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Τρίτη, 12 Δεκεμβρίου 2017

Aberrant left renal vein: CT

A 25 yrs old married woman c/o abdominal pain and nausea for 1 day.  Pregnancy test –ve. CT scan revealed an anomalous and elongated left renal vein draining into the left common iliac vein. Left renal vein is elongated with an aberrant para-aortic virtually vertical course.

Case Submitted by Dr. Abduladeem Al-Tamimi, MD, DMRD, FRCR, Consultant Radiologist





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Naso-jejunal tube insertion - interface between radiology and endoscopy.

Related Articles

Naso-jejunal tube insertion - interface between radiology and endoscopy.

World J Radiol. 2017 Nov 28;9(11):413-415

Authors: Riddel N, Thoufeeq MH

A survey was performed to identify the practice associated with endoscopic placement of naso-jejunal (NJ) tubes. We had a total of 236 responses, of which 228 responded to the frequency of requesting X-ray after placing NJ tubes. The responses suggested that there was a strong variation in the practice. The practice was independent on clinicians' area of interest, hospital setting or experience in endoscopy. Currently there are no accepted guidelines on this. Hence, we advise hospitals to have robust local guidelines until there is internationally agreed consensus.

PMID: 29225738 [PubMed]

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Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

Related Articles

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

World J Radiol. 2017 Nov 28;9(11):405-412

Authors: Turan HG, Özdemir M, Acu R, Küçükay F, Özdemir FAE, Hekimoğlu B, Yıldırım UM

AIM: To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease.
METHODS: Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays.
RESULTS: The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively).
CONCLUSION: There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

PMID: 29225737 [PubMed]

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Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy

A FDG-PET/CT image feature with optimal prognostic potential for locally-advanced non-small cell lung cancer (LA-NSCLC) patients has yet to be identified, and neither has the optimal time for FDG-PET/CT response assessment; furthermore, nodal features have been largely ignored in the literature. We propose to identify image features or imaging time point with maximal prognostic power.

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Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

We report a systematic review of lung radiation doses from breast cancer radiotherapy.

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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

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Elias Mazzawi, Imad Abu El-naaj, Yasmine Ghantous, Salim Balan, Edmond Sabo, Adi Rachmiel, Yoav Leiser
AimThe 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.MethodsOral squamous cell carcinoma patients, who had undergone at least one imaging test 2 weeks before the surgery, were included. Radiological findings were compared with the dissected neck to assess the lymph node status. Sensitivity and specificity of the imaging modalities were calculated using the Chi-square test.ResultsSensitivities for detecting metastatic neck lymph nodes at a threshold of 1cm were 48% (P = 0.02) and 43.8% (P = 0.3) for CT and MRI respectively. Specificities were 76.3% and 70% respectively. As for the 1.5cm threshold sensitivities were 36% (P = 0.002) and 31.3% (P = 0.5) respectively, and specificities were 91.5% and 76.7% respectively. PET-CT was the most sensitive modality in the present study, with a P value 0.02.ConclusionThe different studied imaging modalities used for pre-operational neck staging are not sensitive enough and would lead to underdiagnoses of a respectful proportion of patients. Thus prophylactic neck dissection for occult neck disease is of extreme importance and remains the gold-standard for oral cancer treatment.

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

Publication date: Available online 11 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Luana de Goés Soares, Ricardo Lopes Rocha, Elizabete Bagordakis, Endi Lanza Galvão, Dhelfeson Willya Douglas-de-Oliveira, Saulo Gabriel Moreira Falci
ObjectiveThis study aimed to evaluate if Sjögren's syndrome is related to periodontal status.Study DesignA systematic review was performed based on PRISMA (PROSPERO: CRD42017055202). The search was performed in the PubMed/MEDLINE, LILACS, Web of Science and Science Direct databases. Hand searches and gray literature were also performed. Three researchers independently selected studies, extracted data and assessed methodological quality. Studies that correlated primary and/or secondary SS, with plaque index, gingival index, probing depth and bleeding on probing were included. The risk of bias was estimated based on the Newcastle-Ottawa scale.ResultsSeventeen studies were included, and nine included in the meta-analysis, with a total of 518 and 544 patients, with and without Sjögren's Syndrome, respectively. The mean difference of plaque index (0.29; CI95% 0.17-0.41), gingival index (0.52; CI95% 0.14-0.89) and bleeding on probing (9.92; CI95%4.37-15.47) were larger in SS patients than controls. In primary SS (0.47; CI95% 0.10-0.83) and secondary SS (0.74 CI95% 0.10-1.38), only gingival index mean was larger than in control group. The majority of the included studies were judged as high risk of bias.ConclusionThe present review does not provide strong evidence to ensure that the periodontal status is affected by Sjögren's syndrome.

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Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): MRI

Case Report
24 yrs male presents for MRI of cervical & dorsal spine with H/O neck pain, right upper limb pain, back pain & imbalance in walking of long duration.

MRI findings
Gross thickening with STIR hyperintense signal  in cervical nerve roots in foraminal & extraforaminal segments with severe near symmetric involvement of bilateral brachial plexus in entire extent upto divisions & cords without any focal nodularity in the thickened nerve roots & with intact surrounding fat planes. Thickening with increased signal to mild extent also seen in all the dorsal nerve roots & intercostal nerves bilaterally. Limted sagittal sections of LS spine show significant thickening of lumbar & sacral nerve roots in foraminal & extraforaminal  segments without thickening of nerve roots of cauda equina. Spinal cord is unremarkable without any focal lesion or any extrinsic compression. Findings are not specific to etiology, possibly suggestive of hypertrophic polyneuropathy like chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

Discussion by Dr MGK Murthy, Dr GA Prasad
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is characterized clinically by a progressive or relapsing course of many months to years of symptoms similar to compressive myelopathy.









Remains unknown, but T-cell activation in nerves plays an important role in the pathogenesis of CIDP & antigens in Schwann cells have been identified.

CIDP is characterized by mononuclear cell infiltrates, edema, segmental demyelination, and remyelination & "onion bulb formation" which describes enlarged fascicles with increased endoneural connective tissues in which many myelinated fibers are surrounded by concentrically arranged  Schwann cells  that affects both nerve roots and peripheral nerves leading to nerve hyprtrophy.

Hypertrophy and abnormal enhancement of the cauda equina and lumbar spinal roots are seen. Involvement of cervical roots and the brachial plexus are rare & involvement of
intercostal nerves is also rare. Increased T2 signal intensity and the variable contrast
enhancement of roots and nerve trunks reflect increased water content within the nerve fascicles and breakdown of the blood–nerve barrier, respectively. Gadolinium enhancement possibly suggests active disease.

An elevated protein and low cell count in CSF sample, slowing/ block / prolonged distal latencies, and absence of waves or prolonged minimum f-wave latencies in electrophysiological
studies of nerve conduction suggest CIDP.

Differential diagnosis of nerve root hypertrophy–

1.      Hereditary motor and sensory neuropathies (HMSN) – which are a heterogeneous group of genetically determined peripheral neuropathies characterized by symmetrical and predominately distal motor and sensory disturbances and a slowly progressive course. Charcot-Marie-Tooth and Déjèrine-Sottas disease are the disorders most characteristically associated with marked thickening of peripheral nerves (hypertrophic neuropathies).
-        Dejerine-Sottas disease (also known as hereditary motor and sensory neuropathy type III or hypertrophic interstitial polyneuritis) – predominantly causes enlarged cauda equina nerve roots & cranial nerves.
-        Charcot-Marie-Tooth disease – usually shows diffusely enlarged cauda equina, nerve roots, and ganglia.
Diagnosis is founded on familial history, clinical-laboratory data, electromyography and nerve conduction studies, sural nerve biopsy, and molecular genetic studies.

2.      Neurofibromatosis.
3.      Guillian-Barre syndrome -   acute and rapidly progressive inflammatory demyelinating polyneuropathy &  diagnosis is usually established on the basis of symptoms and signs,  cerebrospinal fluid findings and electrophysiologic criteria. MRI shows  marked enhancement of the thickened nerve roots in the conus medullaris and cauda equine with or without abnormalities on precontrast images.
4.      Neoplastic lesions like lymphoma / leukemia / meningeal carcinomatosis.
5.      Sarcoidosis / Amyloidosis.
6.      CMV polyradiculopathy in patients with AIDS / Lyme's disease.

