cognitive deficits typically present in APPPS1 mice. Our findings suggest a role for iP in the regulation of the innate immune response towards extracellular Aβ-pathology and indicate that inhibition of iP function can modulate the cognitive phenotype upon overexpression of Aβ.



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Coffee consumption and risk of renal cell carcinoma

Abstract

Background

Studies have suggested an inverse association between coffee consumption and risk of renal cell carcinoma (RCC); however, data regarding decaffeinated coffee are limited.

Methods

We conducted a case–control study of 669 incident RCC cases and 1,001 frequency-matched controls. Participants completed identical risk factor questionnaires that solicited information about usual coffee consumption habits. The study participants were categorized as non-coffee, caffeinated coffee, decaffeinated coffee, or both caffeinated and decaffeinated coffee drinkers. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, adjusting for multiple risk factors for RCC.

Results

Compared with no coffee consumption, we found an inverse association between caffeinated coffee consumption and RCC risk (OR 0.74; 95% CI 0.57–0.99), whereas we observed a trend toward increased risk of RCC for consumption of decaffeinated coffee (OR 1.47; 95% CI 0.98–2.19). Decaffeinated coffee consumption was associated also with increased risk of the clear cell RCC (ccRCC) subtype, particularly the aggressive form of ccRCC (OR 1.80; 95% CI 1.01–3.22).

Conclusions

Consumption of caffeinated coffee is associated with reduced risk of RCC, while decaffeinated coffee consumption is associated with an increase in risk of aggressive ccRCC. Further inquiry is warranted in large prospective studies and should include assessment of dose–response associations.



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CT findings in patients with Cabazitaxel induced pelvic pain and haematuria: a case series

Abstract

Background

Haematuria and pelvic pain are recognized and documented adverse reactions related to Cabazitaxel use. To date there has not been any documentation of imaging findings in patients with this presentation.

Cases

We report a case series of five patients who experienced these symptoms while on Cabazitaxel and were all found to have very similar urothelial changes on CT. The patients were noted to have ureteric and renal pelvic dilatation along with urothelial enhancement (in those who had post contrast imaging). All of these changes were noted to be reversible in those who had follow up imaging after cessation of Cabazitaxel and initiation of a short course of steroids.

Conclusion

This case series helps demonstrate the pathological reversible urothelial inflammatory changes that may be occurring in patients experiencing haematuria and pelvic pain on Cabazitaxel therapy. These changes may relate to direct toxic effect of drug metabolites, a radiation recall type phenomenon or a combination of both.



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A case of SAPIEN XT valve fallen into left ventricle during valve-in-valve transcatheter aortic valve implantation

Abstract

Late transcatheter heart valve embolization is a rare but life-threatening complication of transcatheter aortic valve implantation. Surgical intervention is performed for most cases, but some cases were treated by valve-in-valve transcatheter aortic valve implantation. We describe a patient in whom a 29-mm Edwards SAPIEN XT valve migrated into the left ventricular outflow tract 41 days after the initial implantation. We tried to perform valve-in-valve transcatheter aortic valve implantation using a transfemoral approach. As soon as the second transcatheter heart valve touched the first implanted valve, it fell into the left ventricle. Immediate surgical intervention was required. The first valve was removed, and surgical aortic valve replacement was successfully performed. In conclusion, we should choose surgical aortic valve replacement for late transcatheter heart valve embolization. Even if we need to treat by catheter intervention, transapical approach may be better.



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Role of coronal high-resolution diffusion-weighted imaging in acute optic neuritis: a comparison with axial orientation

Abstract

Purpose

Through a comparison with the axial orientation, we aimed to evaluate the role of coronal high-resolution diffusion-weighted imaging (DWI) in acute optic neuritis based on diagnostic accuracy and the reproducibility of apparent diffusion coefficient (ADC) measurements.

Methods

Orbital DWI, using readout-segmented, parallel imaging, and 2D navigator-based reacquisition (RESOLVE-DWI), was performed on 49 patients with acute vision loss. The coronal (thickness = 3 mm) and axial (thickness = 2 mm) diffusion images were evaluated by two neuroradiologists retrospectively. The sensitivity, specificity, and accuracy were calculated through diagnostic test; the inter- and intra-observer reliabilities were assessed with a weighted Cohen's kappa test. In addition, the agreement of ADC measurement among observers was evaluated by the intra-class correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman plots. Comparison of ADC values was also performed by unpaired t test.

Results

Among the 49 patients, 47 clinically positive optic nerves and 51 clinically negative optic nerves were found. The sensitivity, specificity, and accuracy were 85.1/87.2%, 90.2/94.12%, and 87.8/90.8%, respectively, for coronal RESOLVE-DWI and 83.0/85.1%, 66.7/76.5%, and 75.5/79.6%, respectively, for axial RESOLVE-DWI. The inter-observer kappa values were 0.710 and 0.806 for axial and coronal RESOLVE-DWI, respectively, and the intra-observer kappa values were 0.822 and 0.909, respectively (each P < 0.0001). Regarding the reproducibility of ADC measurements on axial and coronal RESOLVE-DWI, the ICCs among observers were 0.846 and 0.941, respectively, and the CV values were 7.046 and 4.810%, respectively. Bland-Altman plots revealed smaller inter-observer variability on coronal RESOLVE-DWI. ADC values were significantly lower in positive group (each P < 0.0001).

