Τετάρτη, 13 Δεκεμβρίου 2017

Lymphangiomyomatosis: RadioPath Series

Presenting an integrated video on Lymphangiomyomatosis with RadioPath correlation. 

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Radiofrequency ablation of surface v/s intraparenchymal hepatocellular carcinoma in cirrhotic patients

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Yashwant Patidar, Praveen Singhal, Shailesh Gupta, Amar Mukund, Shiv K Sarin

Indian Journal of Radiology and Imaging 2017 27(4):496-502

Objective: To retrospectively evaluate the safety and technical efficacy of percutaneous radiofrequency ablation (RFA) of surface hepatocellular carcinoma (HCC) in comparison to intraparenchymal HCC in cirrhotic patients. Materials and Methods: Surface lesions were defined as tumours located or reaching within 1cm of liver capsule including exophytic lesions. Seventy-four surface HCC including 21 exophytic in 58 patients (surface group) and 60 intraparenchymal HCC in 54 patients (intraparenchymal group) measuring up to 4 cm in maximum extent underwent percutaneous [ultrasound (US) or computed tomography-guided (CT-guided)] RFA. The response to the treatment was assessed by contrast enhanced CT/magnetic resonance imaging (MRI) done at 1, 3, 6, 9, and 12 months of RFA and thereafter every 4–6 months. In case of features suggesting residual disease, a repeat RFA was performed. The technical success after single-session RFA, complications and disease recurrence rates were calculated and compared between two groups. Results: Technical success achieved after first session of RFA in surface HCC was 95% (70/74) and intraparenchymal HCC was 97% (58/60). Hundred percent secondary success rate was achieved in both groups after second repeat RFA in residual lesion. No major difference in complication and local recurrence rate in both group on follow-up in surface HCC and intraparenchymal HCC. No case of needle track, peritoneal seeding, and treatment mortality was found. Conclusions: The complication rate and efficacy of RFA for surface and exophytic HCC's were comparable to that of intraparenchymal HCC. Hence surface and exophytic lesions should not be considered a contraindication for RFA in cirrhotic patients.

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A rare case of OEIS complex –newer approach to diagnosis of exstrophy bladder by color doppler and its differentiation from simple omphalocele

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Kavita Aneja

Indian Journal of Radiology and Imaging 2017 27(4):436-440

The objective of this article is to present a new approach to diagnose and differentiate similar ventral masses by color Doppler. Two cases of ventral masses, a rare case of OEIS complex (Omphalocele-exstrophy-imperforate anus-spinal defects) with unusual presentation of exstrophy bladder and another of simple omphalocele, were studied by color Doppler for diagnosis and differentiation between the nature of similar masses. Ventral mass with absent bladder, normal kidneys, and normal amniotic fluid index raised the suspicion of exstrophy bladder. Color Doppler depicting altered intrafetal course of umbilical arteries and umbilical arteries coursing along the sides of ventral mass substantiated the diagnosis. The spatial relation between umbilical artery and aorta (which has no mention in the current literature) in sagittal view has been identified as an acute angle in a normal fetus and coined as "K angle" arbitrarily by the author. Color Doppler reveals altered (widened) "K angle" in exstrophy bladder compared to normal fetuses. Other combined anomalies pointed to the diagnosis of OEIS complex. The second case of simple omphalocele depicts normal intrafetal course of umbilical arteries and normal acute umbilical artery–aorta angle (K angle) on color Doppler. Color Doppler aids the early diagnosis of ventral defects. New method by umbilical artery-aorta angle (K angle) assessment on color Doppler helps differentiate exstrophy bladder from omphalocele.

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18F-FDG PET Biomarkers Help Detect Early Metabolic Response to Irreversible Electroporation and Predict Therapeutic Outcomes in a Rat Liver Tumor Model.

18F-FDG PET Biomarkers Help Detect Early Metabolic Response to Irreversible Electroporation and Predict Therapeutic Outcomes in a Rat Liver Tumor Model.

Radiology. 2017 Dec 12;:170920

Authors: Wang X, Su Z, Lyu T, Figini M, Procissi D, Shangguan J, Sun C, Wang B, Shang N, Gu S, Ma Q, Gordon AC, Lin K, Wang J, Lewandowski RJ, Salem R, Yaghmai V, Larson AC, Zhang Z

Abstract
Purpose To test the hypothesis that biomarkers of fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used for the early detection of therapeutic response to irreversible electroporation (IRE) of liver tumor in a rodent liver tumor model. Materials and Methods The institutional animal care and use committee approved this study. Rats were inoculated with McA-RH7777 liver tumor cells in the left median and left lateral lobes. Tumors were allowed to grow for 7 days to reach a size typically at least 5 mm in longest diameter, as verified with magnetic resonance (MR) imaging. IRE electrodes were inserted, and eight 100-μsec, 2000-V pulses were applied to ablate the tumor tissue in the left median lobe. Tumor in the left lateral lobe served as a control in each animal. PET/computed tomography (CT) and MR imaging measurements were performed at baseline and 3 days after IRE for each animal. Additional MR imaging measurements were obtained 14 days after IRE. After 14-day follow-up MR imaging, rats were euthanized and tumors harvested for hematoxylin-eosin, CD34, and caspase-3 staining. Change in the maximum standardized uptake value (ΔSUVmax) was calculated 3 days after IRE. The maximum lesion diameter change (ΔDmax) was measured 14 days after IRE by using axial T2-weighted imaging. ΔSUVmax and ΔDmax were compared. The apoptosis index was calculated by using caspase-3-stained slices of apoptotic tumor cells. Pearson correlation coefficients were calculated to assess the relationship between ΔSUVmax at 3 days and ΔDmax (or apoptosis index) at 14 days after IRE treatment. Results ΔSUVmax, ΔDmax, and apoptosis index significantly differed between treated and untreated tumors (P < .001 for all). In treated tumors, there was a strong correlation between ΔSUVmax 3 days after IRE and ΔDmax 14 days after IRE (R = 0.66, P = .01) and between ΔSUVmax 3 days after IRE and apoptosis index 14 days after IRE (R = 0.57, P = .04). Conclusion 18F-FDG PET imaging biomarkers can be used for the early detection of therapeutic response to IRE treatment of liver tumors in a rodent model. © RSNA, 2017.

