Ιατρικά Άρθρα Αλέξανδρος Γ. Σφακιανάκης: 12/11/17

Δευτέρα 11 Δεκεμβρίου 2017

Posterior Tibial Tendon Dysfunction: Clinical and Magnetic Resonance Imaging Findings having Histology as Reference Standard

Publication date: Available online 11 December 2017
Source:European Journal of Radiology
Author(s): Domenico Albano, Nicolò Martinelli, Alberto Bianchi, Giovanni Romeo, Gaetano Bulfamante, Massimo Galia, Luca Maria Sconfienza
ObjectiveTo investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition.Materials and MethodsNineteen patients (11 females; age: 46±15year, range 18-75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I–III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used.ResultsICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r=0.454; P=0.051). The HR and FMR tests were significantly correlated to the Movin score (r=0.581; P=0.009 and r=0.538; P=0.018, respectively) and were not significantly correlated to the Bonar score (both with a r=0.424; P=0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p=0.041) but not to the hindfoot valgus angle (p=0.496), the HR test (p=0.943), the Bonar score (p=0.937), and the Movin score (p=0.436). The hindfoot angle was not correlated to any of the other variables (p >0.264).ConclusionFor PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.

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Utilization of virtual mono-energetic images (MonoE) derived from a dual-layer spectral detector CT (SDCT) for the assessment of abdominal arteries in venous contrast phase scans

Publication date: Available online 11 December 2017
Source:European Journal of Radiology
Author(s): Tilman Hickethier, Jonathan Byrtus, Myriam Hauger, Andra-Iza Iuga, Gregor Pahn, David Maintz, Stefan Haneder, Jonas Doerner
ObjectivesTo investigate the utilization of virtual mono-energetic images (MonoE) at low kiloelectron volt (keV) levels derived from a dual-layer spectral detector CT (SDCT) for the assessment of abdominal arteries in venous contrast phase scans using arterial phase imaging as an internal reference standard.Materials and MethodsA total of 50 patients who received arterial and venous phase imaging of the abdomen on a SDCT system were included in this study. Absolute attenuation, noise, signal- and contrast to noise ratios (SNR; CNR) as well as arterial diameters in defined landmarks were assessed. In arterial phase, conventional reconstructions (CRART) as well as MonoEART at 40keV and in venous phase, conventional reconstructions (CRVEN) as well as MonoEVEN at 70 and 40keV were investigated and intra-individual comparisons were performed. If an artery stenosis (10 patients) was present, the degree of stenosis was assessed according to the system of the North American Symptomatic Carotid Endarterectomy Trial (NASCET).ResultsMonoE 40keV yielded significantly higher attenuation values (in arterial as well as in venous phase) compared to CRART (p<0.001) while noise levels were substantially low. This resulted in markedly superior SNR and CNR in large vessel compared to CRART.Luminal diameters were significantly smaller in MonoE 40keV in both contrast phases compared to CRART (p <0.001), whereas no significant differences were found between both MonoE reconstructions (p≥0.92). The degree of vessel stenosis was significantly higher in MonoE 40keV of both contrast phases compared to CRART (p≥0.02).ConclusionMonoE at low keV of venous contrast phase scans derived from a novel SDCT are suitable for the assessment of arteries in the abdomen and subsequent stenosis assessment. However, MonoE at 40keV constantly showed significant smaller luminal diameters than the corresponding conventional reconstructions (including the reference standard). This is possibly due to an improved differentiation of the vessel lumen from the wall and raises the question, which imaging technique should be used as an appropriate reference standard for vascular SDCT imaging studies.

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Relationship between sjögren's syndrome and periodontal status- a systematic review

This study aimed to evaluate if Sjögren's syndrome is related to periodontal status.

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The clinical significant of pre-surgical imaging in oral squamous cell carcinoma compared with lymph node status: a comparative retrospective study

The accuracy and sensitivity of commonly used imaging modalities in evaluating oral cavity cancer was evaluated by comparing the pre-surgical radiological findings and the post-surgical pathological report.

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A well-circumscribed lobulated tumor on the hard palatal mucosa in a child

A 9-year-old Caucasian female presented with a non-tender, slow growing mass on the right hard and soft palate, measuring 2.0 × 1.5 cm. The patient was otherwise healthy. On examination, the lesion presented as a well-circumscribed, soft tissue tumor with a lobulated appearance covered by normal-appearing oral mucosa (Figure 1). There was no ulceration and no induration. Adjacent teeth were vital, and a source of infection was not identified. There was no palpable lymphadenopathy. Computed tomography images showed that there was no bone erosion or tooth resorption.

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Microbial population changes in patients with medication-related osteonecrosis of the jaw treated with systemic antibiotics

This study aimed to investigate the bacterial population in patients with medication-related osteonecrosis of the jaw (MRONJ) after treatment with doxycycline and metronidazole.

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Evidence for regional hippocampal damage in patients with schizophrenia

Abstract

Purpose

Schizophrenia patients show cognitive and mood impairments, including memory loss and depression, suggesting damage in the brain regions. The hippocampus is a brain structure that is significantly involved in memory and mood function and shows impairment in schizophrenia. In the present study, we examined the regional hippocampal changes in schizophrenia patients using voxel-based morphometry (VBM), Freesurfer, and proton magnetic resonance spectroscopy (¹H MRS) procedures.

Methods

¹H MRS and high-resolution T1-weighted magnetic resonance imaging were collected in both healthy control subjects (N = 28) and schizophrenia patients (N = 28) using 3-Tesla whole body MRI system. Regional hippocampal volume was analyzed using VBM and Freesufer procedures. The relative ratios of the neurometabolites were calculated using linear combination model (LCModel).

Results

Compared to controls, schizophrenia patients showed significantly decreased gray matter volume in the hippocampus. Schizophrenia patients also showed significantly reduced glutamate (Glu) and myo-inositol (mI) ratios in the hippocampus. Additionally, significant positive correlation between gray matter volume and Glu/tCr was also observed in the hippocampus in schizophrenia.

Conclusion

Our findings provide an evidence for a possible association between structural deficits and metabolic alterations in schizophrenia patients.

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Evidence for regional hippocampal damage in patients with schizophrenia

Abstract

Purpose

Methods

Results

Conclusion

Our findings provide an evidence for a possible association between structural deficits and metabolic alterations in schizophrenia patients.

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Selecting passive dosimetry technologies for measuring the external dose of terrestrial wildlife

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Phakphum Aramrun, Nicholas A. Beresford, Michael D. Wood
Dosimeters attached to wild animals can be used to validate regulatory assessment approaches and models for estimating radiation exposure of wild animals. Such measurements are also necessary to ensure that robust dose-effect relationships can be developed from the results of field research programmes. This paper presents the first comprehensive evaluation of the different dosimetry technologies available for specifically measuring the external exposure of wildlife. Guidance is provided on the selection of appropriate passive dosimetry approaches for directly measuring external exposure of terrestrial wildlife under field conditions. The characteristics and performance of four available dosimetry technologies (thermoluminescent dosimeter (TLD), optically stimulated luminescent dosimeter (OSLD), radiophotoluminescent dosimeter (RPLD) and direct ion storage, (DIS)) are reviewed. Dosimeter properties, detection limit and dose range, study organisms and the intended application are variables that need to be considered when selecting a suitable dosimetry technology. Evaluated against these criteria, it is suggested that LiF based and Al2O3:C TLDs, OSLD and RPLD could all be used to estimate doses to wildlife. However, only LiF based TLDs have been used to directly measure wildlife doses in field studies to date. DIS is only suitable for comparatively large species (e.g. medium to large mammals), but has the advantage that temporal variation in dose can be recorded. In all cases, dosimeter calibration is required to ensure that the dose measurements reported can be interpreted appropriately for the organisms of interest.

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A review of numerical models to predict the atmospheric dispersion of radionuclides

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Ádám Leelőssy, István Lagzi, Attila Kovács, Róbert Mészáros
The field of atmospheric dispersion modeling has evolved together with nuclear risk assessment and emergency response systems. Atmospheric concentration and deposition of radionuclides originating from an unintended release provide the basis of dose estimations and countermeasure strategies. To predict the atmospheric dispersion and deposition of radionuclides several numerical models are available coupled with numerical weather prediction (NWP) systems. This work provides a review of the main concepts and different approaches of atmospheric dispersion modeling. Key processes of the atmospheric transport of radionuclides are emission, advection, turbulent diffusion, dry and wet deposition, radioactive decay and other physical and chemical transformations. A wide range of modeling software are available to simulate these processes with different physical assumptions, numerical approaches and implementation. The most appropriate modeling tool for a specific purpose can be selected based on the spatial scale, the complexity of meteorology, land surface and physical and chemical transformations, also considering the available data and computational resource. For most regulatory and operational applications, offline coupled NWP-dispersion systems are used, either with a local scale Gaussian, or a regional to global scale Eulerian or Lagrangian approach. The dispersion model results show large sensitivity on the accuracy of the coupled NWP model, especially through the description of planetary boundary layer turbulence, deep convection and wet deposition. Improvement of dispersion predictions can be achieved by online coupling of mesoscale meteorology and atmospheric transport models. The 2011 Fukushima event was the first large-scale nuclear accident where real-time prognostic dispersion modeling provided decision support. Dozens of dispersion models with different approaches were used for prognostic and retrospective simulations of the Fukushima release. An unknown release rate proved to be the largest factor of uncertainty, underlining the importance of inverse modeling and data assimilation in future developments.

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Radiocesium uptake through leaf surfaces of tea plants (Camellia sinensis L.)