Conclusion

Higher specificity and better reproducibility of ADC measurements were found for coronal RESOLVE-DWI, which demonstrated the feasibility of the use of coronal RESOLVE-DWI to examine acute optic neuritis patients.



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Shifting the Physical Inactivity Curve Worldwide by Closing the Gender Gap

Abstract

Purpose

The aims of this study were to (i) examine gender differences in physical inactivity in countries with different levels of Human Development Index (HDI); and (ii) assess whether small changes in the prevalence of inactivity in women could achieve the World Health Organization's (WHO) global inactivity target.

Methods

Data on inactivity were extracted for 142 countries for the year 2010 from the WHO Data Repository. Data for HDI were obtained for the year 2010 from the United Nations Development Program. Absolute and relative gender differences were calculated for countries according to four HDI categories. The potential effects of increasing women's activity levels on achievement of the WHO physical inactivity target were computed.

Results

Overall inactivity prevalence was higher in women (27%) than in men (20%). Women were more inactive than men in all except eight countries. Absolute gender differences [median 7.5% (range −10.1 to 33.2)] did not vary by HDI category, but there was a small negative correlation between relative gender difference in inactivity and HDI (rho −0.19; p = 0.02), which was mostly influenced by three outlier countries with low HDI. A decrease in inactivity levels of 4.8% points among women across the world would achieve the WHO target of reducing global levels of inactivity by 10%.

Conclusion

Gender differences in the prevalence of physical inactivity were highly variable, both within and across categories of HDI. Interventions which result in small changes in inactivity prevalence in women would achieve the 2025 WHO global target for inactivity, without any change to the prevalence in men.



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Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement

Abstract

Purpose

Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach.

Methods

We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0–7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results.

Results

The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p < 0.01), but not at 24 months. Two patients with failed supraclavicular nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers.

Conclusion

Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.



http://ift.tt/2sMjgVW

Pre-anesthetic stroke volume variation can predict cardiac output decrease and hypotension during induction of general anesthesia

Abstract

This study aimed to assess the reliability of stroke volume variation (SVV) in predicting cardiac output (CO) decrease and hypotension during induction of general anesthesia. Forty-five patients undergoing abdominal surgery under general anesthesia were enrolled. Before induction of anesthesia, patients were required to maintain deep breathing (6–8 times/min), and pre-anesthetic SVV was measured for 1 min by electrical cardiometry. General anesthesia was induced with propofol, remifentanil, rocuronium, and sevoflurane. Study duration was defined from the start of fluid administration till 5 min after tracheal intubation. Blood pressure (BP) was measured every minute. Cardiac output was measured continuously by electrical cardiometry. Receiver operating characteristics (ROC) curves were made regarding the incidence of decreased CO (less than 70% of the baseline) and hypotension (mean BP <65 mmHg). The risk of developing decreased CO and hypotension was evaluated by multivariate logistic regression analysis. The time from the start of the procedure to onset of decreased CO was analyzed by the Kaplan–Meier method. The area under the ROC curve and optimal threshold value of pre-anesthetic SVV for predicting decreased CO and hypotension were 0.857 and 0.693. Patients with lower SVV exhibited a significantly slower onset and lower incidence of decreased CO than those with higher SVV (p = 0.003). Multivariate logistic regression analysis indicated high pre-anesthetic SVV as being an independent risk factor for decreased CO and hypotension (odds ratio, 1.43 and 1.16, respectively). In conclusions, pre-anesthetic SVV can predict incidence of decreased CO and hypotension during induction of general anesthesia.



http://ift.tt/2tZvWbc

Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis

Abstract

Purpose

To compare the clinical effectiveness of decompression plus fusion and decompression alone for patients with degenerative lumbar spondylolisthesis, a systematic review and meta-analysis of all available evidence was performed.

Methods

A search of the literature was conducted on PubMed/MEDLINE, EMBASE, and the Cochrane Collaboration Library. Relevant studies comparing decompression plus fusion and decompression alone were selected according to eligibility criteria. Predefined endpoints were extracted and meta-analyzed from the identified studies.

Results

Four randomized controlled trials and 13 observational studies were eligible. The pooled data revealed that fusion was associated with significantly higher rates of satisfaction and lower leg pain scores when compared with decompression alone. However, fusion significantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar ODI, back pain scores, complication rate, and reoperation rate.