PMID: 29232185 [PubMed - as supplied by publisher]



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Feasibility and Safety of Intrathoracic Biopsy and Repeat Biopsy for Evaluation of Programmed Cell Death Ligand-1 Expression for Immunotherapy in Non-Small Cell Lung Cancer.

Feasibility and Safety of Intrathoracic Biopsy and Repeat Biopsy for Evaluation of Programmed Cell Death Ligand-1 Expression for Immunotherapy in Non-Small Cell Lung Cancer.

Radiology. 2017 Dec 12;:170347

Authors: Tsai EB, Pomykala K, Ruchalski K, Genshaft S, Abtin F, Gutierrez A, Kim HJ, Li A, Adame C, Jalalian A, Wolf B, Garon EB, Goldman JW, Suh R

Abstract
Purpose To determine feasibility and safety of biopsy and repeat biopsy for assessment of programmed cell death ligand-1 (PD-L1) status. Materials and Methods This retrospective analysis reviewed 101 patients who underwent transthoracic core needle biopsy for the KEYNOTE-001 (MK-3475) clinical trial of pembrolizumab, an antiprogrammed cell death-1 therapy for non-small cell lung cancer, from May 2012 to September 2014. Sixty-one male patients (mean age, 66.1 years; range 36-83 years) and 40 female patients (mean age, 66.8 years; age range, 36-90 years) were included. Data collected included population characteristics, treatment history, target location, size, and depth from pleura. Adequacy of the tissue sample for diagnostic testing and rates of biopsy-related complications were assessed. Statistical analysis was performed by using univariate and multivariate generalized linear models to determine significant risk factors for biopsy complications. Results A total of 110 intrathoracic biopsies were performed, and 101 (91.8%) were performed as repeat biopsies subsequent to a previous percutaneous or bronchoscopic biopsy or previous surgical biopsy or resection. More than 84.5% (93 of 110) of biopsies were performed in patients who had undergone previous local or systemic therapy. Specimens were adequate for evaluation of PD-L1 expression in 96.4% of biopsies. Procedure-related complications occurred in 28 biopsies (25.4%); pneumothorax was most common (22.7%). Overall mean number of core needle biopsy samples obtained was 7.9 samples. Conclusion Image-guided transthoracic core needle biopsy is an effective method for obtaining tissue for PD-L1 expression analysis. © RSNA, 2017.

PMID: 29232184 [PubMed - as supplied by publisher]



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Loss of Substantia Nigra Hyperintensity at 3.0-T MR Imaging in Idiopathic REM Sleep Behavior Disorder: Comparison with 123I-FP-CIT SPECT.

Loss of Substantia Nigra Hyperintensity at 3.0-T MR Imaging in Idiopathic REM Sleep Behavior Disorder: Comparison with 123I-FP-CIT SPECT.

Radiology. 2017 Dec 12;:162486

Authors: Bae YJ, Kim JM, Kim KJ, Kim E, Park HS, Kang SY, Yoon IY, Lee JY, Jeon B, Kim SE

Abstract
Purpose To examine whether the loss of nigral hyperintensity (NH) on 3.0-T susceptibility-weighted (SW) magnetic resonance (MR) images can help identify high synucleinopathy risk in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). Materials and Methods Between March 2014 and April 2015, 18 consecutively recruited patients with iRBD were evaluated with 3.0-T SW imaging and iodine 123-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (123I-FP-CIT) single photon emission computed tomography and compared with 18 healthy subjects and 18 patients with Parkinson disease (PD). Two readers blinded to clinical diagnosis independently assessed the images. 123I-FP-CIT uptake ratios were compared by using the Kruskal-Wallis test, and intra- and interobserver agreements were assessed with the Cohen κ. The synucleinopathy conversion according to NH status was evaluated in patients with iRBD after follow-up. Results NH was intact in seven patients with iRBD and lost in 11. The 123I-FP-CIT uptake ratios were comparable between those with intact NH (mean, 3.22 ± 0.47) and healthy subjects (mean, 3.37 ± 0.47) (P = .495). The 123I-FP-CIT uptake ratios in the 11 patients with iRBD and NH loss (mean, 2.48 ± 0.44) were significantly lower than those in healthy subjects (mean, 3.37 ± 0.47; P < .001) but higher than those in patients with PD (mean, 1.80 ± 0.33; P < .001). The intra- and interobserver agreements were excellent (κ > 0.9). Five patients with iRBD and NH loss developed symptoms of parkinsonism or dementia 18 months after neuroimaging. Conclusion NH loss at 3.0-T SW imaging may be a promising marker for short-term synucleinopathy risk in iRBD. © RSNA, 2017 Online supplemental material is available for this article.

PMID: 29232183 [PubMed - as supplied by publisher]



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Inflammatorische und entzündlich-infektiöse abdominelle peritoneale und mesenteriale Prozesse

Zusammenfassung

Hintergrund

Mesenteriale und peritoneale inflammatorische Prozesse stellen eine große klinische Herausforderung bezüglich der Differenzialdiagnosen dar. In diesem Übersichtsartikel wird ein systematischer Überblick über die häufigsten Ursachen, eingeteilt nach Autoimmunreaktionen, Infarzierung mit Nekrosen und Protozoen bzw. bakteriellen Infektionen, gegeben.

Ergebnisse

Allen inflammatorischen peritonealen und mesenterialen Prozessen ist eine unspezifische abdominelle Symptomatik der Patienten gemein. Auch radiologisch existieren sehr viele Überschneidungen mit unspezifischen Vergrößerungen von Lymphknoten bzw. nodulären Strukturen im Peritoneum oder Mesenterium. Basierend auf den klinischen Angaben und der Anamnese kann der Radiologe jedoch zu einer Reduktion der Differenzialdiagnosen beitragen und somit durch rechtzeitige Diagnose das therapeutische Outcome positiv beeinflussen.

Schlussfolgerung

Beim großen Spektrum der Ätiologie für inflammatorische peritoneale und mesenteriale Prozesse müssen radiologisch Autoimmunerkrankungen (IgG4-assoziierte Erkrankungen), akute Infarzierung mit Nekrosen bzw. Infektionen mit Protozoen oder Bakterien differenzialdiagnostisch in Betracht gezogen werden.