Biopsy of the involved peripheral nerve, usually sural nerve may help in the diagnosis.
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Anthropogenic 236U in Danish Seawater: Global Fallout versus Reprocessing Discharge.

http:--pubs.acs.org-images-pubmed-acspub Related Articles

Anthropogenic 236U in Danish Seawater: Global Fallout versus Reprocessing Discharge.

Environ Sci Technol. 2017 Jun 20;51(12):6867-6876

Authors: Qiao J, Steier P, Nielsen S, Hou X, Roos P, Golser R

This work focuses on the occurrence of 236U in seawater along Danish coasts, which is the sole water-exchange region between the North Sea-Atlantic Ocean and the Baltic Sea. Seawater collected in 2013 and 2014 were analyzed for 236U (as well as 238U and 137Cs). Our results indicate that 236U concentrations in Danish seawater are distributed within a relatively narrow range of (3.6-8.2) × 107 atom/L and, to a certain extent, independent of salinity. 236U/238U atomic ratios in Danish seawater are more than 4 times higher than the estimated global fallout value of 1× 10-9. The levels of 236U/238U atomic ratios obtained are comparable to those reported for the open North Sea and much higher than several other open oceans worldwide. This indicates that besides the global fallout input, the discharges from the two major European nuclear reprocessing plants are dominating sources of 236U in Danish seawater. However, unexpectedly high 236U/238U ratios as well as high 236U concentrations were observed at low-salinity locations of the Baltic Sea. While this feature might be interpreted as a clue for another significant 236U input in the Baltic Sea, it may also be caused by the complexity of water currents or slow turnover rate.

PMID: 28505439 [PubMed - indexed for MEDLINE]

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mDixon-based texture analysis of an intraosseous lipoma: a case report and current review for the dental clinician.

mDixon-based texture analysis of an intraosseous lipoma: a case report and current review for the dental clinician.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 06;:

Authors: Lee KM, Kim HG, Lee YH, Kim EJ

An intraosseous lipoma is a rare histologic variant of lipoma, accounting for only 0.1% of all primary bone tumors. This may not be the actual incidence because most of these lesions are frequently asymptomatic, but imaging modalities, such as computed tomography or magnetic resonance imaging (MRI) seem to have increased the detection rate. Lipoma occasionally undergoes osseous metaplasia and becomes an osseous lipoma. Although there are numerous papers discussing intraosseous lipoma and some authors have tried to differentiate lipomas from osseous lipomas, there is still a great deal of confusion with regard to characteristic radiologic features and the use of terms. Use of the mDixon sequence in MRI could be an effective, noninvasive method of lesion detection and differential diagnosis. Texture analysis is a useful technique for capturing intratumoral characteristics. We report what is possibly the first use of the mDixon MRI sequence in the measurement of tumoral texture in a case of the extremely rare inferior nasal turbinate intraosseous lipoma in a 58-year-old female. We conclude that mDixon and texture analysis are helpful methods for differentiating intraosseous lipomas from other masses and confirming the benign characteristics of lipoma. Our review of head and neck intraosseous lipoma could be of particular interest to head and neck surgeons and dental clinicians.

PMID: 29226824 [PubMed - as supplied by publisher]

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Percutaneous transgastrostomic interventional radiology-operated endoscopy facilitates foreign body removal using rigid endobronchial forceps.

Percutaneous transgastrostomic interventional radiology-operated endoscopy facilitates foreign body removal using rigid endobronchial forceps.

Diagn Interv Radiol. 2017 Dec 08;:

Authors: Khayat M, Hussain JS, Beecham Chick JF, Hage AN, Srinivasa RN

Retained foreign bodies within the stomach and proximal small bowel may be problematic in patients with prior cerebrovascular injury or head, neck and esophageal malignancy, given the increased vulnerability of this patient population to complications from aspiration and increased difficulty of esophagogastroduodenoscopy in cases of tumoral obstruction. This article presents an alternative method for foreign body retrieval through an existing gastrostomy tract, which offers the benefits of fast procedure times, reduction in radiation dose and fluoroscopy time, and allows for safer retrieval of foreign bodies by using direct visualization. This technique may be performed entirely by interventional radiologists.

PMID: 29225197 [PubMed - as supplied by publisher]

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Mesenchymale Tumoren des Abdomens bei Kindern


Mesenchymale Tumoren im Kindesalter umfassen eine Reihe gutartiger und bösartiger Entitäten, die sich hinsichtlich Prädilektionsort und Altersgipfel sowie bezüglich der klinischen Symptome voneinander unterscheiden. In manchen Fällen ist eine Biopsie unumgänglich. Ist als Differenzialdiagnose ein Nephroblastom möglich, darf auf keinen Fall biopsiert werden, um eine Zellverschleppung zu vermeiden. Aufgabe der Bildgebung ist die Eingrenzung der Differenzialdiagnose und die Bestimmung der Ausdehnung, einschließlich des Stagings. Ultraschall und Magnetresonanztomographie (MRT) stellen diesbezüglich die wichtigsten Modalitäten dar, die Niedrigdosis-Computertomographie des Thorax wird zum Ausschluss einer pulmonalen Metastasierung herangezogen.

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Neuroendokrine Tumoren des Abdomens


Klinisches/methodisches Problem

Gastroenteropankreatische neuroendokrine Neoplasien (GEP-NEN) sind eine heterogene Gruppe komplexer Tumoren, deren Einteilung aufgrund der Heterogenität und unterschiedlichen Lokalisation häufig schwerfällt.

Radiologische Standardverfahren

Für die Lokalisation der NEN sowie zur Ausbreitungsdiagnostik und Metastasensuche stehen Ultraschalldiagnostik, Computertomographie (CT), Magnetresonanztomographie (MRT) und die Positronenemissionstomographie-Computertomographie (PET-CT) zur Verfügung.

Methodische Innovationen

Insbesondere nuklearmedizinische Untersuchungsmethoden mit Somatostatinanaloga sind von hoher Wertigkeit, da sie über radioaktiv markierte Rezeptoliganden Tumoren mit hoher Sensitivität sichtbar machen.


CT und MRT haben hohe Detektionsraten bei den GEP-NEN und konnten durch Weiterentwicklungen, wie Diffusionsbildgebung, weiter verbessert werden. Die nuklearmedizinischen Methoden sind jedoch bezüglich der Detektion – insbesondere der gastrointestinalen NEN – überlegen.


Für den Radiologen ist es wichtig, sich mit den NEN vertraut zu machen, da sie quasi ubiquitär im Bauchraum vorkommen können und als solche identifiziert werden sollten.

Empfehlung für die Praxis

Da GEP-NEN überwiegend hypervaskularisiert sind, ist eine biphasische Untersuchungstechnik nach Kontrastmittelgabe für die Schnittbilddiagnostik obligat. Ein PET-CT mit Somatostatinanaloga sollte zur weiterführenden Diagnostik durchgeführt werden.

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Assessement of estrogenic exposure in brown trout (Salmo trutta) in a Swiss midland river: Integrated analysis of passive samplers, wild and caged fish, and vitellogenin mRNA and protein

This field study examined the vitellogenin (VTG) biomarker response under conditions of low and fluctuating activities of environmental estrogenicity. The present study was performed on immature brown trout (Salmo trutta) exposed to the small river Luetzelmurg, which is located in the prealpine Swiss midland region and receives effluents from a single sewage treatment plant (STP). To understand better factors influencing the relationship between estrogenic exposure and VTG induction, we compared VTG levels in caged (stationary) and feral (free-ranging) fish, VTG levels in fish from up- and downstream of the STP, and two different methods for quantifying VTG (enzyme-linked immunosorbent assay vs real-time reverse transcription-polymerase chain reaction), and we used passive samplers (polar organic chemical integrative sampler [POCIS]) to integrate the variable, bioaccumulative estrogenic load in the river water over time. The POCIS from the downstream site contained approximately 20-fold higher levels of bioassay-derived estrogen equivalents than the POCIS from the upstream site. In feral fish, this site difference in estrogenic exposure was reflected in VTG protein levels but not in VTG mRNA. In contrast, in caged fish, the site difference was evident only for VTG mRNA but not for VTG protein. Thus, the outcome of VTG biomarker measurements varied with the analytical detection method (protein vs mRNA) and with the exposure modus (caged vs feral). Our findings suggest that for environmental situations with low and variable estrogenic contamination, a multiple-assessment approach may be necessary for the assessment of estrogenic exposure in fish.