Conclusions

Based on the available evidence, decompression plus fusion maybe be better than decompression alone in the treatment of degenerative spondylolisthesis. Fusion had advantages of improvement of clinical satisfaction, as well as reduction of postoperative leg pain, with similar complication rate to decompression alone.



http://ift.tt/2s6JaBq

Enhancement of antibiotic productions by engineered nitrate utilization in actinomycetes

Abstract

Nitrate is necessary for primary and secondary metabolism of actinomycetes and stimulates the production of a few antibiotics, such as lincomycin and rifamycin. However, the mechanism of this nitrate-stimulating effect was not fully understood. Two putative ABC-type nitrate transporters were identified in Streptomyces lincolnensis NRRL2936 and verified to be involved in lincomycin biosynthesis. With nitrate supplementation, the transcription of nitrogen assimilation genes, nitrate-specific ABC1 transporter genes, and lincomycin exporter gene lmrA was found to be enhanced and positively regulated by the global regulator GlnR, whose expression was also improved. Moreover, heterologous expression of ABC2 transporter genes in Streptomyces coelicolor M145 resulted in an increased actinorhodin production. Further incorporation of a nitrite-specific transporter gene nirC, as in nirC-ABC2 cassette, led to an even higher actinorhodin production. Similarly, the titers of salinomycin, ansamitocin, lincomycin, and geldanamycin were increased with the integration of this cassette to Streptomyces albus BK3-25, Actinosynnema pretiosum ATCC31280, S. lincolnensis LC-G, and Streptomyces hygroscopicus XM201, respectively. Our work expanded the nitrate-stimulating effect to many antibiotic producers by utilizing the nirC-ABC2 cassette for enhanced nitrate utilization, which could become a general tool for titer increase of antibiotics in actinomycetes.



http://ift.tt/2t5NN3G

Engineered jadomycin analogues with altered sugar moieties revealing JadS as a substrate flexible O -glycosyltransferase

Abstract

Glycosyltransferases (GTs)-mediated glycodiversification studies have drawn significant attention recently, with the goal of generating bioactive compounds with improved pharmacological properties by diversifying the appended sugars. The key to achieving glycodiversification is to identify natural and/or engineered flexible GTs capable of acting upon a broad range of substrates. Here, we report the use of a combinatorial biosynthetic approach to probe the substrate flexibility of JadS, the GT in jadomycin biosynthesis, towards different non-native NDP-sugar substrates, enabling us to identify six jadomycin B analogues with different sugar moieties. Further structural engineering by precursor-directed biosynthesis allowed us to obtain 11 new jadomycin analogues. Our results for the first time show that JadS is a flexible O-GT that can utilize both l- and d- sugars as donor substrates, and tolerate structural changes at the C2, C4 and C6 positions of the sugar moiety. JadS may be further exploited to generate novel glycosylated jadomycin molecules in future glycodiversification studies.



http://ift.tt/2tFiRo9

Development and application of anticancer fluorescent CdS nanoparticles enriched Lactobacillus bacteria as therapeutic microbots for human breast carcinoma

Abstract

Applications of probiotic bacteria and nanoparticles (NPs) as therapeutic agents have great importance. This study demonstrates a combinatorial approach of both the probiotic Lactobacillus spp. (Lactobacillus fermentum and Lactobacillus plantarum) with fluorescent cadmium sulfide (CdS) NPs as therapeutic agents to target MCF-7 cancer cells (human breast cancer cells). In this study, facultative anaerobic Lactobacillus was successfully used as a vehicle to transport NPs into MCF-7 cancer cells. The cell viability assay and invasion study along with confocal and field emission scanning electron microscopy (FESEM) confirmed the release of payload (CdS NPs) into cytoplasm without any external stimuli. The biosynthesized CdS NPs of ∼22 nm were characterized by FESEM, transmission electron microscopy (TEM), atomic force microscopy (AFM), and fluorescence spectroscopy. The bacteria–NPs (microbots) interaction was investigated by growth curve studies, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), FESEM, energy dispersive X-ray spectroscopy (EDX), and fluorescence and confocal microscopy. This alternative approach showed an approved and inexpensive delivering mode of specific functional cargos or therapeutic agents into the cancer cells.



http://ift.tt/2t5Lfm7

Microbial reductive dehalogenation of trihalomethanes by a Dehalobacter -containing co-culture

Abstract

Trihalomethanes such as chloroform and bromoform, although well-known as a prominent class of disinfection by-products, are ubiquitously distributed in the environment due to widespread industrial usage in the past decades. Chloroform and bromoform are particularly concerning, of high concentrations detected and with long half-lives up to several hundred days in soils and groundwater. In this study, we report a Dehalobacter- and Desulfovibrio-containing co-culture that exhibits dehalogenation of chloroform (~0.61 mM) to dichloromethane and bromoform (~0.67 mM) to dibromomethane within 10–15 days. This co-culture was further found to dechlorinate 1,1,1-trichloroethane (1,1,1-TCA) (~0.65 mM) to 1,1-dichloroethane within 12 days. The Dehalobacter species present in this co-culture, designated Dehalobacter sp. THM1, was found to couple growth with dehalogenation of chloroform, bromoform, and 1,1,1-TCA. Strain THM1 harbors a newly identified reductive dehalogenase (RDase), ThmA, which catalyzes chloroform, bromoform, and 1,1,1-TCA dehalogenation. Additionally, based on the sequences of thmA and other identified chloroform RDase genes, ctrA, cfrA, and tmrA, a pair of chloroform RDase gene-specific primers were designed and successfully applied to investigate the chloroform dechlorinating potential of microbial communities. The comparative analysis of chloroform RDases with tetrachloroethene RDases suggests a possible approach in predicting the substrate specificity of uncharacterized RDases in the future.