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Takashi Ikka, Yoshifumi Nishina, Mizuho Kamoshita, Yasuhisa Oya, Kenji Okuno, Akio Morita
To clarify the source of radiocesium detected in newly emerged tea leaves contaminated just before the time of bud opening by fallout of radionuclides from Fukushima Dai-ichi Nuclear Power Plant, ¹³⁷CsCl solution (0.185 M Bq mL⁻¹) was applied to the front or the backside surfaces of mature leaves of tea plant (Camellia sinensis L. cv. Yabukita) at the time of bud opening. A 21 days after foliar application, the buds had grown and developed to the three- or four-leaf stage. In the front treatment, almost all (95%) of the applied ¹³⁷Cs was present in the mature leaves (hot mother leaves). In the backside treatment, 68% of applied ¹³⁷Cs also remained in hot mother leaves, but 22% and 10% was found in the new shoots attached to hot mother leaves and the other parts (non-applied mature leaves, stems and roots), respectively. The images of a hot leaf and its attached new shoots by imaging plate analysis revealed that the results coincided with those of the ¹³⁷Cs distribution above. These suggested that radiocesium was primarily absorbed from the backside surface of tea leaves through the stoma, and then the greater part was transported to newly emerged tea organs during the new shoot growth period.

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Soil-to-cassava transfer of naturally occurring radionuclides from communities along Ghana's oil and gas rich Tano Basin

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Israel Nutifafa Yawo Doyi, David Kofi Essumang, Asare Kwaku Agyapong, Samuel Asumadu-Sarkodie
Soil-to-plant transfer factor (TF) is widely used to assess the impact of soil radioactivity on agricultural crops. The root crop cassava (Manihot esculenta) provides 30%–50% of the calories consumed in Sub-Saharan Africa and is widely used in South America. γ-ray analysis was used to measure activity concentrations of ²³⁸U, ²³²Th, and ⁴⁰K in cassava root and soil. The TF values for ²³⁸U, ²³²Th, and ⁴⁰K were in the range 0.06–0.12, 0.01–0.10 and 0.04–0.28 respectively. The median transfer factors were 0.10 (²³⁸U), 0.04 (²³²Th) and 0.08 (⁴⁰K). For ²³⁸U and ²³²Th, the highest TF values were 0.12 and 0.10 respectively.

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A well-circumscribed lobulated tumor on the hard palatal mucosa in a child

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Alfonso Salcines, Sook-Bin Woo, Vikki Noonan, Michael J. Mansfield, Chia-Cheng Li

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Microbial population changes in patients with medication-related osteonecrosis of the jaw treated with systemic antibiotics

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lieselotte De Bruyn, Ruxandra Coropciuc, Wim Coucke, Constantinus Politis
ObjectiveThis study aimed to investigate the bacterial population in patients with medication-related osteonecrosis of the jaw (MRONJ) after treatment with doxycycline and metronidazole.Study DesignThirty-eight patients with MRONJ (age range 55–88, mean age 73 + 8.82 SD) treated with doxycycline first and secondly with metronidazole were enrolled in this study. Two swabs were taken at the margin of the infected MRONJ lesion after applying pressure on the marginal mucosa and visible pus was secreted. RT-PCR was used to analyse 20 perio-pathogenic and commensal species and the total bacterial level. Bacterial counts were compared between antibiotic treatments and with a control group of orally healthy patients that didn't have periodontal pockets of more than 3 mm (n=29) by means of a Mann-Whitney U test. Comparisons between the two antibiotic treatments were performed by a paired Wilcoxon signed rank test.ResultsThe total bacterial level was significantly higher in the MRONJ patients treated with systemic antibiotics compared with the control group. However, significant lower bacterial amounts were found for 12 of the 20 investigated bacteria. We couldn't establish a significant advantage of metronidazole administration after doxycycline treatment.ConclusionOur findings suggest that the total bacterial level in MRONJ patients is higher even when treated with systemic antibiotics. The significantly different bacterial amounts of the selected species suggest an alteration in the microbial population.

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Short tau inversion recovery in breast diffusion-weighted imaging: signal-to-noise ratio and apparent diffusion coefficients using a breast phantom in comparison with spectral attenuated inversion recovery

Abstract

Objective

This study aimed to compare the signal-to-noise ratios (SNRs) and apparent diffusion coefficients (ADCs) obtained using two fat suppression techniques in breast diffusion-weighted imaging (DWI) of a phantom.

Materials and methods

The breast phantom comprised agar gels with four different concentrations of granulated sugar (samples 1, 2, 3, and 4). DWI with short tau inversion recovery (STIR-DWI) and that with spectral attenuated inversion recovery (SPAIR-DWI) were performed using 3.0-T magnetic resonance imaging, and the obtained SNRs and ADCs were compared. ADCs were also compared between the right and left breast phantoms.

Results

For samples 3 and 4, SNRs obtained using STIR-DWI were lower than those obtained using SPAIR-DWI. For samples 2, 3, and 4, overall ADCs obtained using STIR-DWI were significantly higher than those obtained using SPAIR-DWI (p < 0.001 for all), although no significant difference was observed for sample 1 (p = 0.62). STIR-DWI shows a positive bias and wide limits of agreement in Bland–Altman plot. The coefficients of variance of overall ADCs were good in STIR-DWI and SPAIR-DWI. For all samples, STIR-DWI demonstrated slightly larger percentage differences in ADCs between the right and left phantoms than SPAIR-DWI.

Conclusion

SNRs and ADCs obtained using STIR-DWI are influenced by the T ₁ value; a shorter T ₁ value decreases SNRs, overestimates ADCs, and induces the measurement error in ADCs. STIR-DWI showed a larger difference in ADCs between the right and left phantoms than SPAIR-DWI.

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Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Abstract

Objectives

To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD).

Methods

The writing committee selected the HRCT criteria—the Delphi items—for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as "essential", "optional", or "not relevant". The items rated "essential" by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP.

Results

A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated "essential" by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated "essential" by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting.

Conclusions

This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists.

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Fractal-based radiomic approach to predict complete pathological response after chemo-radiotherapy in rectal cancer

Abstract

The aim of this study was to propose a methodology to investigate the tumour heterogeneity and evaluate its ability to predict pathologically complete response (pCR) after chemo-radiotherapy (CRT) in locally advanced rectal cancer (LARC). This approach consisted in normalising the pixel intensities of the tumour and identifying the different sub-regions using an intensity-based thresholding. The spatial organisation of these subpopulations was quantified using the fractal dimension (FD). This approach was implemented in a radiomic workflow and applied to 198 T2-weighted pre-treatment magnetic resonance (MR) images of LARC patients. Three types of features were extracted from the gross tumour volume (GTV): morphological, statistical and fractal features. Feature selection was performed using the Wilcoxon test and a logistic regression model was calculated to predict the pCR probability after CRT. The model was elaborated considering the patients treated in two institutions: Fondazione Policlinico Universitario "Agostino Gemelli" of Rome (173 cases, training set) and University Medical Centre of Maastricht (25 cases, validation set). The results obtained showed that the fractal parameters of the subpopulations have the highest performance in predicting pCR. The predictive model elaborated had an area under the curve (AUC) equal to 0.77 ± 0.07. The model reliability was confirmed by the validation set (AUC = 0.79 ± 0.09). This study suggests that the fractal analysis can play an important role in radiomics, providing valuable information not only about the GTV structure, but also about its inner subpopulations.

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Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor).

Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor).

Am J Otolaryngol. 2017 Dec 01;:

Authors: Chow TL

PMID: 29223690 [PubMed - as supplied by publisher]

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Lipopolysaccharide induces autophagy by targeting the AMPK-mTOR pathway in Human Nasal Epithelial Cells.

Lipopolysaccharide induces autophagy by targeting the AMPK-mTOR pathway in Human Nasal Epithelial Cells.

Biomed Pharmacother. 2017 Dec 06;:

Authors: Wang XH, Zhang ZH, Cai XL, Ye P, Feng X, Liu TT, Li XZ

Abstract
Chronic rhinosinusitis (CRS) is a well-known disease encountered in the department of otorhinolaryngology, yet little is known about its pathogenesis. Autophagy, a lysosome-dependent degradation process, has been reported to be involved in the process of many chronic inflammatory diseases. Here we tried to evaluate the function of autophagy in CRS as well as explore the related mechanisms. We first stained light chain 3B (LC3B) with immunohistochemistry in uncinate tissues (UT) from patients with and without CRS and found that its expression was up-regulated in CRS patients. Then, Human Nasal Epithelial Cells (HNEpC) were treated with lipopolysaccharide (LPS), one of the most common pathogenic elements in CRS, and we found that autophagy was induced in a dose- and time-dependent manner. This is supported by a rise in the expression of light chain 3B-II (LC3B-II), accumulation of GFP-LC3 vesicles, as well as decreased p62 expression. Furthermore, we found that LPS promoted AMPK phosphorylation and inactived mTOR, while AMPK inhibition by compound C significantly attenuated LPS-induced autophagy. Besides, treatment of HNEpC with LPS increased the amount of Toll-like receptor 4 (TLR4) while inhibiting TLR4 by Polymyxin B (PMB) declined autophagy caused by LPS. Taken together, our study first demonstrated that LPS caused autophagy in HNEpC, and this process was AMPK-mTOR dependent. These data suggested the relationship between LPS and autophagy in the pathogenesis of CRS.

PMID: 29223553 [PubMed - as supplied by publisher]

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Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides.

Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides.

Blood Rev. 2017 Nov 29;:

Authors: Haap M, Wiefels J, Horger M, Hoyer A, Müssig K

Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder with its distinct unicentric (uCD) and multicentric (mCD) entities. The present work aimed at characterizing CD in more detail. From the 775 articles found by a PubMed search, 1133 cases were extracted. Two own cases were included. UCD was identified in 719 (42% males) and mCD in 416 (63% males) cases. Age in uCD was 34±17 and in mCD 48±18years. The hyaline-vascular type predominated in uCD and the plasma cell type in mCD. Clinical symptoms were more common in mCD. The head and neck region was most frequently affected in uCD and the axillary region in mCD. Prevalence of human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8) positivity was higher in mCD. In CT scans, high contrast enhancement and calcifications were more frequent in uCD (all p<0.0001). The two forms of CD not only differ markedly in their clinical, laboratory and imaging findings, but also in treatment response and prognosis.