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Assessing the decline of brown trout (Salmo trutta) in Swiss rivers using a Bayesian probability network

A Bayesian probability network has been developed to integrate the various scientific findings of an interdisciplinary research project on brown trout and their habitat in Switzerland. The network is based on a dynamic, age-structured population model, which is extended to include the effect of natural and anthropogenic influence factors. These include gravel bed conditions, water quality, disease rates, water temperature, habitat conditions, stocking practices, angler catch and flood frequency. Effect strength and associated uncertainty are described by conditional probability distributions. These conditional probabilities were developed using experimental and field data, literature reports, and the elicited judgment of involved scientists. The model was applied to brown trout populations at 12 locations in four river basins. Model testing consisted of comparing predictions of juvenile and adult density under current conditions to the results of recent population surveys. The relative importance of the various influence factors was then assessed by comparing various model scenarios, including a hypothetical reference condition. A measure of causal strength was developed based on this comparison, and the major stress factors were analyzed according to this measure for each location. We found that suboptimal habitat conditions are the most important and ubiquitous stress factor and have impacts of sufficient magnitude to explain the reduced fish populations observed in recent years. However, other factors likely contribute to the declines, depending on local conditions. The model developed in this study can be used to provide these site-specific assessments and predict the effect of candidate management measures. (c) 2005 Elsevier B.V. All rights reserved.

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PCR–DGGE Analysis on Microbial Community Structure of Rural Household Biogas Digesters in Qinghai Plateau


To investigate contribution of environmental factor(s) to microbial community structure(s) involved in rural household biogas fermentation at Qinghai Plateau, we collected slurry samples from 15 digesters, with low-temperature working conditions (11.1–15.7 °C) and evenly distributed at three counties (Datong, Huangyuan, and Ledu) with cold plateau climate, to perform polymerase chain reaction–denaturing gradient gel electrophoresis (PCR–DGGE) and further sequencing. The bacterial communities in the total 15 digesters were classified into 38 genera with Mangroviflexus (12.1%) as the first dominant, and the archaeal communities into ten genera with Methanogenium (38.5%) as the most dominant. For each county, the digesters with higher biogas production, designated as HP digesters, exclusively had 1.6–3.1 °C higher fermentation temperature and the unique bacterial structure composition related, i.e., unclassified Clostridiales for all the HP digesters and unclassified Marinilabiliaceae and Proteiniclasticum for Ledu HP digesters. Regarding archaeal structure composition, Methanogenium exhibited significantly higher abundances at all the HP digesters and Thermogymnomonas was the unique species only identified at Ledu HP digesters with higher-temperature conditions. Redundancy analysis also confirmed the most important contribution of temperature to the microbial community structures investigated. This report emphasized the correlation between temperature and specific microbial community structure(s) that would benefit biogas production of rural household digesters at Qinghai Plateau.

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IJMS, Vol. 18, Pages 2688: The Consequences of Being in an Infectious Biofilm: Microenvironmental Conditions Governing Antibiotic Tolerance

IJMS, Vol. 18, Pages 2688: The Consequences of Being in an Infectious Biofilm: Microenvironmental Conditions Governing Antibiotic Tolerance

International Journal of Molecular Sciences doi: 10.3390/ijms18122688

Authors: Majken Sønderholm Thomas Bjarnsholt Maria Alhede Mette Kolpen Peter Jensen Michael Kühl Kasper Kragh

The main driver behind biofilm research is the desire to understand the mechanisms governing the antibiotic tolerance of biofilm-growing bacteria found in chronic bacterial infections. Rather than genetic traits, several physical and chemical traits of the biofilm have been shown to be attributable to antibiotic tolerance. During infection, bacteria in biofilms exhibit slow growth and a low metabolic state due to O2 limitation imposed by intense O2 consumption of polymorphonuclear leukocytes or metabolically active bacteria in the biofilm periphery. Due to variable O2 availability throughout the infection, pathogen growth can involve aerobic, microaerobic and anaerobic metabolism. This has serious implications for the antibiotic treatment of infections (e.g., in chronic wounds or in the chronic lung infection of cystic fibrosis patients), as antibiotics are usually optimized for aerobic, fast-growing bacteria. This review summarizes knowledge about the links between the microenvironment of biofilms in chronic infections and their tolerance against antibiotics.

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Primary non-Hodgkin lymphoma of the prostate: a case report

Oscar D Martín, Luis Alfredo Wadskier, Yesica Quiroz, Heilen P Bravo, Giovanni Cacciamani, Paola Umaña and Luis Medina

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Sardinian honeys as sources of xanthine oxidase and tyrosinase inhibitors


Sardinian honeys obtained from different floral sources (Arbutus, Asphodelus, Eucalyptus, Thistle, and Sulla) were evaluated for their ability to inhibit tyrosinase and xanthine oxidase enzymes and for their antioxidant activity. Physicochemical parameters, total phenolic, and flavonoids content were also determined. Honey from Arbutus flowers had the highest antioxidant activity followed by Eucalyptus and Thistle ones. These three honeys showed good tyrosinase and xanthine oxidase inhibition properties. Thus, these Sardinian honeys could have a great potential as antioxidant sources for pharmaceutical and cosmetic applications.

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Die Pflanzenreste aus den mittelalterlichen Grubenhäusern von Oberbuchsiten/Bachmatt und ihre Bedeutung für die menschliche Ernährung

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Prospective assessment of fatigue and health status in Greek breast cancer patients undergoing adjuvant radiotherapy

PURPOSE/OBJECTIVES: To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status. DESIGN: Prospective, descriptive, repeated measures. SETTING: A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece. SAMPLE: Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks. METHODS: Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2). MAIN RESEARCH VARIABLES: Fatigue, health status. FINDINGS: Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36. CONCLUSIONS: Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status. IMPLICATIONS FOR NURSING: Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

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Quantifying Smoking Cessation Outcomes: From The Women's Initiative for Nonsmoking Study (X): Methodological Implications

Background: Classification of smoking status has a major impact on the conclusions drawn from smoking cessation intervention research, yet few studies have addressed this critical issue. Objectives: The aim of this study was to compare three classifications (naïve, optimistic, and pessimistic) of smoking cessation outcomes or smoking status from the Women's Initiative for Nonsmoking Study (WINS). Methods: This is a longitudinal prospective study nested within a randomized clinical trial (RCT) design of WINS, an RCT of 277 women over the age of 18 years who reported smoking cigarettes continuously for 1 month prior to a cardiovascular event requiring hospital admission. Women were randomized to either the usual care group (UC) or the intervention group (IG). Recruitment for WINS occurred between October 1996 and December 1998 in 10 hospitals in the San Francisco Bay area. Follow-up data on smoking status was obtained from the UC and the IG using a structured telephone interview at 6 and 12 months from baseline and was confirmed by family members and salivary cotinine levels. Results: Seven-daypointprevalence(self-report of not smoking in the past 7 days; "not even a puff") using the naïve (the most liberal) classification yields a greater number of nonsmokers than the pessimistic or most conservative classification (cotinine level verification of smoking status). The classification of smoking status also affects time to continuous smoking. The pessimistic classification results in the shortest time to continuous smoking, whereas the opposite is observed with the naïve classification. Discussion: It is important to critically evaluate the underlying assumptions made by study investigators when measuring and reporting smoking status. The classification of smoking status and the selection of analysis, meaning point prevalence versus survival analysis, affect study results and contribute to the variability observed in the research findings of smoking cessation intervention trials and the challenges faced in making appropriate comparisons across studies.

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Evaluation of a visit preparation intervention implemented in two rural, underserved counties of Northern California

Objective Evaluate satisfaction with visit preparation at three rural resource center sites. Methods The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003. Results Sixty-seven CP Clients who completed surveys were highly satisfied (mean = 8.67, standard deviation (S.D.) = 1.85, range = 5–10). Variation in satisfaction was associated only with whether or not the CP Provider was a breast cancer survivor serving a breast patient (p = 0.005). Satisfaction was not associated with CP Client demographics; type of upcoming medical visit; or CP Provider age, remuneration status, nursing background, and volume of CP Clients. Conclusion Community-based resource centers have implemented CP to the satisfaction of their clients. Further research should expand the delivery of CP to more underserved members of the community and evaluate its acceptability and impact. There may be a therapeutic alliance formed when survivors provide CP to newly diagnosed patients. Practice implications CP should be considered by patient support programs wishing to expand their client services to include visit preparation.