http://ift.tt/2tFDAIC

Preparation of high toughness nanocomposite hydrogel with UV protection performance and self-healing property

Abstract

An ultraviolet shielding hydrogel of P(NaSS-co-MPTC)/TiO2 was prepared by introducing TiO2 nanoparticles (TiO2 NPS) into polyampholyte matrix through photo-initiated radical copolymerization of cationic monomer of 3-(methacrylamide) propyltrimethylammonium chloride (MPTC) and anionic monomer of sodium 4-vinylbenzenesulfonate (NaSS) in the aqueous solution of sodium chloride (NaCl). FTIR, XPS, TEM, XRD, and SEM were used to characterize the morphology and structure of hydrogel of P(NaSS-co-MPTC)/TiO2. The result showed that anatase TiO2 NPS with the size about 15 ~ 20 nm were not just acted as ultraviolet shielding agent and general photo-initiator, they also could be crosslinked in polyampholyte matrix by hydrogen bonding between hydroxyl groups on the surface of TiO2 NPS and sulfonate groups on the polymer chains. Based on two kinds of reversible weak bonds of hydrogen bond and ionic bond, the P(NaSS-co-MPTC)/TiO2 hydrogel exhibited excellent mechanical properties and self-healing ability at ambient conditions, which will greatly increase its service life being a UV inhibitor.



http://ift.tt/2sMu2vk

CASPER: computer-aided segmentation of imperceptible motion—a learning-based tracking of an invisible needle in ultrasound

Abstract

Purpose

This paper presents a new micro-motion-based approach to track a needle in ultrasound images captured by a handheld transducer.

Methods

We propose a novel learning-based framework to track a handheld needle by detecting microscale variations of motion dynamics over time. The current state of the art on using motion analysis for needle detection uses absolute motion and hence work well only when the transducer is static. We have introduced and evaluated novel spatiotemporal and spectral features, obtained from the phase image, in a self-supervised tracking framework to improve the detection accuracy in the subsequent frames using incremental training. Our proposed tracking method involves volumetric feature selection and differential flow analysis to incorporate the neighboring pixels and mitigate the effects of the subtle tremor motion of a handheld transducer. To evaluate the detection accuracy, the method is tested on porcine tissue in-vivo, during the needle insertion in the biceps femoris muscle.

Results

Experimental results show the mean, standard deviation and root-mean-square errors of \(1.28^{\circ }\) , \(1.09^{\circ }\) and \(1.68^{\circ }\) in the insertion angle, and 0.82, 1.21, 1.47 mm, in the needle tip, respectively.

Conclusions

Compared to the appearance-based detection approaches, the proposed method is especially suitable for needles with ultrasonic characteristics that are imperceptible in the static image and to the naked eye.



http://ift.tt/2s6Y5M5

Counter-intuitive plasma vitamin D and zinc status in HIV-1-infected adults with persistent low-level viraemia after treatment initiation: a pilot case–control study

Abstract

Determinants of persistent low-level viraemia [PLLV, a viral load (VL) of between 50 and 500 copies/mL] have not been elucidated. In a case–control study, we evaluated the influence of micronutrients on PLLV in a population of 454 HIV-1 adults having initiated antiretroviral therapy (ART) between January 2007 and December 2011. Plasma levels of retinol (vitamin A), 25-OH vitamin D2 + D3, vitamin E and zinc were measured at ART initiation in cases (PLLV after 6 months of ART) and in controls (VL <50 copies/mL after 6 months). Cases and controls were matched for the CD4 cell count (±50/mm3) and ethnic origin. Intergroup differences in demographic, biological and treatment parameters and sunshine intensity at ART initiation were adjusted using a propensity score. A receiver operating characteristic (ROC) curve was used to assess intergroup differences in plasma micronutrient levels. Thirty-three of the 454 patients (7.3%) displayed PLLV (median VL: 92 copies/mL). Patients were predominantly male (89%), Caucasian (64%) and CDC stage C (25%). The median age was 38 years, the median initial VL was 5.2 log10 copies/mL and the median CD4 count was 74/mm3. The 22 cases and matched controls were balanced in these respects, and had similar vitamin A/E levels. Two cases (9%) and 9 controls (41%) had a vitamin D level <10.3 ng/mL (p = 0.0015), and 2 cases (9%) and 10 controls (48%) had a zinc level <74.6 μg/dL (p = 0.04). Our results support in vitro studies suggesting that vitamin D favours HIV-1 replication and that HIV-1 is zinc-dependent. Wide-scale, prospective studies are required.



http://ift.tt/2t5ZIy7

The bee, the flower, and the electric field: electric ecology and aerial electroreception