PMID: 29223447 [PubMed - as supplied by publisher]

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Exhaled nitric oxide helps discriminating asthmatic children with and without positive specific IgE to aeroallergens.

Exhaled nitric oxide helps discriminating asthmatic children with and without positive specific IgE to aeroallergens.

Asian Pac J Allergy Immunol. 2018 Dec 10;:

Authors: Fang LC, Shyur SD, Yang J, Wang JY, Kao YH, Yang CH, Yu YT

Abstract
BACKGROUND: Aeroallergen sensitization may predict higher fractional exhaled nitric oxide (FeNO) levels.
OBJECTIVE: We evaluate cut-off values of FeNO in asthmatic children with and without positive specific immunoglobulin E (IgE) to at least one of 5 aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, dog, and cockroach).
METHODS: 564 patients with asthma and allergic rhinitis (AR) aged 5 to 18 years were enrolled into two groups. Sensitized group included 378 children with positive IgE to at least one of 5 inhaled allergens. Non-sensitized group included 186 children. Pulmonary function tests, FeNO, eosinophil counts, and IgE levels were examined. Patients were divided into preschool age (5~6 years old), elementary school children (7~11 years old) and adolescents (12~18 years old).
RESULTS: In preschool children, FeNO?15.5 ppb differentiates between non-sensitized and sensitized groups. (sensitivity 54.3%; specificity 87.5%; positive predictive value (PPV) 86.2%; negative predictive value (NPV) 57.1%; area under receiver operating characteristic curve (AUC) 0.72) Among elementary school children, the cut-off value of FeNO≥19.5 ppb showed sensitivity 66.4%; specificity 85.8%; PPV 90.5%; NPV 55.7%; AUC 0.81. In adolescents, FeNO≥27.5 ppb showed sensitivity 60.2%; specificity 85.4%; PPV 91.2%; NPV 46.1%; AUC 0.76.
CONCLUSION: In asthmatic children, aeroallergen sensitization appears to contribute to higher FeNO levels than those not sensitized. Cut-off values of FeNO which well discriminate asthmatic children with and without aeroallergen sensitization should be chose according to different ages.

PMID: 29223148 [PubMed - as supplied by publisher]

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Pembrolizumab beim fortgeschrittenen Ösophaguskarzinom

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Recent advances in pre-exposure prophylaxis for HIV

AbstractAlthough pre-exposure prophylaxis (PrEP)—the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV—is a promising preventive option, important public health...

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NHS England throws down challenge to government

The government’s budget delivered more new funding for the NHS than many observers had expected but far less than needed to avoid further restrictions on services.1 At its recent board meeting, NHS...

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Atomic layer deposition of nano-TiO2 thin films with enhanced biocompatibility and antimicrobial activity for orthopedic implants

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Models of care for non-invasive ventilation in the Acute COPD Comparison of three Tertiary hospitals (ACT3) study.

Models of care for non-invasive ventilation in the Acute COPD Comparison of three Tertiary hospitals (ACT3) study.

Respirology. 2017 Dec 10;:

Authors: Parker K, Perikala V, Aminazad A, Deng Z, Borg B, Buchan C, Toghill J, Irving LB, Goldin J, Charlesworth D, Mahal A, Illesinghe S, Naughton MT, Young A

Abstract
BACKGROUND AND OBJECTIVE: Non-invasive ventilation (NIV) improves clinical outcomes in hypercapnic acute exacerbations of COPD (AECOPD), but the optimal model of care remains unknown.
METHODS: We conducted a prospective observational non-inferiority study comparing three models of NIV care: general ward (Ward) (1:4 nurse to patient ratio, thrice weekly consultant ward round), a high dependency unit (HDU) (1:2 ratio, twice daily ward round) and an intensive care unit (ICU) (1:1 ratio, twice daily ward round) model in three similar teaching tertiary hospitals. Changes in arterial blood gases (ABG) and clinical outcomes were compared and corrected for differences in AECOPD severity (Blood urea > 9 mmol/L, Altered mental status (Glasgow coma scale (GCS) < 14), Pulse > 109 bpm, age > 65 (BAP-65)) and co-morbidities. An economic analysis was also undertaken.
RESULTS: There was no significant difference in age (70 ± 10 years), forced expiratory volume in 1 s (FEV1 ) (0.84 ± 0.35 L), initial pH (7.29 ± 0.08), partial pressure of CO2 in arterial blood (PaCO2 ) (72 ± 22 mm Hg) or BAP-65 scores (2.9 ± 1.01) across the three models. The Ward achieved an increase in pH (0.12 ± 0.07) and a decrease in PaCO2 (12 ± 18 mm Hg) that was equivalent to HDU and ICU. However, the Ward treated more patients (38 vs 28 vs 15, P < 0.001), for a longer duration in the first 24 h (12.3 ± 4.8 vs 7.9 ± 4.1 vs 8.4 ± 5.3 h, P < 0.05) and was more cost-effective per treatment day ($AUD 1231 ± 382 vs 1745 ± 2673 vs 2386 ± 1120, P < 0.05) than HDU and ICU. ICU had a longer hospital stay (9 ± 11 vs 7 ± 7 vs 13 ± 28 days, P < 0.002) compared with the Ward and HDU. There was no significant difference in intubation rate or survival.
CONCLUSION: In acute hypercapnic Chronic obstructive pulmonary disease (COPD) patients, the Ward model of NIV care achieved equivalent clinical outcomes, whilst being more cost-effective than HDU or ICU models.

PMID: 29224257 [PubMed - as supplied by publisher]

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Long-term cardiovascular re-programming by short-term perinatal exposure to nicotine's main metabolite cotinine.

Long-term cardiovascular re-programming by short-term perinatal exposure to nicotine's main metabolite cotinine.

Acta Paediatr. 2017 Dec 09;:

Authors: Bastianini S, Martire VL, Silvani A, Zoccoli G, Berteotti C, Lagercrantz H, Arner A, Cohen G

Abstract
AIM: Gather "proof-of-concept" evidence of the adverse developmental potential of cotinine (a seemingly benign biomarker of recent nicotine / tobacco smoke exposure).
METHODS: Pregnant C57 mice drank nicotine or cotinine-laced water for 6wks from conception (NPRE = 2% saccharin+100μg nicotine/ml; CPRE = 2% saccharin + 10μg cotinine/ml) or 3wks after birth (CPOST = 2% saccharin + 30μg cotinine/ml). Controls drank 2% saccharin (CTRL). At 17±1weeks (male pups; CTRL n=6; CPOST n=6; CPRE n=8; NPRE n=9) we assessed (i) cardiovascular control during sleep; (ii) arterial reactivity ex vivo; (iii) expression of genes involved in arterial constriction / dilation.
RESULTS: Blood cotinine levels recapitulated those of passive smoker mothers-infants. Pups exposed to cotinine exhibited (i) mild bradycardia - hypotension at rest (p<0.001); (ii) attenuated (CPRE , p<0.0001) or reverse (CPOST ; p<0.0001) BP stress reactivity; (iii) adrenergic hypo-contractility (p<0.0003), low Protein Kinase C (p<0.001) and elevated adrenergic receptor mRNA (p<0.05; all drug-treated arteries); (iv) endothelial dysfunction (NPRE only).
CONCLUSION: Cotinine has subtle, enduring developmental consequences. Some cardiovascular effects of nicotine can plausibly arise via conversion to cotinine. Low-level exposure to this metabolite may pose unrecognized perinatal risks. Adults must avoid inadvertently exposing a fetus or infant to cotinine as well as nicotine. This article is protected by copyright. All rights reserved.

PMID: 29224235 [PubMed - as supplied by publisher]

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Serum ferritin and obstructive sleep apnea-epidemiological study.

Serum ferritin and obstructive sleep apnea-epidemiological study.

Sleep Breath. 2017 Dec 09;:

Authors: Thorarinsdottir EH, Arnardottir ES, Benediktsdottir B, Janson C, Olafsson I, Pack AI, Gislason T, Keenan BT

Abstract
PURPOSE: Ferritin is an intracellular iron storage protein and a marker of inflammation. Studies have shown that subjects with obstructive sleep apnea (OSA) have higher levels of circulating pro-inflammatory cytokines, but little is known about the association between ferritin and OSA. The aims of the study were to evaluate serum ferritin (S-Ferritin) levels in OSA patients compared to levels in the general population and also examine the effect of obesity level and treatment with positive airway pressure (PAP) on S-Ferritin levels.
METHODS: The OSA subjects (n = 796) were part of the Icelandic Sleep Apnea Cohort. The control subjects (n = 637) were randomly chosen Icelanders who participated in an epidemiological study. Propensity score (PS) methodologies were employed to minimize selection bias and strengthen causal inferences when comparing non-randomized groups. S-Ferritin levels were measured and all participants answered the same detailed questionnaire about sleep and health. Only OSA patients underwent a sleep study and were re-invited for a 2-year follow-up.
RESULTS: S-Ferritin levels were significantly higher in OSA males than controls (213.3 vs. 197.3 μg/L, p = 0.007). However, after adjusting for confounders and using our PS methodology, no significant difference was found. S-Ferritin levels were not correlated with severity of OSA, obesity level, or clinical symptoms. Also, no significant change in S-Ferritin levels was found with 2 years of PAP treatment.
CONCLUSIONS: S-Ferritin levels are comparable in OSA patients and controls and do not change consistently with obesity level or PAP treatment in our sample.

PMID: 29224135 [PubMed - as supplied by publisher]

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Association between continuous positive airway pressure and serum aminotransferases in patients with obstructive sleep apnea.

Association between continuous positive airway pressure and serum aminotransferases in patients with obstructive sleep apnea.