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Personzentrierte Gruppentherapie mit Kindern: Konzept, Vorgehen und Evaluation

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Epuliden und ihre Differenzialdiagnosen


Epuliden sind fokale reaktive Hyperplasien der Gingiva. Nach ihrer Histologie werden das teleangiektatische Granulom (Epulis granulomatosa), die fokale fibröse Hyperplasie (Epulis fibromatosa), das periphere ossifizierende Fibrom (ossifizierende fibroide Epulis) und das periphere Riesenzellgranulom (Riesenzellepulis) unterschieden. Epuliden gehen vom periodontalen Ligament aus und entwickeln sich aus dem Sulcus gingivalis, infiltrieren aber den darunterliegenden Knochen nicht. Als Therapie genügt eine konservative Abtragung, auch wenn Rezidive nicht selten vorkommen können (bis zu 17,5 % beim peripheren Riesenzellgranulom). Da eine eindeutige klinische Diagnose nicht möglich ist und zahlreiche gutartige, aber auch maligne Tumoren differenzialdiagnostisch in Betracht kommen, sollten die Läsionen immer histologisch untersucht werden.

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Datenschutz in der (Zahn‑)Arztpraxis

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Postrhinoplasty fibrotic syndrome



Over the years there have been numerous anecdotal reports of nasal tip enlargement and loss of tip definition post rhinoplasty. Subsequent revisionary procedures not only failed to reduce the tip size but aggravated the problem causing an even larger and less defined nasal tip. The final result was often worse than the preop condition and uncorrectable.


Six patients who demonstrated an aggravation of the postop result with subsequent revisionary or secondary surgeries were evaluated to find common causes or circumstances. All patients had 1) worsening of nasal tip result with subsequent procedures, e. g., nasal tip enlargement and/or loss of tip definition with subsequent procedures 2) exhibited substantial postop edema at one or more surgeries and 3) extensive subcutaneous fibrous tissue noted at revisionary procedures.


The nasal scenario described is referred to as postrhinoplasty fibrotic syndrome. It is recommended that if revision surgery is necessary by a surgeon, the scale of the surgery should be smaller than that of the primary operation. If yet another revision is necessary that surgery should be of an even smaller scale than the prior surgery. Augmentation rather than reduction rhinoplasty is clearly a better approach. With the surgical philosophy of smaller and/or less surgery with each revision (should it be necessary) the irreversible condition of postrhinoplasty fibrotic syndrome should be avoidable.

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Neural plasticity and its initiating conditions in tinnitus


Background and objective

Deafferentation caused by cochlear pathology (which can be hidden from the audiogram) activates forms of neural plasticity in auditory pathways, generating tinnitus and its associated conditions including hyperacusis. This article discusses tinnitus mechanisms and suggests how these mechanisms may relate to those involved in normal auditory information processing.

Materials and methods

Research findings from animal models of tinnitus and from electromagnetic imaging of tinnitus patients are reviewed which pertain to the role of deafferentation and neural plasticity in tinnitus and hyperacusis.


Auditory neurons compensate for deafferentation by increasing their input/output functions (gain) at multiple levels of the auditory system. Forms of homeostatic plasticity are believed to be responsible for this neural change, which increases the spontaneous and driven activity of neurons in central auditory structures in animals expressing behavioral evidence of tinnitus. Another tinnitus correlate, increased neural synchrony among the affected neurons, is forged by spike-timing-dependent neural plasticity in auditory pathways. Slow oscillations generated by bursting thalamic neurons verified in tinnitus animals appear to modulate neural plasticity in the cortex, integrating tinnitus neural activity with information in brain regions supporting memory, emotion, and consciousness which exhibit increased metabolic activity in tinnitus patients.

Discussion and conclusion

The latter process may be induced by transient auditory events in normal processing but it persists in tinnitus, driven by phantom signals from the auditory pathway. Several tinnitus therapies attempt to suppress tinnitus through plasticity, but repeated sessions will likely be needed to prevent tinnitus activity from returning owing to deafferentation as its initiating condition.

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Complexity Analysis of Resting-State fMRI in Adult Patients with Attention Deficit Hyperactivity Disorder: Brain Entropy

Objective. Complexity analysis of functional brain structure data represents a new multidisciplinary approach to examining complex, living structures. I aimed to construct a connectivity map of visual brain activities using resting-state functional magnetic resonance imaging (fMRI) data and to characterize the level of complexity of functional brain activity using these connectivity data. Methods. A total of 25 healthy controls and 20 patients with attention deficit hyperactivity disorder (ADHD) participated. fMRI preprocessing analysis was performed that included head motion correction, temporal filtering, and spatial smoothing process. Brain entropy (BEN) was calculated using the Shannon entropy equation. Results. My findings demonstrated that patients exhibited reduced brain complexity in visual brain areas compared to controls. The mean entropy value of the ADHD group was , compared to in the control group. Conclusion. My study adds an important novel result to the growing literature pertaining to abnormal visual processing in ADHD that my ADHD patients had lower BEN values, indicating more-regular functional brain structure and abnormal visual information processing.

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Deep Venous Thrombosis and Bilateral Pulmonary Embolism Revealing Silent Celiac Disease: Case Report and Review of the Literature

Celiac disease (CD) is a systemic, chronic autoimmune disease that occurs in genetically predisposed individuals following dietary gluten exposure. CD can present with a wide range of gastrointestinal and extraintestinal manifestations and requires lifelong adherence to a gluten-free diet [GFD]. Venous thromboembolism (VTE) as a presentation of celiac disease is unusual and rarely reported. We present a case of a 46-year-old man who was admitted for shortness of breath and pleuritic chest pain and was found to have iron deficiency anemia, deep venous thrombosis, and bilateral pulmonary emboli (PE). After work-up for his anemia, the patient was diagnosed with CD. Comprehensive investigation for inherited or acquired prothrombotic disorders was negative. It is becoming increasingly recognized that CD is associated with an increased risk for VTE. PE, however, as a presentation of CD is exceedingly rare and to the best of our knowledge this is the third case report of such an occurrence and the only case report of a patient from North America. It is important to recognize that the first symptoms or signs of celiac disease might be extraintestinal. Furthermore, VTE as a presentation of CD is rare but life-threatening.

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Teratoid Cyst of the Postauricular Region: The First Ever Case Report

Rudolf Virchow is considered to be the first scientist to have used the word sebaceous cyst. It was thought that these lesions occurred due to retention of sebaceous secretion consequent to obstruction of sebaceous ducts of sebaceous glands, although that was found not to be the case. In all these cysts, the cavity is filled with keratin. There are six types of keratin-filled cysts, namely, epidermoid, dermoid, teratoid, keratinous, trichilemmal, and teratoma cyst, which have one common name “dermoid cyst.” Of the six, teratoid cyst is the least common. In contrast to other dermoid cysts, teratoid cysts contain tissue elements derived from all the three germ layers, namely, ectoderm, mesoderm, and endoderm. Teratomas can be differentiated from teratoid cysts by the fact that recognizable organ structures may be found in the former; examples include teeth and skin. Teratoid cysts can develop anywhere in the body but rarely arise in the head and neck region. They have never been reported in the postauricular region. In this case report, we present a case of teratoid cyst in the postauricular region in a 21-year-old female. The significance of this case lies in its rarity.

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Management of Intractable Nasal Hyperreactivity by Selective Resection of Posterior Nasal Nerve Branches

The posterior nasal nerves emerge from the sphenopalatine foramen and contain sensory and autonomic nerve components. Posterior nasal neurectomy is an effective method to remove pathological neural networks surrounding the inferior turbinate that cause unregulated nasal hypersensitivity with excess secretion in patients with severe allergic rhinitis (AR). We describe the sophisticated endoscopic surgical procedure that allows feasible access to the confined area and selective resection of the nerve branches with the preservation of the sphenopalatine artery (SPA). We retrospectively analyzed the cases of 23 symptomatic severe AR patients who failed to respond to standard medical treatment and underwent surgery. There have been no major complications after surgery including nasal bleeding or transient numbness of the upper teeth. The mean total nasal symptom scores (TNSS) were decreased by 70.2% at 12 months after the procedure. Our comparison of the clinical effectiveness based on the number of severed nerve branches revealed that the improvement of the TNSS was significantly higher in patients with >2 branches. We conclude that this minimally invasive technique that preserves the SPA is clinically useful and decreases the rate of postoperative complications. This trial is registered with UMIN000029025.