Abstract

Bees and flowering plants have a long-standing and remarkable co-evolutionary history. Flowers and bees evolved traits that enable pollination, a process that is as important to plants as it is for pollinating insects. From the sensory ecological viewpoint, bee–flower interactions rely on senses such as vision, olfaction, humidity sensing, and touch. Recently, another sensory modality has been unveiled; the detection of the weak electrostatic field that arises between a flower and a bee. Here, we present our latest understanding of how these electric interactions arise and how they contribute to pollination and electroreception. Finite-element modelling and experimental evidence offer new insights into how these interactions are organised and how they can be further studied. Focussing on pollen transfer, we deconstruct some of the salient features of the three ingredients that enable electrostatic interactions, namely the atmospheric electric field, the capacity of bees to accumulate positive charge, and the propensity of plants to be relatively negatively charged. This article also aims at highlighting areas in need of further investigation, where more research is required to better understand the mechanisms of electrostatic interactions and aerial electroreception.



http://ift.tt/2tFapVQ

Safety and effectiveness of tolvaptan for fluid management after pediatric cardiovascular surgery

Abstract

Background

Postoperative fluid management is important after open heart surgery, because cardiopulmonary bypass evokes an abnormal inflammatory response and increases vascular permeability, especially in pediatric patients. We assessed the safety and effectiveness of tolvaptan for management of postoperative fluid retention after congenital heart surgery.

Methods and results

This retrospective study analyzed data from 43 children with uncomplicated congenital heart disease who underwent open heart surgery between September 2013 and August 2016. The patients were divided into two groups. Group N (n = 18; September 2013 through May 2014) received the conventional oral diuretics alone, and Group T (n = 25; June 2014 through August 2016) received a single dose of tolvaptan (0.45 mg/kg) in addition to the conventional oral diuretic therapy. Data were collected, while patients who received intensive care were assessed and compared between groups. Add-on tolvaptan use was associated with increased urinary output standardized by body weight (54.3 ± 4.5 vs 47.3 ± 19.1 mL/kg; p = 0.043), decreased additional intravenous diuretic dose standardized by body weight (0.26 ± 0.23 vs 0.62 ± 0.48 mg/kg; p = 0.001), and a smaller decrease in central venous pressure (1.3 ± 2.7 vs 1.9 ± 3.8 mmHg; p = 0.019). Laboratory analysis showed that electrolyte concentrations in blood and urine did not significantly differ between groups.

Conclusions

Tolvaptan appears to be effective and safe for management of postoperative fluid retention after congenital heart surgery.



http://ift.tt/2t5D74Y

Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery

Abstract

Objective

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. To prevent this complication, routine pharmacological prophylactic drugs could be administered. Our study aimed to analyze the various perioperative factors associated with the development of POAF after coronary artery bypass graft (CABG) surgery.

Methods

This prospective study included 617 patients, who received CABG surgery in the year 2014.

Results

There were 429 (69.5%) male and 188 (30.5%) female patients. Mean patient age was 67.2 (9.4) years, and 365 patients (59.2%) were more than 65 years. Incidence of POAF was 24.1% (N = 149). Multivariable analysis showed that independent predictors of POAF after CABG surgery were: age >65 (P  = 0.008; OR 2.089; 95% CI 1.208–3.613), AF in the past (P < 0.001; OR 10.838; 95% CI 5.28–22.247), preoperative hypertrophy or dilation of left atrium (P = 0.002; OR 4.996; 95% CI 1.823–13.691), CABG surgery using 4 or more bypass grafts (P = 0.042; OR 1.669; 95% CI 0.972–2.866), preoperative hypokalemia (P = 0.001; OR 3.317; 95% CI 1.678–6.559), >trivial mitral (P = 0.024; OR 7.556; 95% CI 0.964–20.376), and aortic (P = 0.009; OR 1.937; 95% CI 1.178–3.187) valve regurgitation.

Conclusions

The profile of patients affected by POAF was considerably different with regard to the demographics, preoperative heart condition, history of previous heart rhythm disorders, and operative data. The most important independent factors that predicted POAF after CABG surgery were associated with structural heart defects, advanced age, history of previous AF, and preoperative hypokalemia.



http://ift.tt/2rNeMwG

Resveratrol alleviates inflammatory hyperalgesia by modulation of reactive oxygen species (ROS), antioxidant enzymes and ERK activation

Abstract

Objectives

Impact of ROS in development of hyperalgesia has recently motivated scientists to focus on ROS as novel target of anti-hyperalgesic interventions. However, role of ROS in molecular signaling of hyperalgesia is still poorly understood. The present study is aimed to analyze the effect of dietary antioxidant resveratrol on antioxidant defense system, ROS level and TNFR1–ERK signaling pathway during early and late phase of inflammatory hyperalgesia.

Methods and materials

Hyperalgesia was assessed by paw withdrawal latency test in complete Freund's adjuvant-induced hyperalgesic rats. Activities of antioxidant enzymes were measured by in-gel assays, ROS level was measured by DCFH2DA, and expression of pERK, ERK and TNFR1 was estimated by Western blotting.

Results

Anti-hyperalgesic effect of resveratrol was observed by paw withdrawal latency test. ROS level was increased in paw skin as well as spinal cord during early phase which was further increased in paw skin, but remained constant in spinal cord up to late phase. Resveratrol differentially regulated the activities of SOD, catalase and GPx in paw skin as well as spinal cord of hyperalgesic rats in both phases. Activities were normalized back showing anti-hyperalgesic effect of resveratrol. Upregulated ERK signaling was modulated by resveratrol, whereas TNFR1 level remained unchanged.