Eur Arch Otorhinolaryngol. 2017 Dec 09;:

Authors: Chen LD, Zhang LJ, Lin XJ, Qi JC, Li H, Wu Z, Xu QZ, Huang YP, Lin L

Abstract
INTRODUCTION: Obstructive sleep apnea (OSA) has been suggested to be a potential contributing factor for nonalcoholic fatty liver disease (NAFLD). Studies on the association between continuous positive airway pressure (CPAP) and NAFLD in OSA patients are limited and controversial.
OBJECTIVES: The aim of this study was to assess the relationship between OSA and NAFLD and the effect of CPAP therapy on serum aminotransferase levels in OSA patients.
METHODS: A total of 160 consecutive patients who underwent standard polysomnography were enrolled. Blood samples were obtained in the morning after sleep for biological profile measurements. Non-invasive ultrasound techniques were used to assess liver steatosis and fibrosis. Within the OSA group, serum aminotransferases were detected before and after CPAP treatment.
RESULTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase, and liver steatosis score increased significantly with an increase in OSA severity. Stepwise multiple regression with liver steatosis score, ALT, AST as dependent variable, respectively, apnea-hypopnea index (β = 0.447, p = 0.020; β = 0.266, p = 0.001; β = 0.351, p = 0.020, respectively) significantly predicted the liver steatosis score, ALT, AST after adjustment for confounders. After 3 months of CPAP treatment, there was a significant decrease in both ALT (54.20 ± 24.34 vs. 46.52 ± 24.95, p = 0.000) and AST (31.82 ± 8.91 vs. 29.00 ± 8.34, p = 0.039).
CONCLUSIONS: OSA severity was independently associated with liver steatosis and elevation of serum aminotransferases. 3 months of CPAP therapy were associated with a statistically significant improvement on liver injury in OSA patients.

PMID: 29224042 [PubMed - as supplied by publisher]

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Prevalence of Physical Problems Detected by the Distress Thermometer and Problem List in Patients With Myeloproliferative Disorders.

Prevalence of Physical Problems Detected by the Distress Thermometer and Problem List in Patients With Myeloproliferative Disorders.

J Natl Compr Canc Netw. 2017 Dec;15(12):1503-1508

Authors: McFarland DC, Shaffer KM, Polizzi H, Mascarenhas J, Kremyanskaya M, Holland J, Hoffman R

Abstract
Background: Patients with myeloproliferative neoplasms (MPNs) can have a severe physical symptom burden over an extended disease trajectory that contributes to decreased quality of life. Few studies, however, have characterized which patients most frequently consider physical symptoms a problem. This study describes the physical symptoms of patients with MPNs and the relationship of these symptoms to patient characteristics. Methods: Patients with MPNs (N=117) completed questionnaires in a dedicated academic medical center MPN clinic. Patients reported demographics (age, race/ethnicity, sex, marital status, employment status), disease characteristics (MPN type, time with MPN), and whether they were bothered by any of 22 variables in the "Physical Problems" list in the Distress Thermometer and Problem List (DT&PL). Results: The median number of physical problems endorsed by patients was 2 (median, 2.26; SD, 3.18), with a range from 0 to 20. Two-fifths endorsed no physical problems, one-fifth endorsed 1 problem, and two-fifths endorsed ≥2 problems, with fatigue (35.5%), sleep (27.1%), pain (21.5%), dry skin/pruritus (18.7%), and memory/concentration (16.8%) being the most commonly reported. Non-Caucasian participants reported more problems with sleep (P=.050), pain (P=.016), and tingling (P=.026). Patients with polycythemia vera (PV) reported more issues with tingling (P=.046) and sexual problems (P=.032). Conclusions: Patients with MPNs are more likely to report physical symptom bother than to report no bother with multiple physical problems on the DT&PL. Patients of minority race/ethnicity and those with PV, however, showed heightened prevalence of physical problems-characteristics which may be used to triage patients for more intensive symptom management.

PMID: 29223988 [PubMed - in process]

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Prognostic Utility of Morning Blood Pressure Surge for 20-Year All-Cause and Cardiovascular Mortalities: Results of a Community-Based Study.

Prognostic Utility of Morning Blood Pressure Surge for 20-Year All-Cause and Cardiovascular Mortalities: Results of a Community-Based Study.

J Am Heart Assoc. 2017 Dec 09;6(12):

Authors: Cheng HM, Wu CL, Sung SH, Lee JC, Kario K, Chiang CE, Huang CJ, Hsu PF, Chuang SY, Lakatta EG, Yin FCP, Chou P, Chen CH

Abstract
BACKGROUND: Morning blood pressure (BP) surge (MS), defined by the MS amplitude, is an independent prognostic factor of cardiovascular outcomes in some, but not all, populations.
METHOD AND RESULTS: We enrolled 2020 participants (1029 men; aged 30-79 years) with 24-hour ambulatory BP data. During a median 19.7-year follow-up, 607 deaths (182 by cardiovascular causes) were confirmed from the National Death Registry. The amplitude of sleep-trough MS (STMS) was derived from the difference between morning systolic BP (SBP) and lowest nighttime SBP. The rate of STMS was derived as the slope of linear regression of sequential SBP measures on time intervals within the STMS period. Thresholds for high STMS amplitude and rate were determined by the 95th percentiles (43.7 mm Hg and 11.3 mm Hg/h, respectively). Multivariable Cox models, adjusting for age, sex, body mass index, smoking, alcohol, low-density lipoprotein cholesterol, 24-hour SBP, night:day SBP ratio, and antihypertensive treatment, revealed that a high STMS rate (hazard ratio, 1.666; 95% confidence interval, 1.185-2.341), but not STMS amplitude (hazard ratio, 1.245; 95% confidence interval, 0.984-1.843), was significantly associated with a greater mortality risk. Similarly, STMS rate (hazard ratio, 2.608; 95% confidence interval, 1.554-4.375), but not STMS amplitude, was significantly associated with the risk of cardiovascular mortality (hazard ratio, 0.966; 95% confidence interval, 0.535-1.747). Moreover, the prognostic values of STMS rate were comparable in subjects with or without morning and nocturnal hypertension (P>0.05 for interaction for all). In simulation studies, STMS rate was less susceptible to measurement errors of the sleep-trough SBP than STMS amplitude.
CONCLUSIONS: STMS rate could independently help identify subjects with an increased cardiovascular risk.

PMID: 29223957 [PubMed - in process]

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What can predict and prevent the long-term use of benzodiazepines?

What can predict and prevent the long-term use of benzodiazepines?

J Psychiatr Res. 2017 Nov 24;97:94-100

Authors: Hata T, Kanazawa T, Hamada T, Nishihara M, Bush AI, Yoneda H, Nakajima M, Katsumata T

Abstract
Although benzodiazepines (BZDs) are commonly prescribed for insomnia or anxiety, long-term use of BZDs causes serious adverse effects such as daytime drowsiness and cognitive decline. In the current study, we evaluated the predictors and preventers of long-term usage of BZDs from a retrospective survey by utilizing the 12-year prescription record of a university hospital. From the prescription data of 92,005 people, users of BZDs (n = 3,470, male = 39.2%, mean age = 60 ± 17.5) were analyzed. During this period, both the number of prescriptions (2722 in 2004 to 1019 in 2016) and the number of BZDs (1.73 in 2004 to 1.36 in 2016) gradually decreased, although more than half of the patients continued to take BZDs for over three years. High risk factors for long-term use of BZDs include elderly patients (>65 years old), high dosage (>5 mg diazepam per day), psychiatrist-prescribers, and users with polytherapy. Discontinuation is significantly found in users of hypnotic BZDs and alternative psychotropic medical drugs (including antipsychotics, serotonergic drugs, or newer types of sleep medicine). Future studies should focus on elucidating interventions that are more effective against long-term usage of BZDs.

PMID: 29223863 [PubMed - as supplied by publisher]

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Temporal and bi-directional associations between sleep duration and physical activity/sedentary time in children: An international comparison.

Temporal and bi-directional associations between sleep duration and physical activity/sedentary time in children: An international comparison.

Prev Med. 2017 Dec 06;:

Authors: Lin Y, Tremblay MS, Katzmarzyk PT, Fogelholm M, Hu G, Lambert EV, Maher C, Maia J, Olds T, Sarmiento OL, Standage M, Tudor-Locke C, Chaput JP, ISCOLE Research Group

Abstract
The purpose of this multinational and cross-sectional study was to investigate whether nighttime sleep duration was associated with physical activity (PA) and sedentary time (SED) the following day, whether daytime PA/SED were associated with sleep duration the subsequent night, and whether the associations were modified by sex and study sites. Data from 5779 children aged 9-11years were analyzed. A waist-worn Actigraph GT3X+ accelerometer was used to assess children's 24-h movement behaviours for 7days, i.e. sleep duration, total SED, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA). Multilevel linear regression models were used to account for the repeated measures nested within participants (there were up to 7 sleep→PA/SED and PA/SED→sleep pairings per participant) and schools, and adjusted for covariates. To facilitate interpretation, all sleep and PA/SED variables were standardized. Results showed that the relationship between sleep and PA/SED is bi-directional in this international sample of children. Specifically, for each one standard deviation (SD) unit increase in sleep duration, SED the following day decreased by 0.04 SD units, while LPA and MVPA increased by 0.04 and 0.02 SD units, respectively. Sleep duration decreased by 0.02 SD units and increased by 0.04 SD units for each one SD unit increase in SED and MVPA, respectively. Sleep duration was not affected by changes in LPA. These associations differed across sex and study sites in both directions. However, since the observed effect sizes are subtle, public health initiatives should consider the clinical and practical relevance of these findings.

PMID: 29223790 [PubMed - as supplied by publisher]

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Obstructive Sleep Apnoea and Alzheimer's Disease: in Search of Shared Pathomechanisms.

Obstructive Sleep Apnoea and Alzheimer's Disease: in Search of Shared Pathomechanisms.