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Epithelial-Mesenchymal Transition in Pancreatic Cancer: A Review

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive solid malignancies and is characterized by its insensitivity to current therapy. The invasion and metastasis of solid tumors such as PDAC are complex processes involving many factors. Recent insights into the role of cancer stem cells (CSCs) and the epithelial-mesenchymal transition (EMT) in tumorigenesis have increased the knowledge base and highlighted new therapeutic targets of this disease. The process of EMT is regulated by a complex network of cytokines, transcription factors, growth factors, signaling pathways, and the tumor microenvironment, exhibiting CSC-like properties. The transition of solid cancer cells from an epithelial to a mesenchymal phenotype increases their migratory and invasive properties, thus promoting metastasis. In PDAC, the exact influence of EMT on the biological behaviors of cancer cells and its impact on clinical therapy remain controversial, but the therapeutic strategy of combining EMT inhibition with chemotherapy deserves attention. Alternatively, anti-inflammatory therapy that targets the interaction between inflammation and EMT is a valid strategy for treating the premalignant stage of tumor progression. In this review, we summarize the latest research on EMT and the potential relationship between EMT and PDAC.

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Role of Transient Receptor Potential Vanilloid 1 in Electroacupuncture Analgesia on Chronic Inflammatory Pain in Mice

Chronic inflammatory pain may result from peripheral tissue injury or inflammation, increasing the release of protons, histamines, adenosine triphosphate, and several proinflammatory cytokines and chemokines. Transient receptor potential vanilloid 1 (TRPV1) is known to be involved in acute to subacute neuropathic and inflammatory pain; however, its exact mechanisms in chronic inflammatory pain are not elucidated. Our results showed that EA significantly reduced chronic mechanical and thermal hyperalgesia in the chronic inflammatory pain model. Chronic mechanical and thermal hyperalgesia were also abolished in TRPV1−/− mice. TRPV1 increased in the dorsal root ganglion (DRG) and spinal cord (SC) at 3 weeks after CFA injection. The expression levels of downstream molecules such as pPKA, pPI3K, and pPKC increased, as did those of pERK, pp38, and pJNK. Transcription factors (pCREB and pNFκB) and nociceptive ion channels (Nav1.7 and Nav1.8) were involved in this process. Inflammatory mediators such as GFAP, S100B, and RAGE were also involved. The expression levels of these molecules were reduced in EA and TRPV1−/− mice but not in the sham EA group. Our data provided evidence to support the clinical use of EA for treating chronic inflammatory pain.

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Synthesis, Molecular Docking Studies, and Antifungal Activity Evaluation of New Benzimidazole-Triazoles as Potential Lanosterol 14α-Demethylase Inhibitors

Due to anticandidal importance of azole compounds, a new series of benzimidazole-triazole derivatives (5a–5s) were designed and synthesized as ergosterol inhibitors. The chemical structures of the target compounds were characterized by spectroscopic methods. The final compounds were screened for antifungal activity against Candida glabrata (ATCC 90030), Candida krusei (ATCC 6258), Candida parapsilosis (ATCC 22019), and Candida albicans (ATCC 24433). Compounds 5i and 5s exhibited significant inhibitory activity against Candida strains with MIC50 values ranging from 0.78 to 1.56 μg/mL. Cytotoxicity results revealed that IC50 values of compounds 5i and 5s against NIH/3T3 are significantly higher than their MIC50 values. Effect of the compounds 5i and 5s against ergosterol biosynthesis was determined by LC-MS-MS analysis. Both compounds caused a significant decrease in the ergosterol level. The molecular docking studies were performed to investigate the interaction modes between the compounds and active site of lanosterol 14-α-demethylase (CYP51), which is as a target enzyme for anticandidal azoles. Theoretical ADME predictions were also calculated for final compounds.

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Small Intestinal Bacterial Overgrowth Affects the Responsiveness to Colchicine in Familial Mediterranean Fever

Objective. Familial Mediterranean fever (FMF) is an autosomal recessive disease due to a MEFV gene mutation. Since Helicobacter pylori infection has been described to increase the severity and frequency of FMF attacks, we evaluate if overgrowth of small intestinal bacterial (SIBO), associated with a release of bacterial products, can affect the response to colchicine in FMF patients poorly responsive to colchicine. Methods. We revised our Periodic Fever Centre database to detect FMF patients who were poorly responsive to colchicine, without a well-defined cause of drug resistance. They were evaluated for SIBO presence, then treated with decontamination therapy. Results. Among 223 FMF patients, 49 subjects show colchicine resistance, and no other known causes of colchicine unresponsiveness has been found in 25 patients. All 25 patients underwent glucose breath test; 20 (80%) of them were positive, thus affected by SIBO. After a successful decontamination treatment, 11 patients (55%) did not show FMF attacks during the following three months (), while 9 of them revealed a significant reduction of the number of attacks compared to three months before (). Conclusion. The SIBO eradication improves laboratory and clinical features of FMF patients. Thus, patients with unresponsiveness to colchicine treatment should be investigated for SIBO.

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Accurate 2-D AOA Estimation and Ambiguity Resolution for a Single Source under Fixed Uniform Circular Arrays

This paper presents an analytic algorithm for accurate two-dimensional (2-D) angle of arrival (AOA) estimation of a single source under fixed uniform circular arrays (UCAs). Algebraic and explicit formulations for 2-D AOA estimation are first developed in the Fourier domain. It is shown that three is the minimum number of antennas for 2-D AOA estimation based on phase measurement. Then a signal model for phase extraction is established with equivalent phase noises through observations of signal samples corrupted by additive Gaussian white noise. Under fixed UCAs, 2-D AOA estimation of a single source would suffer from phase ambiguity, and hence, ambiguity resolution is also addressed in the Fourier domain by integer search. Numerical examples are provided to verify the effectiveness and appealing performance of the proposed 2-D AOA estimation algorithm.

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Clinical and Mortality Risk Factors in Bloodstream Infections with Carbapenem-Resistant Enterobacteriaceae

Objective. To investigate the risk factors underlying the occurrence and mortality of bloodstream infections (BSIs) with carbapenem-resistant Enterobacteriaceae (CRE). Methods. Medical information was retrospectively analyzed from 148 cases of patients with Enterobacteriaceae BSIs at a medical center in China, between 2013 and 2015. Results. The 30-day mortality rate in the CRE group was 65.4%. Indwelling urethral catheterization, admission to the ICU, use of antibiotics within 30 days, and BSIs from the respiratory system were associated with CRE BSIs. Lung infection, abdominal infection, central venous catheterization, and use of hormones within 30 days were associated with mortality. Conclusion. The 30-day mortality rate of CRE BSIs was high. Lung infections, abdominal infections, central venous catheterization, and use of hormones within 30 days increased the mortality rate of Enterobacteriaceae BSIs.

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Combined Sector and Channel Hopping Schemes for Efficient Rendezvous in Directional Antenna Cognitive Radio Networks

Rendezvous is a prerequisite and important process for secondary users (SUs) to establish data communications in cognitive radio networks (CRNs). Recently, there has been a proliferation of different channel hopping- (CH-) based schemes that can provide rendezvous without relying on any predetermined common control channel. However, the existing CH schemes were designed with omnidirectional antennas which can degrade their rendezvous performance when applied in CRNs that are highly crowded with primary users (PUs). In such networks, the large number of PUs may lead to the inexistence of any common available channel between neighboring SUs which result in a failure of their rendezvous process. In this paper, we consider the utilization of directional antennas in CRNs for tackling the issue. Firstly, we propose two coprimality-based sector hopping (SH) schemes that can provide efficient pairwise sector rendezvous in directional antenna CRNs (DIR-CRNs). Then, we propose an efficient CH scheme that can be combined within the SH schemes for providing a simultaneous sector and channel rendezvous. The guaranteed rendezvous of our schemes are proven by deriving the theoretical upper bounds of their rendezvous delay metrics. Furthermore, extensive simulation comparisons with other related rendezvous schemes are conducted to illustrate the significant outperformance of our schemes.