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Knieschmerzen einer Marathonläuferin



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Dermoscopy of Morphea and Cutaneous Lichen Sclerosus: Clinicopathological Correlation Study and Comparative Analysis

Background: Dermoscopy of morphea and cutaneous lichen sclerosus (CLS) has been described by various studies, with none of them considering variability according to clinical phases and investigating dermoscopic-histological correlations. Objective: To evaluate dermoscopic features in general and according to clinical stage, identify possible distinctive dermoscopic clues, and assess dermoscopy accuracy in detecting subclinical alterations in morphea and CLS. Methods: A representative dermoscopic image of target lesions was evaluated for the presence of specific features, correlating them with clinical subtype (inflammatory, inflammatory-sclerotic, sclerotic, or sclerotic-atrophic). In case of clinical-dermoscopic discordance (inflammatory, sclerotic, and atrophic findings in noninflammatory, nonsclerotic, and nonatrophic lesions, respectively), dermoscopic-pathological correspondence was assessed. Results: A total of 86 lesions (51 morphea/35 CLS) were analyzed, with most of them displaying an inflammatory-sclerotic or sclerotic clinical pattern. The most common dermoscopic findings of morphea were “fibrotic beams,” while CLS was mainly characterized by bright white/white-yellowish patches and yellowish-white keratotic follicular plugs; all these structures displayed complete specificity for the correspondent dermatosis. Additionally, pigmentary structures were significantly more frequent in morphea and white scaling and hemorrhagic spots in CLS. Only few dermoscopic features reached a statistical significance for a specific clinical stage. Regarding the clinical-dermoscopic discordance rate, it was significantly more common in morphea than CLS; in all cases there was a correspondence between dermoscopic and pathological findings. Conclusion: Dermoscopy of morphea and CLS reveals distinctive dermoscopic clues which are often unrelated to clinical stage but show a constant histological correspondence, thus emphasizing its usefulness in diagnosis and therapeutic management of these conditions.
Dermatology

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Phylogenetic comparison of the VP7, VP4, VP6, and NSP4 genes of rotaviruses isolated from children in Nizhny Novgorod, Russia, 2015–2016, with cogent genes of the Rotarix and RotaTeq vaccine strains

Abstract

Group A rotaviruses (RVA) are one of the leading causes of gastroenteritis in young children worldwide. The introduction of universal mass vaccination around the world has contributed to a reduction in hospitalizations and outpatient visits associated with rotavirus infection. Continued surveillance of RVA strains is needed to determine long-term effects of vaccine introduction. In the present work, we carried out the analysis of the genotypic diversity of RVA strains isolated in Nizhny Novgorod (Russia) during the 2015–2016 epidemic season. Also we conducted a comparative analysis of the amino acid sequences of T-cell epitopes of wild-type and vaccine (RotaTeq and Rotarix) strains. In total, 1461 samples were examined. RVAs were detected in 30.4% of cases. Rotaviruses with genotype G9P[8] (40.5%) dominated in the 2015-16 epidemic season. Additionally, RVAs with the following genotypes were detected: G4P[8] (25.4%), G1P[8] (13%), G2P[4] (3.2%). Rotaviruses with genotypes G3P[9], G6P[9], and G1P[9] totaled 3%. The number of partially typed and untyped RVA samples was 66 (14.9%). The findings of a RVA of G6P[9] genotype in Russia were an original observation. Our analysis of VP6 and NSP4 T-cell epitopes showed highly conserved amino acid sequences. The found differences seem not to be caused by the immune pressure but were rather related to the genotypic affiliations of the proteins. Vaccination against rotavirus infection is not included in the national vaccination schedule in Russia. Monitoring of the genotypic and antigenic diversity of contemporary RVA will allow providing a comparative analysis of wild-type strains in areas with and without vaccine campaign.



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Anatomical map of the cranial vasculature and sensory ganglia

Abstract

There is growing evidence of a direct influence of vasculature on the development of neurons in the brain. The development of the cranial vasculature has been well described in zebrafish but its anatomical relationship with the adjacent developing sensory ganglia has not been addressed. Here, by 3D imaging of fluorescently labelled blood vessels and sensory ganglia, we describe for the first time the spatial organization of the cranial vasculature in relation to the cranial ganglia during zebrafish development. We show that from 24 h post-fertilization (hpf) onwards, the statoacoustic ganglion (SAG) develops in direct contact with two main blood vessels, the primordial hindbrain channel and the lateral dorsal aortae (LDA). At 48 hpf, the LDA is displaced medially, losing direct contact with the SAG. The relationship of the other cranial ganglia with the vasculature is evident for the medial lateral line ganglion and for the vagal ganglia that grow along the primary head sinus (PHS). We also observed that the innervation of the anterior macula runs over the PHS vessel. Our spatiotemporal anatomical map of the cranial ganglia and the head vasculature indicates physical interactions between both systems and suggests a possible functional interaction during development.



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Heterogeneous and Competitive Multiagent Networks: Couple-Group Consensus with Communication or Input Time Delays

This paper discusses the couple-group consensus problems for a class of heterogeneous multiagent networks including the following two cases: with communication and input time delays, respectively. Different from the related cooperative networks, two novel delayed group consensus protocols are designed based on the competitive relationship between the agents. Furthermore, we absolutely relax the in-degree balance and other restrictive preconditions which existed in the relevant works. Some sufficient algebraic criteria for the achievement of couple-group consensus and the upper bound of the input time delays are technically obtained via the frequency domain method and matrix theory, respectively. The results show that the achievement of the couple-group consensus depends on the second-order agents’ in-degree and the control parameters of the systems, whereas it is independent of the communication time delays. Meanwhile, the upper bound of the input time delay is determined by the control parameters and the in-degree of the first-order agents. Finally, the validity of the proposed results is verified by several simulated examples.

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Optimal Channel Selection Based on Online Decision and Offline Learning in Multichannel Wireless Sensor Networks

We propose a channel selection strategy with hybrid architecture, which combines the centralized method and the distributed method to alleviate the overhead of access point and at the same time provide more flexibility in network deployment. By this architecture, we make use of game theory and reinforcement learning to fulfill the optimal channel selection under different communication scenarios. Particularly, when the network can satisfy the requirements of energy and computational costs, the online decision algorithm based on noncooperative game can help each individual sensor node immediately select the optimal channel. Alternatively, when the network cannot satisfy the requirements of energy and computational costs, the offline learning algorithm based on reinforcement learning can help each individual sensor node to learn from its experience and iteratively adjust its behavior toward the expected target. Extensive simulation results validate the effectiveness of our proposal and also prove that higher system throughput can be achieved by our channel selection strategy over the conventional off-policy channel selection approaches.