Neurosci Biobehav Rev. 2017 Dec 06;:

Authors: Polsek D, Gildeh N, Cash D, Winsky-Sommerer R, Williams SCR, Turkheimer F, Leschziner GD, Morrell MJ, Rosenzweig I

Abstract
Alzheimer's disease (AD) is a significant public health concern. The incidence continues to rise, and it is set to be over one million in the UK by 2025. The processes involved in the pathogenesis of AD have been shown to overlap with those found in cognitive decline in patients with Obstructive Sleep Apnoea (OSA). Currently, the standard treatment for OSA is Continuous Positive Airway Pressure. Adherence to treatment can, however, be an issue, especially in patients with dementia. Also, not all patients respond adequately, necessitating the use of additional treatments. Based on the body of data, we here suggest that excessive and prolonged neuronal activity might contribute to genesis and acceleration of both AD and OSA in the absence of appropriately structured sleep. Further, we argue that external factors, including systemic inflammation and obesity, are likely to interfere with immunological processes of the brain, and further promote disease progression. If this hypothesis is proven in future studies, it could have far-reaching clinical translational implications, as well as implications for future treatment strategies in OSA.

PMID: 29223769 [PubMed - as supplied by publisher]

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Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery-Perioperative Challenges and Management.

Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery-Perioperative Challenges and Management.

J Cardiothorac Vasc Anesth. 2017 May 19;:

Authors: Patel PA, Hall A, Augoustides JGT, Patel S, Feinman JW, Weber B, Gutsche JT, Fabbro M, Maldonado Y

PMID: 29223721 [PubMed - as supplied by publisher]

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Sleep and quality of life of patients with glycogen storage disease on standard and modified uncooked cornstarch.

Sleep and quality of life of patients with glycogen storage disease on standard and modified uncooked cornstarch.

Mol Genet Metab. 2017 Sep 11;:

Authors: Rousseau-Nepton I, Huot C, Laforte D, Mok E, Fenyves D, Constantin E, Mitchell J

Abstract
BACKGROUND: Glycemic control in hepatic glycogen storage diseases (GSDs) relies on specific nutritional recommendations, including strict avoidance of a fasting period. Uncooked cornstarch (UCCS) is an important therapeutic component. A new modified UCCS, Glycosade™, was created with the objective of prolonging euglycemia. We aimed to determine the length of euglycemia on Glycosade™ using a continuous glucose monitor (CGM) and to evaluate whether longer euglycemia and thus less nighttime interruptions would improve sleep and quality of life (QoL) after the introduction of the modified cornstarch.
METHODS: We conducted a prospective cohort study to assess quality and quantity of sleep and quality of life (QoL) in patients with GSDs on standard UCCS and after the introduction of Glycosade™. Sleep and QoL evaluation was done for patients using validated questionnaires, a standardized sleep diary and actigraphy. Length of fast and glucose variability were determined with CGM.
RESULTS: Nine adults with GSD Ia took part in the study. Glycosade™ introduction was done under close supervision during a hospital admission. Comparison of sleep in 9 patients showed sleep disturbances on standard UCCS that were improved with Glycosade™. QoL was normal both pre and post Glycosade™. The CGM confirmed maintenance of a longer fasting period with Glycosade™ at home.
CONCLUSION: Glycosade™ represents an alternative option for GSD patients. We showed possible benefits in terms of sleep quality. We also confirmed the longer length of fast on Glycosade™.
SYNOPSIS: A new modified form of uncooked starch for patients with glycogen storage disease represents an alternative option as it showed a longer length of fast and improvements in sleep quality.

PMID: 29223626 [PubMed - as supplied by publisher]

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Neuropeptides and breathing in health and disease.

Neuropeptides and breathing in health and disease.

Pulm Pharmacol Ther. 2017 Dec 06;:

Authors: Kaczyńska K, Zając D, Wojciechowski P, Kogut E, Szereda-Przestaszewska M

Abstract
Regulatory neuropeptides control and regulate breathing in physiological and pathophysiological conditions. While they have been identified in the neurons of major respiratory areas, they can be active not only at the central level, but also at the periphery via chemoreceptors, vagal afferents, or locally within lungs and airways. Some neuropeptides, such as leptin or substance P, are respiratory stimulants; others, such as neurotensin, produce variable effects on respiration depending on the site of application. Some neuropeptides have been implicated in pathological states, such as obstructive sleep apnea or asthma. This article provides a concise review of the possible role and functions of several selected neuropeptides in the process of breathing in health and disease and in lung pathologies.

PMID: 29223509 [PubMed - as supplied by publisher]

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Impact of chronic kidney disease on mortality in adults undergoing balloon aortic valvuloplasty.

Impact of chronic kidney disease on mortality in adults undergoing balloon aortic valvuloplasty.

Cardiovasc Revasc Med. 2017 Oct 26;:

Authors: Parikh PB, Novotny S, Jeremias A, Butler J, Yang J, Yin D, Gruberg L

Abstract
BACKGROUND: Balloon aortic valvuloplasty (BAV) is often utilized as a bridge prior to surgical or transcatheter aortic valve replacement. Chronic kidney disease (CKD) is commonly present in patients with aortic stenosis, however, its association with outcomes following BAV has not been well studied. Accordingly, we sought to assess the impact of CKD on mortality in adults undergoing BAV.
METHODS: The Nationwide Inpatient Sample was screened for hospitalizations involving adults undergoing BAV from 2006 to 2012. Demographic data and clinical history were recorded. Patients were divided into those with and without CKD as a documented comorbidity and were compared for adjusted in-hospital mortality risk.
RESULTS: Among a national cohort of 10,845 adults undergoing BAV, 3842 (35.4%) adults had CKD while 7003 (64.6%) did not. Patients with CKD were older, more often male, and had higher rates of coronary disease, heart failure, diabetes mellitus, hypertension, peripheral artery disease, obesity, obstructive sleep apnea, and atrial fibrillation. Adults with CKD undergoing BAV had significantly higher in-hospital mortality rates (10.2% vs 6.3%, p=0.0005). In multivariable analysis, CKD was independently associated with a nearly 2-fold higher odds of in-hospital mortality (odds ratio 1.98, 95% confidence interval 1.45-2.70, p<0.0001). Other predictors of mortality included presence of atrial fibrillation and absence of prior myocardial infarction, hypertension, peripheral arterial disease, and smoking.
CONCLUSIONS: CKD was independently associated with a nearly 2-fold higher odds of in-hospital mortality in adults undergoing BAV. Further studies are warranted to determine whether preventive interventions can improve outcomes in this high-risk population.

PMID: 29223500 [PubMed - as supplied by publisher]

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Transport of polymer stabilized nano-scale zero-valent iron in porous media.

Transport of polymer stabilized nano-scale zero-valent iron in porous media.

J Contam Hydrol. 2017 Nov 21;:

Authors: Mondal PK, Furbacher PD, Cui Z, Krol MM, Sleep BE

Abstract
This study presents a set of laboratory-scale transport experiments and numerical simulations evaluating carboxymethyl cellulose (CMC) polymer stabilized nano-scale zero-valent iron (nZVI) transport. The experiments, performed in a glass-walled two-dimensional (2D) porous medium system, were conducted to identify the effects of water specific discharge and CMC concentration on nZVI transport and to produce data for model validation. The transport and movement of a tracer lissamine green B® (LGB) dye, CMC, and CMC-nZVI were evaluated through analysis of the breakthrough curves (BTCs) at the outlets, the time-lapsed images of the plume, and retained nZVI in the sandbox. The CMC mass recovery was >95% when injected alone and about 65% when the CMC-nZVI mixture was used. However, the mean residence time of CMC was significantly higher than that of LGB. Of significance for field implementation, viscous fingering was observed in water displacement of previously injected CMC and CMC-nZVI. The mass recovery of nZVI was lower (<50%) than CMC recovery due to attachment onto sand grain surfaces. Consecutive CMC-nZVI injections showed higher nZVI recovery in the second injection, a factor to be considered in field trials with successive CMC-nZVI injections. Transport of LGB, CMC, and nZVI were modeled using a flow and transport model considering LGB and CMC as solutes, and nZVI as a colloid, with variable solution viscosity due to changes in CMC concentrations. The simulation results matched the experimental observations and provided estimates of transport parameters, including attachment efficiency, that can be used to predict CMC stabilized nZVI transport in similar porous media, although the extent of viscous fingering may be underpredicted. The experimental and simulation results indicated that increasing specific discharge had a greater effect on decreasing CMC-nZVI attachment efficiency (corresponding to greater possible travel distances in the field) than increasing CMC concentration.

PMID: 29223368 [PubMed - as supplied by publisher]

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Comprehensive determinants of growth trajectories and body composition in school children: A longitudinal cohort study.

Comprehensive determinants of growth trajectories and body composition in school children: A longitudinal cohort study.

Obes Res Clin Pract. 2017 Dec 06;:

Authors: Fan HY, Lee YL, Yang SH, Chien YW, Chao JC, Chen YC

Abstract
OBJECTIVE: To fully explain the dynamic and comprehensive etiology of the trajectory associated with adiposity indices.
METHODS: This study involved data of 5572 children, aged 6-11 years, as part of the Taiwan Children Health Study (TCHS). The present study introduced four distinct BMI trajectories, identified previously among children: persistently healthy weight; late-onset overweight or obesity; persistent overweight or obesity; and declining BMI class. Logistic regression was used to examine the effect of non-modifiable factors on BMI trajectory classes. Generalized estimating equations were used to examine the effect of dynamically modifiable factors on either BMI trajectory classes or adiposity indices.
RESULTS: Compared with class 1 (persistently healthy weight), class 2 exhibited a significantly increased risk of weight gain and fat mass, affected by lower family incomes and poor-quality sleep. Class 3 had a higher risk of persistent obesity and abdominal obesity, affected by higher birthweight and sedentary lifestyle. Class 4 approached a healthy weight due to increased physical activity, which was associated with a decrease in body fat and central obesity.
CONCLUSIONS: We found crucially non-modifiable and modifiable factors that could describe each high BMI growth pattern, and calculated their modifiable contributions to adiposity indices. Modifiable factors that focus on those crucially dynamic factors are recommended for preventing obese growth trajectories.

PMID: 29223363 [PubMed - as supplied by publisher]

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Burden of skin pain in atopic dermatitis.

Burden of skin pain in atopic dermatitis.