Conclusion

Overall results suggest that resveratrol alleviates inflammatory hyperalgesia by downregulation of ERK activation, modulation of ROS and differential regulation of antioxidant enzymes during early and late phases.



http://ift.tt/2s6I8Wt

Extra central nervous system metastases from glioblastoma: a new possible trigger event?

Abstract

Extra-cranial metastases of glioblastoma (GBM) represent a rare event, and the biological-genetic mechanisms involved in the pathogenesis have not yet been determined. We report the case of a young patient with multiple visceral and osseous metastases occurred after 4 years after first diagnosis of GBM. The strangeness as well as the rarity of this event does not allow to identify an effective treatment for GBM metastases, making the management of this ominous tumor an even greater challenge.



http://ift.tt/2rNasNS

Regeneration of hyaline cartilage promoted by xenogeneic mesenchymal stromal cells embedded within elastin-like recombinamer-based bioactive hydrogels

Abstract

Over the last decades, novel therapeutic tools for osteochondral regeneration have arisen from the combination of mesenchymal stromal cells (MSCs) and highly specialized smart biomaterials, such as hydrogel-forming elastin-like recombinamers (ELRs), which could serve as cell-carriers. Herein, we evaluate the delivery of xenogeneic human MSCs (hMSCs) within an injectable ELR-based hydrogel carrier for osteochondral regeneration in rabbits. First, a critical-size osteochondral defect was created in the femora of the animals and subsequently filled with the ELR-based hydrogel alone or with embedded hMSCs. Regeneration outcomes were evaluated after three months by gross assessment, magnetic resonance imaging and computed tomography, showing complete filling of the defect and the de novo formation of hyaline-like cartilage and subchondral bone in the hMSC-treated knees. Furthermore, histological sectioning and staining of every sample confirmed regeneration of the full cartilage thickness and early subchondral bone repair, which was more similar to the native cartilage in the case of the cell-loaded ELR-based hydrogel. Overall histological differences between the two groups were assessed semi-quantitatively using the Wakitani scale and found to be statistically significant (p < 0.05). Immunofluorescence against a human mitochondrial antibody three months post-implantation showed that the hMSCs were integrated into the de novo formed tissue, thus suggesting their ability to overcome the interspecies barrier. Hence, we conclude that the use of xenogeneic MSCs embedded in an ELR-based hydrogel leads to the successful regeneration of hyaline cartilage in osteochondral lesions.

Graphical Abstract



http://ift.tt/2t24wo0

Impact of Site Selection and Study Conduct on Outcomes in Global Clinical Trials

Abstract

Purpose of Review

There are over 25 million patients living with heart failure globally. Overall, and especially post-discharge, clinical outcomes have remained poor in heart failure despite multiple trials, with both successes and failures over the last two decades. Matching therapies to the right patient population, identifying high-quality sites, and ensuring optimal trial design and execution represent important considerations in the development of novel therapeutics in this space.

Recent Findings

While clinical trials have undergone rapid globalization, this has come with regional variation in comorbidities, clinical parameters, and even clinical outcomes and treatment effects across international sites.

Summary

These issues have now highlighted knowledge gaps about the conduct of trials, selection of study sites, and an unmet need to develop and identify "ideal" sites. There is a need for all stakeholders, including academia, investigators, healthcare organizations, patient advocacy groups, industry sponsors, research organizations, and regulatory authorities, to work as a multidisciplinary group to address these problems and develop practical solutions to improve trial conduct, efficiency, and execution. We review these trial-level issues using examples from contemporary studies to inform and optimize the design of future global clinical trials in heart failure.



http://ift.tt/2s1zjSw

Designing Future Clinical Trials in Heart Failure With Preserved Ejection Fraction: Lessons From TOPCAT

Abstract

Purpose of Review

Spironolactone did not demonstrate benefit with respect to the primary composite endpoint in the global TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial in patients with chronic heart failure with preserved ejection fraction (HFpEF). We identify key lessons from the TOPCAT experience that can be applied to future HFpEF trials.

Recent Findings

Subsequent analyses of TOPCAT have revealed marked regional heterogeneity in patient profiles, event rates, drug adherence, and treatment effects. Significant regional variation may impact the success of global HFpEF trials. Given potential benefits in the Americas subgroup in TOPCAT, mineralocorticoid receptor antagonists can be considered in appropriately selected patients with HFpEF to reduce risk of heart failure hospitalization. A planned registry-based trial should provide additional evidence regarding the role of spironolactone in HFpEF.

Summary

The overall design, execution, and study oversight of TOPCAT have provided key insights into the conduct of future HFpEF trials.



http://ift.tt/2sMAG4w

Novel Endpoints for Heart Failure Clinical Trials

Abstract

Purpose of Review

With the growing prevalence of heart failure, there is a particular need to develop new pharmacologic treatments that can improve outcomes. While there are several approved therapies for heart failure with reduced ejection fraction, there is currently no approved agent for those with preserved ejection fraction. The current review aimed to explore the utility of alternate endpoints to mortality and hospitalization.