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Effect of Green Technology Investment on a Production-Inventory System with Carbon Tax

Carbon emissions play the central role in global warming. Manufacturing firms are significant contributors to carbon emissions. In many countries, regulatory authorities are taking actions to reduce emissions. Carbon taxation and cap-and-trade schemes are two mechanisms implemented in many countries. In the present paper, the author analyzes a production-inventory model under a carbon tax system. The production rate is assumed to be a decision variable and can be set at any level within machine limits. A proportion of items produced are defective, and this proportion depends on the production rate. Demand depends on the selling price. Unit price is a decreasing function of the production rate. Emissions can be reduced to some extent by capital investment on green technology, and this capital investment amount is a decision variable. Customers are categorized as retail customers and wholesale customers. A discount is offered to the wholesale customers on the regular selling price. The results are illustrated by a numerical example and a sensitivity analysis is performed.

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High Prevalence of Leptotrichia amnionii, Atopobium vaginae, Sneathia sanguinegens, and Factor 1 Microbes and Association of Spontaneous Abortion among Korean Women

Objective. The purpose of this study was to (i) determine the cervical microbial composition in different abortion samples and to (ii) investigate the correlation between spontaneous abortion and cervical microbes in Korean women. Methods. We collected cervical swabs from women who had never undergone abortion (), had spontaneous abortion (), and had undergone induced abortion () and subjected those samples to 16S rRNA pyrosequencing. Further, factor analysis and correlation between cervical microbiota and spontaneous abortion were evaluated by logistic regression analysis. Results. In spontaneous abortion women, 16 S rRNA gene sequences showed significant increases in Atopobium vaginae, Megasphaera spp., Gardnerella vaginalis, Leptotrichia amnionii, and Sneathia sanguinegens compared to women in nonabortion group. In multivariate logistic regression analysis, A. vaginae (OD = 11.27; 95% = 1.57–81), L. amnionii (OD = 11.47; 95% = 1.22–107.94), S. sanguinegens (OD = 6.89; 95% = 1.07–44.33), and factor 1 microbes (OD = 16.4; 95% = 1.88–42.5) were strongly associated with spontaneous abortion. Conclusions. This study showed a high prevalence of L. amnionii, A. vaginae, S. sanguinegens, and factor 1 microbes in spontaneous abortion and association with spontaneous abortion in Korean women.

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Design of Robust Supertwisting Algorithm Based Second-Order Sliding Mode Controller for Nonlinear Systems with Both Matched and Unmatched Uncertainty

This paper proposes a robust supertwisting algorithm (STA) design for nonlinear systems where both matched and unmatched uncertainties are considered. The main contributions reside primarily to conceive a novel structure of STA, in order to ensure the desired performance of the uncertain nonlinear system. The modified algorithm is formed of double closed-loop feedback, in which two linear terms are added to the classical STA. In addition, an integral sliding mode switching surface is proposed to construct the attractiveness and reachability of sliding mode. Sufficient conditions are derived to guarantee the exact differentiation stability in finite time based on Lyapunov function theory. Finally, a comparative study for a variable-length pendulum system illustrates the robustness and the effectiveness of the proposed approach compared to other STA schemes.

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Face-to-Face or Telematic Cognitive Stimulation in Patients with Multiple Sclerosis and Cognitive Impairment: Why Not Both?

Introduction. Cognitive impairment (CI) affects 40–65% of patients with multiple sclerosis (MS). Few studies address telematic cognitive stimulation (TCS) in MS. The objective of this study is to evaluate the efficacy and impact of telestimulation or distance cognitive stimulation (TCS), with and without the support of face-to-face cognitive stimulation (FCS) in cognitive impairment in MS. Methods. Multicentre, prospective, randomised, controlled study. We will include 98 MS patients with EDSS ≤ 6, symbol digit modality test (SDMT) ≤ Pc 25, and Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) > 26 points. Patients will be randomised into 3 groups, a TCS group, a mixed TCS/FCS group, and a control group. CS is performed 3 days a week for 3 months. Processing speed, memory, attention, and executive functions will be rehabilitated. FCS will include ecological exercises and strategies. EDSS and a cognitive evaluation (SDMT, CTMT, PASAT, and TAVEC), MSNQ, psychological impact scales (MSIS), and depression (BDI) will be carried out, baseline, postrehabilitation, and also 6 and 12 months later, to evaluate the effect of CS in the longer term. Conclusion. This study could help to establish the usefulness of TCS or, in its absence, TCS with face-to-face help for CI in MS. The interest lies in the clear benefits of remote rehabilitation in the daily life of patients.

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Analysis of a Generalized Lorenz–Stenflo Equation

Although the globally attractive sets of a hyperchaotic system have important applications in the fields of engineering, science, and technology, it is often a difficult task for the researchers to obtain the globally attractive set of the hyperchaotic systems due to the complexity of the hyperchaotic systems. Therefore, we will study the globally attractive set of a generalized hyperchaotic Lorenz–Stenflo system describing the evolution of finite amplitude acoustic gravity waves in a rotating atmosphere in this paper. Based on Lyapunov-like functional approach combining some simple inequalities, we derive the globally attractive set of this system with its parameters. The effectiveness of the proposed methods is illustrated via numerical examples.

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The Role of Lower Airway Dysbiosis in Asthma: Dysbiosis and Asthma

With the development of culture-independent techniques, numerous studies have demonstrated that the lower airway is not sterile in health and harbors diverse microbial communities. Furthermore, new evidence suggests that there is a distinct lower airway microbiome in those with chronic respiratory disease. To understand the role of lower airway dysbiosis in the pathogenesis of asthma, in this article, we review the published reports about the lung microbiome of healthy controls, provide an outlook on the contribution of lower airway dysbiosis to asthma, especially steroid-resistant asthma, and discuss the potential therapies targeted for lower airway dysbiosis.