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Melatonin and Angelman Syndrome: Implications and Mathematical Model of Diurnal Secretion

The main aim of the study was to compare the melatonin rhythms in subjects with Angelman syndrome () and in children with () and without () epilepsy (nonepileptic patients diagnosed with peripheral nerve palsies, myopathy, and back pain) using our mathematical model of melatonin circadian secretion. The characteristics describing the diurnal hormone secretion such as minimum melatonin concentration, release amplitude, phase shift of melatonin release, and sleep duration as well as the dim light melatonin onset (DLMO) of melatonin secretion and the γ shape parameter allow analyzing the fit and deducing about how much the measured melatonin profile differs from a physiological bell-shaped secretion. The estimated sleep duration and phase shift of melatonin release as well as the DMLO offsets at 25% and 50% relative thresholds are the key characteristic of Angelman syndrome children. As revealed from the γ shape parameter, the melatonin secretion profiles are disturbed in majority of the AG subjects revealing rather a triangular course instead of the bell-like one.

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Psychosocial Aspects of Immediate versus Delayed Breast Reconstruction

Breast Care

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Prophylactic Surgery: For Whom, When and How?

Breast Care

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Highlights from ABC4 - Bridging the Gap

Breast Care

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Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice

Breast Care

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Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer?

Breast Care

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Pathogens, Vol. 6, Pages 65: Differences of Rotavirus Vaccine Effectiveness by Country: Likely Causes and Contributing Factors

Pathogens, Vol. 6, Pages 65: Differences of Rotavirus Vaccine Effectiveness by Country: Likely Causes and Contributing Factors

Pathogens doi: 10.3390/pathogens6040065

Authors: Ulrich Desselberger

Rotaviruses are a major cause of acute gastroenteritis in infants and young children worldwide and in many other mammalian and avian host species. Since 2006, two live-attenuated rotavirus vaccines, Rotarix® and RotaTeq®, have been licensed in >100 countries and are applied as part of extended program of vaccination (EPI) schemes of childhood vaccinations. Whereas the vaccines have been highly effective in high-income countries, they were shown to be considerably less potent in low- and middle-income countries. Rotavirus-associated disease was still the cause of death in >200,000 children of <5 years of age worldwide in 2013, and the mortality is concentrated in countries of sub-Saharan Africa and S.E. Asia. Various factors that have been identified or suggested as being involved in the differences of rotavirus vaccine effectiveness are reviewed here. Recognition of these factors will help to achieve gradual worldwide improvement of rotavirus vaccine effectiveness.

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Oneness and Particularity in Chinese Natural Cosmology: The Notion tianrenheyi

The sensibilities suggested by the notion tianrenheyi have pervaded the Chinese philosophical narrative since, at the earliest, the Spring and Autumn Period, triggering ever novel and enriching interpretations. This paper, far from searching for some ostensible essence of the notion, engages tianrenheyi philosophically from a contemporary perspective. Investigating, inter alia, the kind of unity stipulated by the notion, its moral and spiritual entailments, as well as its relation to transcendence clears the way - now freed from some metaphysical barriers - to a fresh outlook on the interplay of oneness and particularity in Chinese natural cosmology. The relation between oneness and particularity will thereby emerge as necessarily vague and as mutually co-implicative, and resist any assertion of a preference for the one over the other.

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Zwangsstörungen: So helfen sie ihrem Patienten aus der Endlosschleife

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Domain-specific identity, epistemic regulation, and intellectual ability as predictors of belief-biased reasoning: A dual-process perspective

To explore the hypothesis that domain-specific identity development predicts reasoning biases, adolescents and young adults completed measures of domain-general and domain-specific identity, epistemic regulation, and intellectual ability and evaluated arguments that either supported or threatened their occupational goals. Biases were defined as the use of sophisticated reasoning to reject goal-threatening arguments and the use of cursory reasoning to accept goal-supportive arguments. Across two measures of bias, hierarchical regression analyses showed that domain-specific vocational identity and epistemic regulation best predicted reasoning biases. Neither age nor intellectual ability predicted significant variance in biases after vocational identity and epistemic regulation scores were entered into the regression equations. The results support the thesis that biases in specific domains can be explained both by domain-specific personality attributes and by domain-general metacognitive dispositions to monitor reasoning and decontextualize problem structure from superficial contents. A dual-process framework is proposed to explain the relationships among identity, epistemic regulation, age, intellectual ability, and reasoning biases.

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Mind over matter: Psychoneuroendokrine Evaluation einer Expositionstherapie bei Spinnenängstlichen

Theoretischer Hintergrund: Neuere Befunde zeigen, dass psychobiologische Prozesse an der Entstehung emotionaler Prozesse beteiligt sind, wobei dysfunktionale Reaktionen neuroendokriner Systeme als mögliche biologische Korrelate psychischer Störungen diskutiert werden. Unklar ist, ob effektive psychotherapeutische Maßnahmen, wie z.B. Expositionstherapie bei Phobien, nicht nur auf Symptomebene, sondern auch physiologische Prozesse beeinflusst. Fragestellung: Hat eine erfolgreiche kognitiv-verhaltenstherapeutische Intervention (Wiederholte Exposition bei Spinnenängstlichen) Auswirkungen auf biologische Parameter und welche Rolle spielen dabei kognitive Prozesse? Methoden: Psychologischen (Bewertung, Angst) und biologischen Reaktionen (Cortisol und Herzrate) von fünfzehn Spinnenängstliche und fünfzehn gesunde Kontrollpersonen wurden während einer Spinnenexposition verglichen. Zusätzlich wurden bei Spinnenängstlichen Veränderungen dieser Parameter über den Verlauf von drei Expositionsterminen erfasst. Ergebnisse: Im Vergleich zu Kontrollpersonen zeigten Spinnenängstliche erhöhte biologische und emotionale Reaktion in der Exposition, welche sich im Verlauf der weiteren Expositionen normalisierten. Das Ausmaß dieser Veränderungen stand im Zusammenhang mit dem Ausmaß der Veränderungen der Bewertungsprozesse. Diskussion: Die Ergebnisse der Untersuchung zeigen, dass erfolgreiche Psychotherapie (auch) biologische Konsequenzen, im Sinne einer Normalisierung der kardiovaskulären und der endokrinen Stressreaktion, hat. Auf dem Hintergrund der physiologischen Bedeutung dieser Reaktionssysteme stellen diese physiologischen Effekte mögliche Voraussetzungen von Neulernen im Sinne einer neuronaler Reorganisation dar.

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[Review of] Handbook of chronic fatigue syndrome, L.A. Jason, P.A. Fennell, R.R. Taylor (Eds.), John Wiley & Sons, Hoboken, NJ (2003)

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Generation of a microglial developmental index in mice and in humans reveals a sex difference in maturation and immune reactivity

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Issue Information - Table of Contents

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Neonatal mouse cortical but not isogenic human astrocyte feeder layers enhance the functional maturation of induced pluripotent stem cell-derived neurons in culture


Human induced pluripotent stem (iPS) cell-derived neurons and astrocytes are attractive cellular tools for nervous system disease modeling and drug screening. Optimal utilization of these tools requires differentiation protocols that efficiently generate functional cell phenotypes in vitro. As nervous system function is dependent on networked neuronal activity involving both neuronal and astrocytic synaptic functions, we examined astrocyte effects on the functional maturation of neurons from human iPS cell-derived neural stem cells (NSCs). We first demonstrate human iPS cell-derived NSCs can be rapidly differentiated in culture to either neurons or astrocytes with characteristic cellular, molecular and physiological features. Although differentiated neurons were capable of firing multiple action potentials (APs), few cells developed spontaneous electrical activity in culture. We show spontaneous electrical activity was significantly increased by neuronal differentiation of human NSCs on feeder layers of neonatal mouse cortical astrocytes. In contrast, co-culture on feeder layers of isogenic human iPS cell-derived astrocytes had no positive effect on spontaneous neuronal activity. Spontaneous electrical activity was dependent on glutamate receptor-channel function and occurred without changes in INa, IK, Vm, and AP properties of iPS cell-derived neurons. These data demonstrate co-culture with neonatal mouse cortical astrocytes but not human isogenic iPS cell-derived astrocytes stimulates glutamatergic synaptic transmission between iPS cell-derived neurons in culture. We present RNA-sequencing data for an immature, fetal-like status of our human iPS cell-derived astrocytes as one possible explanation for their failure to enhance synaptic activity in our co-culture system.

Thumbnail image of graphical abstract

Main Points

  • Human iPS cell-derived NSCs were differentiated to isogenic neurons or astrocytes.
  • Few neurons developed spontaneous activity.
  • Spontaneous activity was significantly increased by neuronal co-culture on mouse but not isogenic human astrocytes.