Recent Findings

There is increased interest in the use of alternative endpoints such as functional status and quality of life for heart failure drug development to focus on patients feeling better in addition to improving outcomes. This should ideally be measured using objective as well as subjective parameters.

Summary

While mortality and hospitalization remain important endpoints for clinical trials in heart failure, other more patient-centered outcomes are attractive alternatives yet how to best incorporate these in a trial setting remains to be elucidated.



http://ift.tt/2s2kgI7

Role of SGLT2 Inhibitors in Patients with Diabetes Mellitus and Heart Failure

Abstract

Purpose of Review

This review aims to summarize the evidence on cardiovascular risks and benefits of glucose-lowering drugs in diabetic patients, with a particular focus on the role of sodium-glucose transporter-2 (SGLT-2) inhibitors and their promising potential as a heart failure treatment.

Recent Findings

The SGLT-2 inhibitor empagliflozin has emerged as the first glucose-lowering drug to lower cardiovascular mortality in diabetes with an unprecedented 38% relative risk reduction. In addition, empagliflozin significantly reduced the rate of heart failure admissions with 35% when compared to placebo in diabetic patients with established atherosclerosis.

Summary

SGLT-2 inhibitors should be considered as a first-line drug to achieve glycemic control in diabetic patients at high risk for cardiovascular diseases and heart failure in particular. As SGLT-2 inhibitors target different pathophysiological pathways in heart failure, they might even be considered in the broader population without diabetes, but this remains the topic of further study.



http://ift.tt/2sMlCnH

An Update on the Risk of Lymph Node Metastasis for the Follicular Variant of Papillary Thyroid Carcinoma with the New Diagnostic Paradigm

Abstract

Previous data has shown that the risk of nodal metastases is significantly greater for classical papillary thyroid carcinoma (PTC) as compared to the follicular variant (FVPTC). Given a recent change in diagnostic paradigm and definition of the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) we intended to investigate if there remains a significant difference in nodal involvement between classical PTC and FVPTC. A 6-year retrospective review of all cases with FVPTC in the diagnostic line from the University of Utah/ARUP Laboratories was conducted. Two pathologists reviewed the remaining cases using the recently described histologic criteria of NIFTP to determine the total number the FVPTCs fitting the new classification paradigm. Histologic and clinical follow-up was tracked for all patients to determine the rate of nodal disease for all groups. 127 cases were identified using the above listed criteria. Forty-seven cases (37%) were classified as NIFTPs. None of the 47 patients had nodal disease either at the time of surgery or on follow-up. Twenty-eight cases met the current criteria for FVPTC (21%); of these 7/28 (25%) had evidence of nodal disease. By comparison, 17/45 (38%) of patients with mixed classical and FVPTC had nodal disease. Overall, there was no statistically significant difference in the risk of nodal metastasis between the pure FVPTC and mixed classical/FVPTC groups (p = 0.43). Our data indicates that implementing new definition for FVPTC will narrow the gap in the risk of nodal metastases between the classical PTC and FVPTC histologic subtypes.



http://ift.tt/2t1EH7z

Varicocele and semen quality: a retrospective case–control study of 4230 patients from a single centre

Abstract

Purpose

The aim of the present study is to assess impairment of spermatogenesis induced by varicocele in, to our knowledge, the largest single-centre caseload available to date.

Materials and methods

We conducted a retrospective study on 4230 consecutive patients attending our Department for andrological outpatient assessment and preconception check-ups between 2011 and 2014. A total of 2113 patients had varicocele (Group V), while the remaining 2117 were selected as the control group (Group C). All patients were divided into age classes (<17, 18–28, 29–39 and ≥40 years), and Group V patients were classified as "low" (I–II) or "high" (III–IV) grade.

Results

Varicocele patients had a higher mean height than controls, as well as lower BMI. There was also a statistically significant reduction in the concentration/mL and the total sperm number in Group V against Group C. When stratified by age, values for all semen parameters were significantly worse in the older than in the younger age classes in both Group V and Group C, except for concentration/mL and total sperm number in the 29–39 and ≥40 age classes in both groups. A multivariable logistic regression analysis showed that factors independently predicting the presence of varicocele were older age, higher BMI and smoking for more than 10 years.

Conclusions

Varicocele patients show worse semen parameters compared to controls, although their values were still within WHO reference limits. Semen quality is further worsened by increased age, grade and chronic smoking.



http://ift.tt/2s6tnmr

The evaluation of the right inferior phrenic artery diameter in cirrhotic patients

Abstract

Purpose

The purpose of this study is to evaluate the relationship between right inferior phrenic artery diameter and portal hypertension in cirrhotic patients.

Methods

CT examinations of 38 patients with chronic liver disease (patient group) and 40 patients without any liver disease (control group) were evaluated. The right inferior phrenic artery diameter of the patient and control group were measured. CT findings of portal hypertension, which were accepted as ascites, collaterals, splenomegaly and portal vein diameter greater than 13 mm, were determined and scored in the patient group. Patients obtained scores between one and four with respect to portal hypertension findings, and the scores were compared with phrenic artery diameters. Child-Pugh and MELD scores of the patients were also calculated.