Ann Allergy Asthma Immunol. 2017 Dec;119(6):548-552.e3

Authors: Vakharia PP, Chopra R, Sacotte R, Patel KR, Singam V, Patel N, Immaneni S, White T, Kantor R, Hsu DY, Silverberg JI

Abstract
BACKGROUND: Atopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.
OBJECTIVE: To characterize the patient burden of skin pain in AD.
METHODS: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist.
RESULTS: Overall, 305 patients (age range, 13-97 years) were included in the study, with 564 encounters. The cohort included 195 females (63.9%) and 193 whites (63.7%). The mean (SD) age at enrollment was 42.3 (18.1) years, and the mean (SD) age of patient-reported AD onset was 29.6 (31.9) years. At baseline, 144 patients (42.7%) reported skin pain in the past week, with 42 (13.8%) reporting severe or very severe pain. Twenty-four (16.8%) thought the skin pain was part of their itch, 16 (11.2%) from scratching, and 77 (72.0%) from both. Patients with skin pain were more likely to describe their itch using terms that resembled neuropathic pain. Prevalence of skin pain was increased in patients with vs without excoriations (72.6% vs 57.6%; χ2 test P = .02) but not other morphologic characteristics. Skin pain severity was most strongly correlated with the Patient-Oriented Eczema Measure (Spearman ρ = 0.54), followed by ItchyQOL (ρ = 0.52), 5-dimensions of itch scale (ρ = 0.47), Dermatology Life Quality Index (ρ = 0.45), numeric rating scale for itch (ρ = 0.43) and sleep (ρ = 0.36), Patient Health Questionnaire 9 (ρ = 0.36), patient-reported global AD severity (ρ = 0.34), Eczema Area and Severity Index (ρ = 0.23), and objective Scoring AD index (ρ = 0.20) (P < .001 for all). Patients with both severe itch and pain vs those with only one or neither symptom being severe had significant increases in all these measures.
CONCLUSION: Skin pain is a common and burdensome symptom in AD. Skin pain severity should be assessed with itch severity in AD patients and may be an important end point for monitoring treatment response.

PMID: 29223299 [PubMed - in process]

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Human studies on hypothalamo-pituitary-adrenal (HPA) axis.

Human studies on hypothalamo-pituitary-adrenal (HPA) axis.

Best Pract Res Clin Endocrinol Metab. 2017 Oct;31(5):459-473

Authors: Liyanarachchi K, Ross R, Debono M

Abstract
The daily rhythm of the hypothalamo-pituitary-adrenal (HPA) axis is regulated by the central clock in the suprachiasmatic nucleus. Cortisol, a glucocorticoid, acts as a secondary messenger between the central clock and the peripheral tissues. Changes in clock time, as seen in shift workers, alters the HPA axis and results in metabolic disturbances associated with ill health. Depression, anorexia nervosa and obstructive sleep apnoea, are associated with cortisol rhythm phase shifts and increased cortisol exposure. Higher nocturnal cortisol exposure is observed in patients with Cushing's syndrome and adrenal incidentalomas with autonomous cortisol secretion and is associated with insulin resistance, and increased cardiovascular risk and mortality. A decrease in cortisol rhythm amplitude is seen in adrenal insufficiency, and despite replacement, patients have an impaired quality of life and increased mortality. Research on cortisol replacement has focused on replacing the cortisol daily rhythm by subcutaneous hydrocortisone infusions and oral modified release hydrocortisone formulations with the aim of improving disease control and quality of life.

PMID: 29223281 [PubMed - in process]

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A Woman in Her 60s With Lung Adenocarcinoma Presents With Copious Watery Sputum and Respiratory Failure.

A Woman in Her 60s With Lung Adenocarcinoma Presents With Copious Watery Sputum and Respiratory Failure.

Chest. 2017 Dec;152(6):e143-e146

Authors: Roeder NL, Marshall JD, Britto CJ

Abstract
CASE PRESENTATION: A woman in her 60s presented with 1 month of progressive dyspnea, watery rhinorrhea, and paroxysmal cough productive of clear, watery sputum. She was diagnosed with epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma at another institution 1 week prior to presentation and 3 weeks after the onset of symptoms. She was a never-smoker. She denied fevers and had completed a course of antibiotics for presumed pneumonia, without clinical improvement. She presented to the hospital due to increasing severity of her shortness of breath.

PMID: 29223274 [PubMed - in process]

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A 40-Year-Old Man With Cough, Shortness of Breath, and Suspected Pleural Effusion: "Catastrophe Averted".

A 40-Year-Old Man With Cough, Shortness of Breath, and Suspected Pleural Effusion: "Catastrophe Averted".

Chest. 2017 Dec;152(6):e125-e127

Authors: Mittal S, Amir M, Madan K

PMID: 29223270 [PubMed - in process]

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Exploring the Art of Ciliary Beating: The Benefits of High-Speed Video Analysis.

Exploring the Art of Ciliary Beating: The Benefits of High-Speed Video Analysis.

Chest. 2017 Dec;152(6):1348-1349

Authors: Lucas JS, Evans HJ, Haarman EG, Hirst RA, Hogg C, Jackson CL, Nielsen KG, Omran H, Papon JF, Robinson P, Shoemark A, Walker WT

PMID: 29223261 [PubMed - in process]

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Long non-coding RNAs in metastasis

Abstract

Long non-coding RNA (lncRNA) genes have recently been discovered as key regulators of developmental, physiological, and pathological processes in humans. Recent studies indicate that lncRNAs regulate every step of gene expression, and their aberrant expression can be found in the majority of cancer types. Particularly, lncRNAs were found to function in tumor development and metastasis, which is the major cause of cancer-related death. Thus, exploring key roles of lncRNAs in metastasis is predicted to enhance our knowledge of metastasis, and uncover novel therapeutic targets and biomarkers of this process. In this review, we discuss the molecular mechanisms of lncRNAs in gene expression regulation and their function in metastasis.

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Prospective transfrontal sheep model of skull-base reconstruction using vascularized mucosa

Background

No high-fidelity animal model exists to examine prospective wound healing following vascularized reconstruction of the skull base. Such a model would require the ability to study the prospective behavior of vascularized mucosal repairs of large dural and arachnoid defects within the intranasal environment. The objective of this study was to therefore develop and validate a novel, in vivo, transfrontal sheep model of cranial base repair using vascularized sinonasal mucosa.

Methods

Twelve transfrontal craniotomy and 1.5-cm durotomy reconstructions were performed in 60-kg to 70-kg Dorset/Ovis Aries sheep using vascularized mucosa with or without an adjunctive Biodesign™ underlay graft (n = 6 per group). Histologic outcomes were graded (scale, 0 to 4) by a blinded veterinary histopathologist after 7, 14, and 28 days for a range of wound healing parameters.

Results

All sheep tolerated the surgery, which required 148 ± 33 minutes. By day 7, the mucosa was fully adherent with complete partitioning of the sinus and intracranial compartments. Fibroblast infiltration and flap neovascularization scores significantly increased between day 7 (0.3 ± 0.5 and 0.0 ± 0.0) and day 28 (4.0 ± 0.0, p = 0.01 and 2.0 ± 0.8, p = 0.01; respectively), while hemorrhage scores significantly decreased from 2.5 ± 0.6 to 0.0 ± 0.0 (p = 0.01). The inflammatory scores were not significantly different between the heterologous graft and control sides.

Conclusion

The described sheep model accurately reflects prospective intranasal wound healing following vascularized mucosal reconstruction of dural defects. This model can be used in future studies to examine novel reconstructive materials, tissue glues, and transmucosal drug delivery to the central nervous system.

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The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis

Background

While Eustachian tube dysfunction (ETD) is a known comorbidity of chronic rhinosinusitis (CRS), the prevalence of ETD symptoms in the CRS population is poorly understood. We sought to determine the cross-sectional prevalence of ETD in patients with CRS using the validated Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate ETDQ-7 scores with 22-item Sino-Nasal Outcome Test (SNOT-22) scores, endoscopy scores, and computed tomography (CT) scores.

Methods

A total of 101 patients with confirmed CRS completed the ETDQ-7 and SNOT-22 at their initial visit to our rhinology clinic. Lund-Mackay CT and Lund-Kennedy endoscopy scores were also obtained. Spearman's correlation coefficient (ρ) was calculated.

Results

Among the 101 patients, 49 patients (48.5%) had an ETDQ-7 score of ≥14.5, signifying clinically significant ETD. The mean ± standard deviation (SD) ETDQ-7 score of the entire cohort was 17.8 ± 10.1. There was a moderately strong correlation between ETDQ-7 and the SNOT-22 ear subdomain (ρ = 0.691, p < 0.001). The correlation coefficient between ETDQ-7 and total SNOT-22 scores was ρ = 0.491 (p < 0.001), indicating moderate correlation. ETDQ-7 scores were poorly correlated to objective measures of sinonasal disease, including Lund-Mackay CT score (ρ = −0.055, p = 0.594) and Lund-Kennedy endoscopy score (ρ = −0.099, p = 0.334).

Conclusion

Symptoms of ETD are highly prevalent among patients with CRS as documented by patient-reported outcome measures. The correlation between ETDQ-7 scores and SNOT-22 ear subdomain scores is moderately strong, while the correlation between ETDQ-7 scores and SNOT-22 scores is moderate. ETD severity does not correlate with CT score or nasal endoscopy score.

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The association of air pollutants and allergic and nonallergic rhinitis in chronic rhinosinusitis

Background

There has been little investigation regarding air quality and rhinitis in the pathophysiology of upper airway disease. In this study, we assessed the impact of inhalant pollutants (particulate matter 2.5 [PM_2.5] and black carbon [BC]) on allergic rhinitis and chronic rhinosinusitis (CRS) disease severity.

Methods

CRS patients with nasal polyps (CRSwNP) and without polyps (CRSsNP) were identified. Spatial modeling from pollutant monitoring sites was used to estimate exposures for patients meeting the inclusion criteria (total, n = 125; CRSsNP, n = 67; CRSsNP, n = 58). Skin-prick, intradermal dilutional, and in-vitro testing methods were utilized to determine aeroallergen sensitization. Disease severity indicators were measured by modified Lund-Mackay score (LMS), the 22-item Sino-Nasal Outcome Test (SNOT-22), systemic steroid therapy, and number of functional endoscopic sinus surgeries (FESS).