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

Publication date: Available online 12 December 2017
Source:Radiotherapy and Oncology
Author(s): Marianne C. Aznar, Frances K. Duane, Sarah C. Darby, Zhe Wang, Carolyn W. Taylor
Background and purposeWe report a systematic review of lung radiation doses from breast cancer radiotherapy.Methods and materialsStudies describing breast cancer radiotherapy regimens published during 2010–2015 and reporting lung dose were included. Doses were compared between different countries, anatomical regions irradiated, techniques and use of breathing adaptation.Results471 regimens from 32 countries were identified. The average mean ipsilateral lung dose (MLDipsi) was 9.0 Gy. MLDipsi for supine radiotherapy with no breathing adaption was 8.4 Gy for whole breast/chest wall (WB/CW) radiotherapy, 11.2 Gy when the axilla/supraclavicular fossa was irradiated, and 14.0 Gy with the addition of internal mammary chain irradiation; breathing adaptation reduced MLDipsi by 1 Gy, 2 Gy and 3 Gy respectively (p < 0.005). For WB/CW radiotherapy, MLDipsi was lowest for tangents in prone (1.2 Gy) or lateral decubitus (0.8 Gy) positions. The highest MLDipsi was for IMRT in supine position (9.4 Gy).The average mean contralateral lung dose (MLDcont) for WB/CW radiotherapy was higher for IMRT (3.0 Gy) than for tangents (0.8 Gy).ConclusionsLung doses from breast cancer radiotherapy varied substantially worldwide, even between studies describing similar regimens. Lymph node inclusion and IMRT use increased exposure, while breathing adaptation and prone/lateral decubitus positioning reduced it.



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

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Publication date: Available online 12 December 2017
Source:Radiotherapy and Oncology
Author(s): Jean-Pierre Bissonnette, Mei Ling Yap, Katy Clarke, Andrea Shessel, Jane Higgins, Douglass Vines, Eshetu G. Atenafu, Nathan Becker, Claudia Leavens, Andrea Bezjak, David A. Jaffray, Alexander Sun
Background and purposeA 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.Materials and methodsConsecutive consenting patients with LA-NSCLC receiving curative intent CRT were enrolled. 4DPET/4DCT scans were acquired 0, 2, 4, and 7 weeks during IMRT treatment. Eleven image features and their rates of change were recorded for each time point and tested for each of the possible outcome 2 years post CRT using the Kaplan–Meier method.Results32 consecutive patients were recruited, 27 completing all scans. Restricting analysis to 4DPET/4DCT features and rates of change with p < 0.005, several volume-based features and their rates of change reached significance. Image features involving nodal disease were the only ones associated with overall survival.ConclusionsSeveral 4DPET/CT features and rates of change can reach significant association (p < 0.005) with outcomes, including overall survival, at many time points. The optimal time for adaptive CRT is therefore not constrained uniquely on imaging.



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Religiöse Identitätsbildung

Religionen setzen Imaginationspraktiken voraus, mit denen Wirklichkeit transformiert wird. Dem Erzählen kommt dabei eine besondere Rolle zu. Erzählungen haben zugleich modellierende und plausibilisieende Funktion: Sie vermitteln zwischen Sinneswelten und Sinnsystemen. Sie machen das Nicht-Präsente anwesend und modelieren damit religiöse Wirklichkeiten, in denen sinnlich Gegebenes als Ausdruck von etwas anderem erscheint (Traut/Wilke 2015, 18). Zugleich werden diese transformierten Wirklichkeiten durch Erzählungen plausibilisiert (Grieser 2013, 322f.). Erzählen ist somit ein notwendiger Teil religiöser Praxis; erst im Akt des Erzählens konsolidieren sich religiöse Identitäten, die ebenso dynamisch sind wie die Erzählkulturen , in denen sie sich ausbilden.

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Remembering Violence. Risky Pedagogies and Contested Aesthetics



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Die Bürger werden im Dunkeln gelassen



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"Es geht Luther darum, dass man sich in der Arbeit selbstverwirklicht"



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Factors related to disagreement in implant size between preoperative CT-based planning and the actual implants used intraoperatively for total hip arthroplasty

Abstract

Purpose

In total hip arthroplasty, prediction of the optimal implant size is important in order to prevent perioperative complications. However, it is not easy to achieve complete agreement between the planned size and the actual size required appropriate implant fit. No previous report has adequately discussed the factors related to mismatch between predicted and actual implant sizes. The purpose was to report the results of a single surgeon case series of patients undergoing THA using computed tomography (CT)-based templating and the possible factors related to implant size mismatch.

Methods

The study included 141 hips of 126 patients who underwent primary total hip arthroplasty with CT-based navigation. We retrospectively reviewed the planned and actual implant sizes used in these patients. Cup position, cup orientation and stem alignment were evaluated as surgical factors that could possibly be related to mismatch in implant size. Cortical index and canal flare index were also evaluated as morphological factors.

Results

The final inclusions in this study were 124 hips of 111 patients including 82% of those were developmental dysplasia of the hip. Agreement in implant size was seen for 94.4% of cups and 85.5% of stems, respectively. No related factors were found for cup size mismatch. Stem alignment in the sagittal and coronal planes showed significant differences between the size-matched stem group and the smaller stem group ( \(p<0.05\) ).

Conclusions

Implant size agreement rates between the three-dimensional plan and the actual implants used intraoperatively were high. However, broach alignment should be checked in the coronal and sagittal planes if the intraoperative broach is smaller than the planned size.



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Nonlinear Hydroelastic Waves Generated due to a Floating Elastic Plate in a Current

Effects of underlying uniform current on the nonlinear hydroelastic waves generated due to an infinite floating plate are studied analytically, under the hypotheses that the fluid is homogeneous, incompressible, and inviscid. For the case of irrotational motion, the Laplace equation is the governing equation, with the boundary conditions expressing a balance among the hydrodynamics, the uniform current, and elastic force. It is found that the convergent series solutions, obtained by the homotopy analysis method (HAM), consist of the nonlinear hydroelastic wave profile and the velocity potential. The impacts of important physical parameters are discussed in detail. With the increment of the following current intensity, we find that the amplitudes of the hydroelastic waves decrease very slightly, while the opposing current produces the opposite effect on the hydroelastic waves. Furthermore, the amplitudes of waves increase very obviously for higher opposing current speed but reduce very slightly for higher following current speed. A larger amplitude of the incident wave increases the hydroelastic wave deflections for both opposing and following current, while for Young’s modulus of the plate there is the opposite effect.