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IJMS, Vol. 18, Pages 2687: Predicting the Functional Impact of CDH1 Missense Mutations in Hereditary Diffuse Gastric Cancer

IJMS, Vol. 18, Pages 2687: Predicting the Functional Impact of CDH1 Missense Mutations in Hereditary Diffuse Gastric Cancer

International Journal of Molecular Sciences doi: 10.3390/ijms18122687

Authors: Soraia Melo Joana Figueiredo Maria Fernandes Margarida Gonçalves Eurico Morais-de-Sá João Sanches Raquel Seruca

The role of E-cadherin in Hereditary Diffuse Gastric Cancer (HDGC) is unequivocal. Germline alterations in its encoding gene (CDH1) are causative of HDGC and occur in about 40% of patients. Importantly, while in most cases CDH1 alterations result in the complete loss of E-cadherin associated with a well-established clinical impact, in about 20% of cases the mutations are of the missense type. The latter are of particular concern in terms of genetic counselling and clinical management, as the effect of the sequence variants in E-cadherin function is not predictable. If a deleterious variant is identified, prophylactic surgery could be recommended. Therefore, over the last few years, intensive research has focused on evaluating the functional consequences of CDH1 missense variants and in assessing E-cadherin pathogenicity. In that context, our group has contributed to better characterize CDH1 germline missense variants and is now considered a worldwide reference centre. In this review, we highlight the state of the art methodologies to categorize CDH1 variants, as neutral or deleterious. This information is subsequently integrated with clinical data for genetic counseling and management of CDH1 variant carriers.

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Normal aPTT in children with mild factor XI deficiency


It has been suggested that persons with factor XI deficiency can have a normal activated partial thromboplastin time (aPTT). This notion is based on limited data, especially in children. Because of the central role the aPTT plays in diagnostic algorithms for bleeding disorders, it is important to know if a normal aPTT eliminates the need for factor XI activity testing. Our institutional database contains seven children with factor XI deficiency, of whom four have a normal aPTT. This supports the hypothesis that children with factor XI deficiency can have a normal aPTT. Clinicians may wish to consider this evidence when evaluating children with abnormal bleeding.

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Three-dimensional printed model of bilateral Wilms tumor: A useful tool for planning nephron sparing surgery


Nephron sparing surgery (NSS) is increasingly utilized to treat patients with bilateral Wilms tumor. We present a case of NSS planning using a three-dimensional computerized and printed model of both kidneys with anatomical structures of interest (parenchyma, renal pelvis, major calyx, renal artery, renal vein, and tumor). This model allowed a better understanding of the anatomic relation between the tumor and the normal kidney on each side, improving the surgical planning and the preoperative discussion with the patient's family.

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Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia



Treatment of relapsed childhood acute lymphoblastic leukemia (ALL) is particularly challenging due to the high treatment intensity needed to induce and sustain a second remission. To improve results, it is important to understand how treatment-related toxicity impacts survival.


In this retrospective population-based study, we described the causes of death and estimated the risk for treatment-related mortality in patients with first relapse of childhood ALL in the Nordic Society of Paediatric Haematology and Oncology ALL-92 and ALL-2000 trials.


Among the 483 patients who received relapse treatment with curative intent, we identified 52 patients (10.8%) who died of treatment-related causes. Twelve of these died before achieving second remission and 40 died in second remission. Infections were the cause of death in 38 patients (73.1%), predominantly bacterial infections during the chemotherapy phases of the relapse treatment. Viral infections were more common following hematopoietic stem cell transplantation (HSCT) in second remission. Independent risk factors for treatment-related mortality were as follows: high-risk stratification at relapse (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.3–3.9; P < 0.01), unfavorable cytogenetic aberrations (HR 3.4; 95% CI 1.3–9.2; P = 0.01), and HSCT (HR 4.64; 95% CI 2.17–9.92; P < 0.001). In contrast to previous findings, we did not observe any statistically significant sex or age differences. Interestingly, none of the 17 patients with Down syndrome died of treatment-related causes.


Fatal treatment complications contribute significantly to the poor overall survival after relapse. Implementation of novel therapies with reduced toxicity and aggressive supportive care management are important to improve survival in relapsed childhood ALL.

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Hypogammaglobulinemia due to CAR T-cell therapy

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Diagnostic value of cell bound and circulating neutrophil antibody detection in pediatric neutropenia



Chronic benign neutropenia of infancy includes primary autoimmune neutropenia (pAIN) and chronic idiopathic neutropenia (CIN). A diagnosis of CIN is supported by the absence of free and/or cell-bound neutrophil autoantibodies, which can be detected by flow cytometry with the indirect-granulocyte immunofluorescence test (I-GIFT) and direct-granulocyte immunofluorescence test (D-GIFT), respectively. Conclusive evidence is lacking on the diagnostic value of the D-GIFT, whose performance requires specific laboratory expertise, may be logistically difficult, and hampered by very low neutrophil count in patient samples. This study investigated whether the evaluation of D-GIFT improves the diagnostic accuracy of pediatric neutropenia.


I-GIFT and D-GIFT were performed in 174 pAIN, 162 CIN, 81 secondary AIN, 51 postinfection neutropenic, and 65 nonautoimmune neutropenic children referred to this laboratory during 2002–2014.


Using 90% specific median fluorescence intensity cut-off values calculated by receiver operating characteristic curves, D-GIFT was positive in 49% of CIN patients, who showed similar clinical features as those with pAIN. In 44 (27%) of 162 CIN patients, I-GIFT was repeated two to three times in a year, resulting positive in 12 and two patients at second and third screening, respectively. Interestingly, 10 of the latter 14 patients showed a positive D-GIFT at the first serological screening. False positive D-GIFT was shown by 12% and 22% of nonneutropenic and nonautoimmune neutropenic patients, respectively.


D-GIFT evaluation improves the diagnostic accuracy of pediatric neutropenia, but improvement of cell-bound antibody detection is needed to decrease false positive results.

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Parents’ pain medication underdosing is associated with more emergency department visits in sickle cell disease



To determine the association between health literacy, medication knowledge, and pain treatment skills with emergency department (ED) use of parents of children with sickle cell disease (SCD).


Parents of children 1- to 12-years-old with SCD were enrolled. Health literacy was assessed using the Newest Vital Sign. Parents completed a structured interview assessing knowledge of the dosage and frequency of home pain medications and an applied skills task requiring them to dose a prescribed pain medication. Underdosage was defined by too small a dose (dosage error) or too infrequent a dose (frequency error). The association between medication knowledge and applied skills with ED visits for pain over the past year was evaluated using Poisson regression adjusting for genotype.


One hundred parent/child pairs were included; 50% of parents had low health literacy. Low health literacy was associated with more underdose frequency errors (38% vs. 19%, P = 0.02) on the skills task. On medication knowledge, underdose dosage errors (adjusted incidence rate ratio [aIRR] 2.0, 95% confidence interval [CI] 1.3–3.0) and underdose frequency errors (aIRR, 1.7, 95% CI 1.2–2.6) were associated with a higher rate of ED visits for pain. On the skills task, underdose dosage errors (aIRR 1.6, 95% CI 1.1-2-.4) and underdose frequency errors were associated with more ED visits (aIRR 1.5, 95% CI 1.1–2.1).


For medication knowledge and skills tasks, children of parents who underdosed pain medication had a higher rate of ED visits for pain. Health literate strategies to improve parents’ medication skills may improve pain treatment at home and decrease healthcare utilization.

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Audiological monitoring in Swiss childhood cancer patients



Full audiological monitoring is the best strategy to detect hearing loss early and to provide timely intervention in the absence of a clinical method of otoprotection. Full monitoring requires audiological evaluation before, and then during and after ototoxic cancer treatment. In a worldwide context of monitoring protocols that vary substantially, we analyzed the audiological monitoring of childhood cancer patients over the last decade across treatment centers in Switzerland.


We retrospectively searched for audiological evaluations in all nine Swiss Pediatric Oncology Centers. We analyzed proportions of patients who had audiological monitoring and described type and timing of monitoring. We determined predictors of audiological monitoring using multivariable logistic regression and described time trends.


We included 185 patients from the Swiss Childhood Cancer Registry diagnosed from 2005 to 2013 who had platinum chemotherapy and/or cranial radiation ≥30 Gray and who were alive at time of study. Less than half of children, 43%, had full audiological monitoring (before, during, and after treatment), while 72% were tested after cancer treatment. Nonstudy patients were less likely to have had monitoring in all phases of cancer treatment. Patients who received treatment with cisplatin or both platinum chemotherapy and cranial radiation were more likely to have had monitoring after treatment. Monitoring during and after treatment increased over the study period, but monitoring before treatment was insufficient in all time periods.