Results

Thirty-six percent (n = 45) of patients who described rhinitis symptoms demonstrated no reactivity to aeroallergen testing. Sixty-four percent (n = 80) tested positive for at least 1 allergen, with no differences found between CRSsNP and CRSwNP (62.1% vs 67.2%). There were significant differences in air pollutants between patients testing negative and positive for allergies (nonallergic vs allergic: PM_2.5, 11.32 vs 11.07 μg/m³, p = 0.030; BC, 0.81 vs 0.76 absorbance, p =0.044). Nonallergic CRSwNP demonstrated higher PM_2.5 compared with allergic counterparts (11.48 vs 11.09 μg/m³, p = 0.032). A similar pattern was observed with BC (0.82 vs 0.75 absorbance, p = 0.017). In CRSsNP, BC correlated significantly with SNOT-22 (r = 0.55, p = 0.042).

Conclusion

Our results suggest that small inhalant pollutants may contribute to nonallergic symptomatology in patients with and without nasal polyps. Regardless of allergy status, BC may play a role in CRS symptom severity.

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IJERPH, Vol. 14, Pages 1550: Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership

IJERPH, Vol. 14, Pages 1550: Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121550

Authors: Emee Estacio Mike Oliver Beth Downing Judy Kurth Joanne Protheroe

This paper aims to explore key elements needed to successfully develop healthy partnerships and collaborative working in community-based health promotion. It draws upon the lessons learned from a case study with the Health Literacy Partnership in Stoke-on-Trent, UK in developing the health literacy strategy in the area. The process was underpinned by respect for diverse yet complementary perspectives and skills from the grassroots up. This involved engagement with key stakeholders, development and support for community projects, and sharing of good practice with other national and local organizations. Stakeholders involved in developing the strategy also had a keen interest in health literacy and a strong commitment to promoting health and well-being in the area. Through patience, perseverance, and continuous open communication and learning, the health literacy strategy in Stoke-on-Trent, UK is beginning to have a ripple effect into local practice, and will potentially influence policy in the future.

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LncRNA XIST regulates myocardial infarction by targeting miR-130a-3p

Abstract

The study was employed to probe long non-coding RNA X-inactive specific transcript RNA (lncRNA XIST) expression profile and its influence on cell cycle, proliferation and apoptosis in myocardial cells. We also aimed to explore the possible meditating relationship between XIST, PDE4D and miR-130a-3p. Gene differential analysis was carried out using Human LncRNA Microarray V3.0. Quantitative real-time PCR (qRT-PCR) was used to test mRNA expressions of XIST, miR-130a-3p and PDE4D in normal cells and post-myocardial infarction (MI) cells. Western blot was applied to determine the protein expression profile of PED4D. Changes in viability and cell cycle/apoptosis of post-MI myocardial cells after silencing of XIST or PDE4D were investigated by MTT assay and flow cytometry, respectively. The targeting relationship between miR-130a-3p and XIST, PDE4D in myocardial cells were verified by dual luciferase reporter assay. Simulated MI environment was constructed by performing anoxic preconditioning in normal cells to probe the influence of XIST on myocardial cell apoptosis. XIST and PDE4D were overexpressed in post-MI myocardial cells, while miR-130a-3p was underexpressed in post-MI myocardial cells. High-expressed XIST and PDE4D both promoted myocardial cell apoptosis. High-expressed XIST also inhibited myocardial cell proliferation. XIST down-regulated miR-130a-3p and PDE4D was a direct target of miR-130a-3p. LncRNA XIST promotes MI by targeting miR-130a-3p. MI induced by PDE4D can be reversed by miR-130a-3p. This article is protected by copyright. All rights reserved

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MiR-1290 promotes proliferation, migration and invasion of glioma cells by targeting LHX6

Abstract

Objective: To investigate the interaction of miR-1290 and LHX6 in gliomas, and their influence on the propagation and metastasis of glioma cells.

Methods: The differential expression of miR-1290 in glioma cells was identified by chip screening. The expression level of miR-1290 and LHX6 were determined by qRT-PCR and western blot. The influence of miR-1290 on propagation of glioma cells were analyzed by MTT assay, EdU incorporation and colony formation, while the impact of miR-1290 on metastasis was assessed by transwell assay. The relationship between LHX6 and miR-1290 was testified by luciferase reporter assay. The gliomas orthotopic implantation model of nude mice was established to investigate the influence of miR-1290 and LHX6 on tumor growth. Tumor volumes were evaluated by photon density, and the expression of Ki67 protein was analyzed by immunohistochemistry.

Results: MiR-1290 presented a higher expression in glioma cells and tissues. MiR-1290 overexpression significantly promoted propagation and metastasis of glioma cells, while miR-1290 knockdown inhibited glioma development. MiR-1290 suppressed LHX6 expression, facilitating development of glioma cells. The orthotopic implantation model showed that miR-1290 overexpression promoted tumor growth while LHX6 overexpression inhibited it.

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The Effects of Aromatherapy on Intensive Care Unit Patients’ Stress and Sleep Quality: A Nonrandomised Controlled Trial

Background. Stress has both physiological and psychological effects and can negatively impact patients’ treatment and recovery. We examined whether the aromatherapy alleviated patients’ stress and improved their sleep quality and provided data that can be utilized in clinical settings. Methods. This was a nonrandomised controlled experimental study. Participants included lucid adult patients who were admitted to the intensive care unit and had spent more than two nights there. The experimental treatment required participants to engage in deep breathing with essential oils as part of the aromatherapy. The control group was instructed to go to sleep without receiving the lavender aroma oil. Results. The experimental group and control group showed a significant difference in perceived stress (, ), objective stress index (, ), systolic blood pressure (, ), diastolic blood pressure (, ), heart rate (, ), and sleep quality (, ). Conclusions. The results revealed that aromatherapy alleviated stress and improved sleep quality in intensive care unit patients after 2 days of the experimental treatment. These results demonstrate that aromatherapy affects stress and sleep quality, thus indicating its value in nursing interventions. This trial is registered with KCT0002344.

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Primary Signet-Ring Cell Adenocarcinoma of the Urinary Bladder Treated with Partial Cystectomy: A Case Report and Review of the Literature

Primary signet-ring cell carcinoma is a variant of adenocarcinoma which is extremely rare, associated with poor prognosis and generally found to be resistant to chemotherapy and radiotherapy. We report a case of primary signet-ring cell carcinoma of the bladder which was successfully treated with partial cystectomy. A 71-year-old female with a history of type 2 diabetes, hypertension, and ischaemic heart disease presented with painless haematuria for 2 months’ duration. The abdominal ultrasonography showed a localised polypoidal vesical growth arising from the bladder dome. Cystoscopy revealed an exophytic solid tumour in the anterior fundal wall. A deep transurethral resection of bladder tumour was done and histology revealed an adenocarcinoma composed of mucinous and signet-ring cell components. Later, considering the patient’s age and the poor general condition, a partial cystectomy was done. Follow-up cystoscopy and ultrasonography were done at 12 months and there was no evidence of tumour recurrence and the patient is currently symptom-free. Partial cystectomy may be considered in patients with localised tumour without evidence of metastasis and poor general condition. Regular cystoscopies and ultrasound imaging are necessary for follow-up and early identification of recurrences.

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In Vitro Control of Uropathogenic Microorganisms with the Ethanolic Extract from the Leaves of Cochlospermum regium (Schrank) Pilger

The roots of Cochlospermum regium, popularly known as “algodãozinho-do-cerrado,” are used for the treatment of genitourinary infections. However, the removal of their subterranean structures results in the death of the plant, and the use of the leaves becomes a viable alternative. Therefore, the antimicrobial activity of Cochlospermum regium leaf’s ethanolic extract and its action on the biofilm formation of microorganisms associated with urinary infection were evaluated. The total phenolic compounds, flavoids, and tannins were quantified using the reagents Folin-Ciocalteu, aluminum chloride, and vanillin, respectively. The antimicrobial activity was evaluated by the broth microdilution method and the effect of the extract in the biofilm treatment was measured by the drop plate method. Cytotoxicity was evaluated by the method based on the reduction of MTS and the mutagenicity by the Ames test. The ethanolic extract of C. regium leaves presented 87.4 mg/EQ of flavonoids, 167.2 mg/EAG of total phenolic compounds, and 21.7 mg/ECA of condensed tannins. It presented reduction of the biofilm formation for E. coli and C. tropicalis and antimicrobial action of 1 mg/mL and 0.5 mg/mL, respectively. The extract showed no cytotoxicity and mutagenicity at the concentrations tested. This study demonstrated that C. regium leaves are a viable option for the treatment of genitourinary infections and for the species preservation.

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Local Anesthetics, Procaine, Lidocaine, and Mepivacaine Show Vasodilatation but No Type 1 Allergy: A Double-Blind, Placebo-Controlled Study

Background. Therapy with local anesthetics (LAs), also known as neural therapy, is used in integrative medicine because of its anti-inflammatory properties. Ester-linked LAs are often avoided because of their alleged high allergenicity. Little data supports this assumption and hence the importance of our investigation on type-1 allergies against ester- and amide-linked LAs. We performed a prospective, double-blinded, placebo-controlled observational study. Methods. 177 patients received 340 intracutaneous injections with 1% procaine, 0.5% lidocaine, 1% mepivacaine, or saline solution. Every patient received two different tests on each forearm. Reactions were monitored for 15 minutes. Results. No type-1 allergy was observed. The mean erythema diameter of the wheals after 10 minutes was procaine mm, mepivacaine mm, lidocaine mm, and NaCl mm. The wheal diameter of all substances showed a crescendo-decrescendo phenomenon. The procaine and mepivacaine wheals were significantly larger than those of lidocaine and NaCl. No general signs of hypersensitivity were observed. Diameter and intensity were independent of the injection site, order of injection, age, gender, and body mass index. Conclusion. This study shows no higher type-1 allergenicity of the ester-linked LA procaine, compared to the amide-linked LAs lidocaine and mepivacaine, and supports its use in therapy and short-track surgery.