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SDF-1 induces TNF-mediated apoptosis in cardiac myocytes

Abstract

Chemokines are small secreted proteins with chemoattractant properties that play a key role in inflammation. One such chemokine, Stromal cell-derived factor-1 (SDF-1) also known as CXCL12, and its receptor, CXCR4, are expressed and functional in cardiac myocytes. SDF-1 both stimulates and enhances the cellular signal which attracts potentially beneficial stem cells for tissue repair within the ischemic heart. Paradoxically however, this chemokine is known to act in concert with the inflammatory cytokines of the innate immune response which contributes to cellular injury through the recruitment of inflammatory cells during ischemia. In the present study, we have demonstrated that SDF-1 has dose dependent effects on freshly isolated cardiomyocytes. Using Tunnel and caspase 3-activation assays, we have demonstrated that the treatment of isolated adult rat cardiac myocyte with SDF-1 at higher concentrations (pathological concentrations) induced apoptosis. Furthermore, ELISA data demonstrated that the treatment of isolated adult rat cardiac myocyte with SDF-1 at higher concentrations upregulated TNF-α protein expression which directly correlated with subsequent apoptosis. There was a significant reduction in SDF-1 mediated apoptosis when TNF-α expression was neutralized which suggests that SDF-1 mediated apoptosis is TNF-α-dependent. The fact that certain stimuli are capable of driving cardiomyocytes into apoptosis indicates that these cells are susceptible to clinically relevant apoptotic triggers. Our findings suggest that the elevated SDF-1 levels seen in a variety of clinical conditions, including ischemic myocardial infarction, may either directly or indirectly contribute to cardiac cell death via a TNF-α mediated pathway. This highlights the importance of this receptor/ligand in regulating the cardiomyocyte response to stress conditions.



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Prevalence and associations for use of a traditional medicine provider in the SAMINOR 1 Survey: a population-based study on Health and Living Conditions in Regions with Sami and Norwegian Populations

In Northern Norway, traditional medicine (TM) is shaped by both Christianity and traditional Sami nature worship. The healing rituals may include prayer and the use of tools such as moss, water, stones, wool a...

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Optical Coherence Tomography for Assessment of Epithelialization in a Human Ex Vivo Wound Model

ABSTRACT

The ex vivo human skin wound model is a widely accepted model to study wound epithelialization. Due to a lack of animal models that fully replicate human conditions, the ex vivo model is a valuable tool to study mechanisms of wound re-epithelialization, as well as for pre-clinical testing of novel therapeutics. The current standard for assessment of wound healing in this model is histomorphometric analysis, which is labor intensive, time consuming, and requires multiple biological and technical replicates in addition to assessment of different time points. Optical Coherence Tomography (OCT) is an emerging non-invasive imaging technology originally developed for non-invasive retinal scans that avoids the deleterious effects of tissue processing. This study investigated OCT as a novel method for assessing re-epithelialization in the human ex vivo wound model. Excisional ex vivo wounds were created, maintained at air-liquid interface, and healing progression was assessed at days 4 and 7 with OCT and histology. OCT provided adequate resolution to identify the epidermis, the papillary and reticular dermis, and importantly, migrating epithelium in the wound bed. We have deployed OCT as a non-invasive tool to produce, longitudinal "optical biopsies" of ex vivo human wound healing process, and we established an optimal quantification method of re-epithelialization based on en face OCT images of the total wound area. Pairwise statistical analysis of OCT and histology based quantifications for the rate of epithelialization have shown the feasibility and superiority of OCT technology for non-invasive monitoring of human wound epithelialization. Furthermore, we have utilized OCT to evaluate therapeutic potential of allogeneic adipose stem cells revealing their ability to promote re-epithelialization in human ex vivo wounds. OCT technology is promising for its applications in wound healing and evaluation of novel therapeutics in both the laboratory and the clinical settings. This article is protected by copyright. All rights reserved.



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Clinical Approaches to Breast Reconstruction: What Is the Appropriate Reconstructive Procedure for My Patient?


Breast Care

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Mastectomy - Current Challenges and Questions


Breast Care

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Draft genome sequence of Paenibacillus sp. EZ-K15 isolated from wastewater systems

Paenibacillus species, belonging to the family Paenibacillaceae, are able to survive for long periods under adverse environmental conditions. Several Paenibacillus species produce anti...

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Effect of drying temperature on the sugars, organic acids, limonoids, phenolics, and antioxidant capacities of lemon slices

Abstract

Changes in contents of sugars, organic acids, limonoids, phenolics contents, and antioxidant capacities of lemon slices dried at different temperatures were evaluated. Air drying (AD) promoted losses of sugars, citric acid, ascorbic acid, extractable phenolics (EPs), and non-extractable phenolics (NEPs), while it introduced an increase in limonoids. Phenolics of lemon were mainly presented in their extractable form. Hesperidin and eriocitrin were the main EPs; protocatechuic acid and poncirin were the predominant NEPs. The decrease in extractable phenolic acid, EP, and NEP content in lemon is lower at low drying temperatures, while the increase in non-extractable phenolic acid content is higher at high drying temperatures. The antioxidant capacity of EP was higher than that of NEP. Phenolics contributed to antioxidant capacities of lemon slices, and flavonoids were the main contributors among phenolics. Considering limonoids contents and the high levels of EP, NEP, and antioxidant capacities, AD at 60 °C could be an appreciate treatment for dehydrating lemon slices.



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Preparation, characterization, and cellular uptake of resveratrol-loaded trimethyl chitosan nanoparticles

Abstract

The aim of the study was to encapsulate resveratrol (RV) in trimethyl chitosan (TMC) nanoparticles cross-linked with tripolyphosphate (TPP) and/or alginate to achieve controlled release and improved cellular uptake. TMC (degree of quaternization of 78%) was prepared by reacting purified chitosan with iodomethane. Three types of RV-loaded TMC nanoparticles were prepared: TMC–TPP (TP-NPs), TMC–alginate (TA-NPs), and TMC–alginate–TPP (TAP-NPs). TA-NPs and TAP-NPs showed lower particle size and encapsulation efficiency (EE), better distribution, and more sustained release than TP-NPs due to the high molecular weight and viscous property of alginate. Caco-2 cellular uptake of RV was improved by TMC nanoencapsulation, and TP-NPs showed the highest uptake due to its significantly higher EE. Compared with TAP-NPs, TA-NPs with higher positive surface charge showed higher cellular uptake. Moreover, Caco-2 cell growth-inhibiting activity of RV was significantly increased by TMC nanoencapsulation and TP-NPs showed the significantly highest activity with a good agreement with the permeability results.