Results

The mean diameter of the right inferior phrenic artery in the patient group was larger than that in the control group (p < 0.001). The mean phrenic artery diameter of the patients with score 1 was significantly different from those with score 2 (p = 0.028), score 3 (p = 0.001) and score 4 (p = 0.005). We found a linear and moderate relationship between phrenic artery diameter values and Child-Pugh scores (p = 0.012, r = 0.405).

Conclusion

Dilatation of the right inferior phrenic artery in cirrhotic patients may be a nonspecific sign of developing portal hypertension.



http://ift.tt/2s1JkPv

Influence of multi-leaf collimator leaf transmission on head and neck intensity-modulated radiation therapy and volumetric-modulated arc therapy planning

Abstract

The aim of this study was to quantify the effect of multi-leaf collimators (MLCs) with different leaf widths on the planning of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Toward this objective, dose transmission through a high-definition 120-leaf MLC (HD120MLC) and 120-leaf Millennium MLC (M120MLC) was investigated, using it with a test case and clinical case studies. In test case, studies with IMRT and VMAT plans, the difference in MLC leaf width had a limited effect on planning target volumes (PTVs). Organs at risk (OARs) were more affected by a reduction in dose transmission through the MLC than by a reduction in MLC leaf width. The results of the test case studies and clinical case studies were mostly similar. In the latter, the different MLCs had no effect on the PTV regardless of the treatment method; however, the HD120MLC plans achieved dose reductions to OARs similar to or larger than the dose reduction of the M120MLC plans. The similar results of the test case and clinical case studies showed that despite a limitation of the irradiation field size, the HD120MLC plans were superior.



http://ift.tt/2sMgCiS

The influence of head-of-bed elevation in patients with obstructive sleep apnea

Abstract

Purpose

The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality.

Methods

OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE.

Results

Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m2, neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values.

Conclusions

Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.



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Quantum chemical computation by DFT application of NLO molecule 2-aminopyridinium p -toluenesulphonate

Abstract

In the present work, we have reported a theoretical study on molecular structure and vibrational spectra of organic nonlinear optical 2-aminopyridinium p-toluenesulphonate (APPTS). The molecular geometry, electrostatic potential surface and vibrational wave numbers with Raman intensities and infrared absorption intensities in the ground state have been calculated by density functional theory (DFT) method using various basis sets and Beckes three-parameter hybrid functional (B3LYP). Finally, the results were applied to simulate infrared and Raman spectra of the title compound. The assignments of the vibrational spectra have been carried out with the aid of normal coordinate analysis.



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Sentinel node biopsy for axillary management after neoadjuvant therapy for breast cancer: a single-center retrospective analysis with long follow-up

Abstract

Purpose

Sentinel node biopsy (SNB) after neoadjuvant therapy (NAT) for breast cancer remains controversial. We conducted a retrospective study of patients who underwent SNB after NAT to evaluate the effectiveness of this procedure.

Methods

A consecutive 105 women with locally advanced breast cancer (cT1–4, cN0–3, M0) were treated with NAT between 2006 and 2015. The subjects were 80 of these patients who became or remained clinically node-negative after NAT, 53 of whom had axillary management determined by SNB (group A) and the other 27 underwent axillary lymph node dissection (ALND) without SNB (group B). SNB was performed using a modified dye method.

Results

The sentinel node (SN) identification rate was 94.3% and the mean number of removed SNs was 2.4. ALND was avoided in 33 patients, who were confirmed as SN-negative. There was no difference in recurrence-free and overall survival rates between groups A and B (p = 0.71 and p = 0.46, respectively) during the median follow-up time of 63 months. Of the 33 patients who did not undergo ALND, 10 suffered recurrence (33%). One patient (3%) had recurrence in an axillary lymph node and four had recurrence in a supraclavicular lymph node.

Conclusion

Axillary SNB after NAT did not affect the axillary failure rate or the prognosis. SNB may be a reliable procedure, even after NAT.



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Management of Traumatic Hemothorax, Retained Hemothorax, and Other Thoracic Collections

Abstract

Purpose of Review

This review focuses on the various approaches for the treatment of post-traumatic hemothorax, retained hemothorax, and other thoracic collections.

Recent Findings

Early diagnosis and complete evacuation of post-traumatic hemothorax are essential to avoid complications. Incomplete evacuation of blood may result in retained hemothorax, fibrothorax, or empyema. Tube thoracostomy has been the most commonly used option for draining blood and other collections. Alternative options include image-guided placement of small-bore chest tubes, video-assisted thoracoscopic surgery (VATS), and thoracotomy. However, as data supporting safety and efficacy of image-guided placement of small-bore chest tubes have been increasingly published, the technique has been widely adopted as a primary treatment option for patients with various pleural collections after trauma.

Summary

Traumatic pleural collections have traditionally been treated with tube thoracostomy, VATS, or thoracotomy. However, recent data suggest that placement of small-bore chest tubes is similarly effective with a reduced rate of complication and should be considered as a viable option.



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Response to: systematic review of dietary, nutritional, and physical activity interventions for the prevention of prostate cancer progression and mortality by Hackshaw-McGeagh and Colleagues



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