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Late Emergence of an Imatinib-Resistant ABL1 Kinase Domain Mutation in a Patient with Chronic Myeloid Leukemia

The introduction of the tyrosine kinase inhibitor (TKI) imatinib has revolutionised the outlook of chronic myeloid leukemia (CML); however, a significant proportion of patients develop resistance through several mechanisms, of which acquisition of ABL1 kinase domain mutations is prevalent. In chronic-phase patients, these mutations become evident early in the disease course. A case is described of a chronic-phase CML patient who achieved a sustained, deep molecular response but who developed an Y253H ABL1 kinase domain mutation nearly nine years after commencing imatinib. Switching therapy to bosutinib resulted in a rapid reachievement of a major molecular response. Long-term TKI treatment impacts on quality of life and late losses of responses are usually due to lack of adherence. This case highlights the requirement for ABL1 kinase domain mutation analysis in those CML patients on long-term imatinib who lost their molecular response, regardless of whether nonadherence is suspected.

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Effect of Uniaxial Tensile Cyclic Loading Regimes on Matrix Organization and Tenogenic Differentiation of Adipose-Derived Stem Cells Encapsulated within 3D Collagen Scaffolds

Adipose-derived mesenchymal stem cells have become a popular cell choice for tendon repair strategies due to their relative abundance, ease of isolation, and ability to differentiate into tenocytes. In this study, we investigated the solo effect of different uniaxial tensile strains and loading frequencies on the matrix directionality and tenogenic differentiation of adipose-derived stem cells encapsulated within three-dimensional collagen scaffolds. Samples loaded at 0%, 2%, 4%, and 6% strains and 0.1 Hz and 1 Hz frequencies for 2 hours/day over a 7-day period using a custom-built uniaxial tensile strain bioreactor were characterized in terms of matrix organization, cell viability, and musculoskeletal gene expression profiles. The results displayed that the collagen fibers of the loaded samples exhibited increased matrix directionality with an increase in strain values. Gene expression analyses demonstrated that ASC-encapsulated collagen scaffolds loaded at 2% strain and 0.1 Hz frequency showed significant increases in extracellular matrix genes and tenogenic differentiation markers. Importantly, no cross-differentiation potential to osteogenic, chondrogenic, and myogenic lineages was observed at 2% strain and 0.1 Hz frequency loading condition. Thus, 2% strain and 0.1 Hz frequency were identified as the appropriate mechanical loading regime to induce tenogenic differentiation of adipose-derived stem cells cultured in a three-dimensional environment.

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Nanotechnology-Based Cardiac Targeting and Direct Cardiac Reprogramming: The Betrothed

Cardiovascular diseases represent the first cause of morbidity in Western countries, and chronic heart failure features a significant health care burden in developed countries. Efforts in the attempt of finding new possible strategies for the treatment of CHF yielded several approaches based on the use of stem cells. The discovery of direct cardiac reprogramming has unveiled a new approach to heart regeneration, allowing, at least in principle, the conversion of one differentiated cell type into another without proceeding through a pluripotent intermediate. First developed for cancer treatment, nanotechnology-based approaches have opened new perspectives in many fields of medical research, including cardiovascular research. Nanotechnology could allow the delivery of molecules with specific biological activity at a sustained and controlled rate in heart tissue, in a cell-specific manner. Potentially, all the mediators and structural molecules involved in the fibrotic process could be selectively targeted by nanocarriers, but to date, only few experiences have been made in cardiac research. This review highlights the most prominent concepts that characterize both the field of cardiac reprogramming and a nanomedicine-based approach to cardiovascular diseases, hypothesizing a possible synergy between these two very promising fields of research in the treatment of heart failure.

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Linking Cancer Cachexia-Induced Anabolic Resistance to Skeletal Muscle Oxidative Metabolism

Cancer cachexia, a wasting syndrome characterized by skeletal muscle depletion, contributes to increased patient morbidity and mortality. While the intricate balance between protein synthesis and breakdown regulates skeletal muscle mass, the suppression of basal protein synthesis may not account for the severe wasting induced by cancer. Therefore, recent research has shifted to the regulation of “anabolic resistance,” which is the impaired ability of nutrition and exercise to stimulate protein synthesis. Emerging evidence suggests that oxidative metabolism can regulate both basal and induced muscle protein synthesis. While disrupted protein turnover and oxidative metabolism in cachectic muscle have been examined independently, evidence suggests a linkage between these processes for the regulation of cancer-induced wasting. The primary objective of this review is to highlight the connection between dysfunctional oxidative metabolism and cancer-induced anabolic resistance in skeletal muscle. First, we review oxidative metabolism regulation of muscle protein synthesis. Second, we describe cancer-induced alterations in the response to an anabolic stimulus. Finally, we review a role for exercise to inhibit cancer-induced anabolic suppression and mitochondrial dysfunction.

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Ambrogino d??oro 2017: oncologi dell??Istituto Nazionale dei Tumori di Milano nell??elenco dei premiati

COMUNICATO STAMPA

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SABCS 2017: Eribulin mesylate and pembrolizumab in patients with metastatic triple-negative breast cancer

Eisai today announced updated results of ENHANCE 1, a Phase 1b/2 trial investigating eribulin mesylate, in combination with pembrolizumab, in patients with metastatic triple-negative breast cancer . Findings presented during the 2017 San Antonio Breast...

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The metagenomic approach to characterization of the microbial community shift during the long-term cultivation of anammox-enriched granular sludge

Abstract

A metagenomic approach was used to investigate how the microbial community composition changes when an anammox-based granular sludge reactor is seeded with nitritation-anammox biomass from a wastewater treatment plant. In the seed sample, the abundance of Candidatus Kuenenia stuttgartiensis was similar to Candidatus Jettenia caeni (12.63 vs. 11.68%). This biomass was typical in terms of microbial nitrogen conversion; both ammonia (Nitrosomonas sp.) and nitrite (Nitrospira sp.) oxidizing bacteria were detected. In the lab-scale reactor, Candidatus Kuenenia stuttgartiensis and Candidatus Jettenia caeni bacteria were also present in equal proportions (18.57 vs. 20.89%). On the contrary, Candidatus Nitrospira defluvii bacteria were highly abundant in this reactor, but no known ammonia-oxidizing bacteria were detected. In light of recent studies showing that Nitrospira sp. are capable of complete nitrification, the results presented here may well indicate that both stages of nitrification in the anammox-based granular sludge reactor were performed by this bacteria.

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Air exposure may be associated with the histological differentiation of a cultured epidermal autograft (JACE)

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HLA-B*1502 haplotype screening prior to carbamazepine administration in individuals of south-east Asian ancestry nears cost-effectiveness in preventing severe cutaneous adverse drug reactions

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Proportion of melanoma excisions performed by different specialties in Australia

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Optimizing hemodynamics of transcatheter aortic valve-in-valve implantation in 19-mm surgical aortic prostheses

Abstract

Objective

To demonstrate the feasibility of achieving good hemodynamic results with valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for degenerated 19 mm surgical bioprosthetic valves.

Background

Considerable controversy exists regarding ViV TAVR within 19mm surgical prostheses due to concerns of elevated valve gradients and mortality.

Methods

Among all patient undergoing ViV TAVR between 7/2016 and 4/2017 for symptomatic severe bioprosthetic aortic stenosis (AS), five had a 19 mm surgical valve in place and were included in this publication. None of the patients had patient-prosthesis mismatch. Aggressive post-dilation was performed in four out of five cases using a special technique we describe below.

Results

In all cases, mean aortic valve (AV) gradients significantly improved post-ViV TAVR, particularly after post-dilation. Interestingly, high pressure post-dilation of the ViV resulted in an increase in the diameter of surgical valve stent frame dimensions in nearly all patients who underwent post-dilation.

Conclusions

Good hemodynamic outcome is possible with aggressive post-dilation in patients with 19 mm failed surgical bioprostheses. High-risk patients with 19 mm failed surgical prostheses who do not otherwise have viable surgical options should be considered for ViV TAVR.

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Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR)

Abstract

Objective

Demonstrate proof-of-concept validation of a computed tomography (CT) computer-aided design prediction modeling tool to identify patients at risk for left ventricular outflow tract (LVOT) obstruction in transcatheter mitral valve replacement (TMVR).

Background

LVOT obstruction is a significant and even fatal consequence of TMVR.

Methods

From August 2013 to August 2017, 38 patients in 5 centers underwent TMVR with compassionate use of balloon-expandable valves for severe mitral valve dysfunction because of degenerative surgical mitral ring, bioprosthesis, or severe native mitral stenosis from to severe mitral annular calcification. All patients had preprocedural CT scans performed for anatomic screening, intraprocedural TEE and invasive hemodynamics performed. Preprocedural prediction modeling was performed utilizing computer-aided design (CAD) of the neo-LVOT post-TMVR. Post-TMVR CT scans were obtained and compared to pre-TMVR LVOT modeling datasets for validation.

Results

All patients underwent successful TMVR without device embolization. Seven of the 38 patients experienced LVOT obstruction, defined as an increase of ≥10 mmHg LVOT peak gradient post-TMVR. Anatomic screening using CT was validated in 20/38 patients as preprocedural predicted neo-LVOT surface area correlated well with post-TMVR measurements (R² = 0.8169, P < 0.0001). A receiver operating curve curve found a predicted neo-LVOT surface area of ≤ 189.4 mm² to have 100% sensitivity and 96.8% specificity for predicting TMVR-induced LVOT obstruction.

Conclusion

CAD design and CT postprocessing are indispensable tools in predicting LVOT obstruction and necessary for anatomic screening in percutaneous TMVR.

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Δευτέρα 11 Δεκεμβρίου 2017

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