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Automatic lung segmentation in functional SPECT images using active shape models trained on reference lung shapes from CT

Abstract

Objective

Image segmentation is an essential step in quantifying the extent of reduced or absent lung function. The aim of this study is to develop and validate a new tool for automatic segmentation of lungs in ventilation and perfusion SPECT images and compare automatic and manual SPECT lung segmentations with reference computed tomography (CT) volumes.

Methods

A total of 77 subjects (69 patients with obstructive lung disease, and 8 subjects without apparent perfusion of ventilation loss) performed low-dose CT followed by ventilation/perfusion (V/P) SPECT examination in a hybrid gamma camera system. In the training phase, lung shapes from the 57 anatomical low-dose CT images were used to construct two active shape models (right lung and left lung) which were then used for image segmentation. The algorithm was validated in 20 patients, comparing its results to reference delineation of corresponding CT images, and by comparing automatic segmentation to manual delineations in SPECT images.

Results

The Dice coefficient between automatic SPECT delineations and manual SPECT delineations were 0.83 ± 0.04% for the right and 0.82 ± 0.05% for the left lung. There was statistically significant difference between reference volumes from CT and automatic delineations for the right (R = 0.53, p = 0.02) and left lung (R = 0.69, p < 0.001) in SPECT. There were similar observations when comparing reference volumes from CT and manual delineations in SPECT images, left lung (bias was − 10 ± 491, R = 0.60, p = 0.005) right lung (bias 36 ± 524 ml, R = 0.62, p = 0.004).

Conclusion

Automated segmentation on SPECT images are on par with manual segmentation on SPECT images. Relative large volumetric differences between manual delineations of functional SPECT images and anatomical CT images confirms that lung segmentation of functional SPECT images is a challenging task. The current algorithm is a first step towards automatic quantification of wide range of measurements.



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Set organic pollution as an impact category to achieve more comprehensive evaluation of life cycle assessment in wastewater-related issues

Abstract

For wastewater-related issues (WRI), life cycle assessment (LCA) is often used to evaluate environmental impacts and derive optimization strategies. To promote the application of LCA for WRI, it is critical to incorporate local impact of water pollutants. Organic pollution, a main type of water pollution, has not been given much consideration in current LCA systems. This paper investigates the necessity of setting a regionalized impact category to reflect the local impact of organic pollution. A case study is conducted concerning an upgraded wastewater treatment plant (WWTP) in China, which is assumed to meet different sewage control strategies. Chemical oxygen demand (COD) is selected to represent the organic pollution and treated as an individual impact category. CML 2002 is used to quantify the environmental impacts of different strategies. Results show that abnormal LCA results are generated with the traditional eutrophication impact category, and after the introduction of COD, more reasonable LCA results are obtained, making the entire comparison of different control strategies more meaningful and compelling. Moreover, BEES, Ecovalue 08, and Chinese factors are adopted here as different weighting methods. Different weighting results exhibited various trade-offs for the increasingly strict control strategies; the results of BEES and Ecovalue08 underlined the potential environmental burden, but the results of Chinese factors only emphasized the local environmental improvement. It is concluded that setting regionalized impact category for organic pollution can make LCA results more reasonable in wastewater treatment, especially in evaluating Chinese cases because of the serious water pollution caused by large quantities of COD emission.



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Automatic lung segmentation in functional SPECT images using active shape models trained on reference lung shapes from CT

Abstract

Objective

Image segmentation is an essential step in quantifying the extent of reduced or absent lung function. The aim of this study is to develop and validate a new tool for automatic segmentation of lungs in ventilation and perfusion SPECT images and compare automatic and manual SPECT lung segmentations with reference computed tomography (CT) volumes.

Methods

A total of 77 subjects (69 patients with obstructive lung disease, and 8 subjects without apparent perfusion of ventilation loss) performed low-dose CT followed by ventilation/perfusion (V/P) SPECT examination in a hybrid gamma camera system. In the training phase, lung shapes from the 57 anatomical low-dose CT images were used to construct two active shape models (right lung and left lung) which were then used for image segmentation. The algorithm was validated in 20 patients, comparing its results to reference delineation of corresponding CT images, and by comparing automatic segmentation to manual delineations in SPECT images.

Results

The Dice coefficient between automatic SPECT delineations and manual SPECT delineations were 0.83 ± 0.04% for the right and 0.82 ± 0.05% for the left lung. There was statistically significant difference between reference volumes from CT and automatic delineations for the right (R = 0.53, p = 0.02) and left lung (R = 0.69, p < 0.001) in SPECT. There were similar observations when comparing reference volumes from CT and manual delineations in SPECT images, left lung (bias was − 10 ± 491, R = 0.60, p = 0.005) right lung (bias 36 ± 524 ml, R = 0.62, p = 0.004).

Conclusion

Automated segmentation on SPECT images are on par with manual segmentation on SPECT images. Relative large volumetric differences between manual delineations of functional SPECT images and anatomical CT images confirms that lung segmentation of functional SPECT images is a challenging task. The current algorithm is a first step towards automatic quantification of wide range of measurements.



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Osteomas of Temporal Bone: A Retrospective Study

Abstract

Osteomas of temporal bone are rare, slow growing benign tumours and they are reported in all parts of temporal bone. This study is a retrospective study of the clinical presentation, management and complications of temporal bone osteoma done from January 1999 through January 2017. The study population is thirteen patients, all who has been radiologically and histopathologically proven to be a case of osteoma. Total number of patients were 13 of which 7 were females and rest 6 were male. Presenting complaints included swelling behind the ear (6 cases), reduced hearing in 4 cases, 2 cases had ear discharge, 3 of them were asymptomatic in whom it was diagnosed accidently. The duration of symptoms ranged from 1 month to 10 years. Of total 13 patients 7 had external auditory canal involvement and 4 cases had mastoid region. Two patients were managed conservatively, one refused surgery and rest ten cases underwent excision. The specimen was sent for histopathological examination and diagnosis of osteoma was confirmed. The decision regarding whether to operate or not depends on each case depending on its size, symptoms and more importantly the complications. Excision of osteoma remains the treatment of choice.