Our population-based study indicates that audiological monitoring is insufficient in Switzerland, particularly for nonstudy patients. Clinicians must become more aware of the importance of full audiological monitoring.

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Response in a child with a BRAF V600E mutated desmoplastic infantile astrocytoma upon retreatment with vemurafenib


Infants with low-grade glioma (LGG) and diencephalic syndrome have a poor outcome. The patient described here had a desmoplastic infantile astrocytoma harboring a BRAF V600E mutation. After relapse following initial standard chemotherapy treatment, he was successfully treated with the BRAF V600E inhibitor vemurafenib at the age of 3 years 11 months and 5 years 0 months. A rapid response was observed on both occasions. This illustrates the possibility of continuous oncogenic addiction and the therapeutic potential of BRAF V600E inhibitor monotherapy in LGG, even in very young severely compromised children. BRAF V600E inhibition in LGG and possible (re-)treatment regimens are briefly discussed.

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The relationship between putamen-SMA functional connectivity and sensorimotor abnormality in ESRD patients


The basal ganglia (BG) are composed of several nuclei involved in neural processing associated with integration of sensory and motor information. Recent neuroimaging studies implicated its key role in control of voluntary motor function. As the sensorimotor abnormality is common among the end-stage renal disease (ESRD) population, in the current study, we aimed to investigate the abnormal structure and functional connectivity patterns of BG in ESRD patients. Twenty-nine ESRD and twenty-nine age and gender-matched healthy controls (HC) were enrolled to compare the volume of the subsets in the BG (e.g., caudate nucleus, putamen and globus pallidus) by using the VBM analysis; resting-state functional connectivity was analyzed by a seed-based method. Compared with the HC group, ESRD patients had a smaller volume in the right putamen. Taking the right putamen as a seed region, we further found reduced functional connectivity in patients mainly between the putamen and supplementary motor area (SMA), insula, posterior mid-cingulate gyrus, and primary motor cortex. In ESRD group, the severity score of restless legs syndrome was negatively correlated with putamen-SMA functional connectivity, while the hemoglobin level was positively correlated with functional connectivity degree between the putamen and SMA. Our results revealed an abnormal volume of the putamen and its decreased functional connectivity patterns during resting state in ESRD with sensorimotor abnormalities. These preliminary results indicated that the decreased functional connectivity in putamen-SMA was associated with sensorimotor abnormalities, and anemia was correlated with this abnormal functional pattern in ESRD patients.

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A Bayesian Network Approach to Causation Analysis of Road Accidents Using Netica

Based on an overall consideration of factors affecting road safety evaluations, the Bayesian network theory based on probability risk analysis was applied to the causation analysis of road accidents. By taking Adelaide Central Business District (CBD) in South Australia as a case, the Bayesian network structure was established by integrating K2 algorithm with experts’ knowledge, and Expectation-Maximization algorithm that could process missing data was adopted to conduct the parameter learning in Netica, thereby establishing the Bayesian network model for the causation analysis of road accidents. Then Netica was used to carry out posterior probability reasoning, the most probable explanation, and inferential analysis. The results showed that the Bayesian network model could effectively explore the complex logical relation in road accidents and express the uncertain relation among related variables. The model not only can quantitatively predict the probability of an accident in certain road traffic condition but also can find the key reasons and the most unfavorable state combination which leads to the occurrence of an accident. The results of the study can provide theoretical support for urban road management authorities to thoroughly analyse the induction factors of road accidents and then establish basis in improving the safety performance of the urban road traffic system.

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Analysis of the Impacts of Bearing on Vibration Characteristics of Rotor

Aiming at a Top Gas Recovery Turbine Unit (TRT) with double support rotor and the extending disk end, theoretical and experimental analysis about influence of cylindrical bearing and four-lobe bearing on vibration of TRT rotor system are conducted in this paper. The results indicate that vibration of the rotor supported by cylindrical bearing is more stable than that supported by four-lobe bearing at the driving end (DE) and the nondriving end (NDE). The amplitude of rotor is supported by both of these types of bearing increases as the speed increases at the NDE, while the amplitude of the DE remains unchanged. Comparing with the result of theoretical analysis, the practical test results are more consistent with the theoretical response analysis conducted by applying unbalanced mass at the extending disk end. This paper presents an analysis method of the critical characteristics of a double support rotor system with the extending disk end and provides reference value for dealing with vibration fault of double support rotor system with the extending disk end.

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Natural Preservatives to Improve Food Quality and Safety

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Lateral Ramus Cortical Bone Plate in Alveolar Cleft Osteoplasty with Concomitant Use of Buccal Fat Pad Derived Cells and Autogenous Bone: Phase I Clinical Trial

Tissue regeneration has become a promising treatment for craniomaxillofacial bone defects such as alveolar clefts. This study sought to assess the efficacy of lateral ramus cortical plate with buccal fat pad derived mesenchymal stem cells (BFSCs) in treatment of human alveolar cleft defects. Ten patients with unilateral anterior maxillary cleft met the inclusion criteria and were assigned to three treatment groups. First group was treated with anterior iliac crest (AIC) bone and a collagen membrane (AIC group), the second group was treated with lateral ramus cortical bone plate (LRCP) with BFSCs mounted on a natural bovine bone mineral (LRCP+BFSC), and the third group was treated with AIC bone, BFSCs cultured on natural bovine bone mineral, and a collagen membrane (AIC+BFSC). The amount of regenerated bone was measured using cone beam computed tomography 6 months postoperatively. AIC group showed the least amount of new bone formation (%). LRCP+BFSC group demonstrated defect closure and higher amounts of new bone formation (%) but less than AIC+BFSC (%), suggesting that use of BFSCs within LRCP cage and AIC may enhance bone regeneration in alveolar cleft bone defects; however, the differences were not statistically significant. This clinical trial was registered at clinicaltrial.gov with NCT02859025 identifier.

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Performance Evaluation of Commercial Dengue Diagnostic Tests for Early Detection of Dengue in Clinical Samples

The shattering rise in dengue virus infections globally has created a need for an accurate and validated rapid diagnostic test for this virus. Rapid diagnostic test (RDT) and reverse transcription-polymerase chain reaction (RT-PCR) diagnostic detection are useful tools for diagnosis of early dengue infection. We prospectively evaluated the diagnostic performance of nonstructural 1 (NS1) RDT and real-time RT-PCR diagnostic kits in 86 patient serum samples. Thirty-six samples were positive for dengue NS1 antigen while the remaining 50 were negative when tested with enzyme-linked immunosorbent assay (ELISA). Commercially available RDTs for NS1 detection, RTK ProDetect™, and SD Bioline showed high sensitivity of 94% and 89%, respectively, compared with ELISA. GenoAmp® Trioplex Real-Time RT-PCR and RealStar® Dengue RT-PCR tests presented a comparable kappa agreement with 0.722. The result obtained from GenoAmp® Real-Time RT-PCR Dengue test showed that 14 samples harbored dengue virus type 1 (DENV-1), 8 samples harbored DENV-2, 2 samples harbored DENV-3, and 1 sample harbored DENV-4. 1 sample had a double infection with DENV-1 and DENV-2. The NS1 RDTs and real-time RT-PCR tests were found to be a useful diagnostic for early and rapid diagnosis of acute dengue and an excellent surveillance tool in our battle against dengue.

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Characterization of Surface Modification of 347 Stainless Steel upon Shot Peening

Plastic deformations, such as those obtained by shot peening on specimen surface, are an efficient way to improve the mechanical behavior of metals. Generally, scanning electron microscopy (SEM) and electron backscattered diffraction (EBSD) are commonly used to observe the complex microstructural evolutions, such as grain refinement and phase transformation, induced by the surface treatment. In this work, the microstructure of 347 stainless steel, after ultrasonic shot peening (USP) treatments, was investigated. SEM, EBSD, transmission electron microscopy, and X-ray diffraction were used to observe the microstructural evolutions, such as grain refinement and phase transformation. Deformation depth after the USP treatment was about 200 μm. Grain size on the treated surface layer was about 100 nm, with two phases: austenite and α′-martensite. The percentages of the austenite and α′-martensite phases were 54% and 46%, respectively, which constitute an exact expression of the degree of plastic deformation on austenitic stainless steel.

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