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Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria

Hepatitis E virus (HEV) remains a major public health concern in resource limited regions of the world. Yet data reporting is suboptimal and surveillance system is inadequate. In Nigeria, there is dearth of information on prevalence of acute HEV infection. This study was therefore designed to describe acute HEV infection among antenatal clinic attendees and community dwellers from two geographical regions in Nigeria. Seven hundred and fifty plasma samples were tested for HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) technique. The tested samples were randomly selected from a pool of 1,115 blood specimens previously collected for viral hepatitis studies among selected populations (pregnant women, 272; Oyo community dwellers, 438; Anambra community dwellers, 405) between September 2012 and August 2013. One (0.4%) pregnant woman in her 3rd trimester had detectable HEV IgM, while community dwellers from the two study locations had zero prevalence rates of HEV IgM. Detection of HEV IgM in a pregnant woman, especially in her 3rd trimester, is of clinical and epidemiological significance. The need therefore exists for establishment of a robust HEV surveillance system in Nigeria and especially amidst the pregnant population in a bid to improve maternal and child health.

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MicroRNA and Putative Target Discoveries in Chrysanthemum Polyploidy Breeding

MicroRNAs (miRNAs), around 22 nucleotides (nt) in length, are a class of endogenous and noncoding RNA molecule that play an essential role in plant development, either by suppressing the transcription of target genes at a transcriptional level or inhibiting translation at a posttranscriptional level. To understand the roles of miRNAs and their target genes in chrysanthemum polyploidy breeding, three sRNA libraries of normal and abnormal embryos after hybridization were performed by RNA-Seq. As a result, a total of 170 miRNAs were identified and there are 41 special miRNAs in cross of paternal chromosome doubling, such as miR169b, miR440, and miR528-5p. miR164c and miR159a were highly expressed in a normal embryo at 18 days after pollination, suggesting the regulatory role at the late stage of embryonic development. miR172c was only detected in the normal embryo at 18 days after pollination, which means that miR172c mainly mediates gene expression in postembryonic development and these genes may promote embryo maturation. Other miRNAs, including miR414, miR2661, and miR5021, may regulate the genes participated in pathways of auxin response and energy metabolism; then they regulate the complex embryonic development together.

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Decellularized Swine Dental Pulp as a Bioscaffold for Pulp Regeneration

Endodontic regeneration shows promise in treating dental pulp diseases; however, no suitable scaffolds exist for pulp regeneration. Acellular natural extracellular matrix (ECM) is a favorable scaffold for tissue regeneration since the anatomical structure and ECM of the natural tissues or organs are well-preserved. Xenogeneic ECM is superior to autologous or allogeneic ECM in tissue engineering for its unlimited resources. This study investigated the characteristics of decellularized dental pulp ECM from swine and evaluated whether it could mediate pulp regeneration. Dental pulps were acquired from the mandible anterior teeth of swine 12 months of age and decellularized with 10% sodium dodecyl sulfate (SDS) combined with Triton X-100. Pulp regeneration was conducted by seeding human dental pulp stem cells into decellularized pulp and transplanted subcutaneously into nude mice for 8 weeks. The decellularized pulp demonstrated preserved natural shape and structure without any cellular components. Histological analysis showed excellent ECM preservation and pulp-like tissue, and newly formed mineralized tissues were regenerated after being transplanted in vivo. In conclusion, decellularized swine dental pulp maintains ECM components favoring stem cell proliferation and differentiation, thus representing a suitable scaffold for improving clinical outcomes and functions of teeth with dental pulp diseases.

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Exercise Training under Exposure to Low Levels of Fine Particulate Matter: Effects on Heart Oxidative Stress and Extra-to-Intracellular HSP70 Ratio

Fine particulate matter (PM2.5) promotes heart oxidative stress (OS) and evokes anti-inflammatory responses observed by increased intracellular 70 kDa heat shock proteins (iHSP70). Furthermore, PM2.5 increases the levels of these proteins in extracellular fluids (eHSP70), which have proinflammatory roles. We investigated whether moderate and high intensity training under exposure to low levels of PM2.5 modifies heart OS and the eHSP70 to iHSP70 ratio (H-index), a biomarker of inflammatory status. Male mice (), 30 days old, were divided into six groups for 12 weeks: control (CON), moderate (MIT) and high intensity training (HIT), exposure to 5 μg of PM2.5 daily (PM2.5), and moderate and high intensity training exposed to PM2.5 (MIT + PM2.5 and HIT + PM2.5 groups). The CON and PM2.5 groups remained sedentary. The MIT + PM2.5 group showed higher heart lipid peroxidation levels than the MIT and PM2.5 groups. HIT and HIT + PM2.5 showed higher heart lipid peroxidation levels and lower eHSP70 and H-index levels compared to sedentary animals. No alterations were found in heart antioxidant enzyme activity or iHSP70 levels. Moderate exercise training under exposure to low levels of PM2.5 induces heart OS but does not modify eHSP70 to iHSP70 ratio (H-index). High intensity exercise training promotes anti-inflammatory profile despite exposure to low levels of PM2.5.

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Nonlinear Hydroelastic Waves Generated due to a Floating Elastic Plate in a Current

Effects of underlying uniform current on the nonlinear hydroelastic waves generated due to an infinite floating plate are studied analytically, under the hypotheses that the fluid is homogeneous, incompressible, and inviscid. For the case of irrotational motion, the Laplace equation is the governing equation, with the boundary conditions expressing a balance among the hydrodynamics, the uniform current, and elastic force. It is found that the convergent series solutions, obtained by the homotopy analysis method (HAM), consist of the nonlinear hydroelastic wave profile and the velocity potential. The impacts of important physical parameters are discussed in detail. With the increment of the following current intensity, we find that the amplitudes of the hydroelastic waves decrease very slightly, while the opposing current produces the opposite effect on the hydroelastic waves. Furthermore, the amplitudes of waves increase very obviously for higher opposing current speed but reduce very slightly for higher following current speed. A larger amplitude of the incident wave increases the hydroelastic wave deflections for both opposing and following current, while for Young’s modulus of the plate there is the opposite effect.

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Origin and Geochemical Processes of Porewater in Clay-Rich Deposits in the North Jiangsu Coastal Plain, China

The hydrogeochemical and stable isotope compositions of aquitard porewater samples from three boreholes were investigated to determine the origin, salinization, and hydrochemical evolution of water in the North Jiangsu coastal plain, China. Three porewater groups were identified based on the water-bearing subsystems. The total dissolved solids (TDS) of porewater samples highly varied from 0.03 to 26.1 g/L. Molar Cl/Br ratios and δ18O and δ2H data indicate that the source of Group 1 salinized porewater was the Holocene seawater, whereas Group 3 salinized samples were probably related to the remnant palaeoseawater of the Late Pleistocene. Group 2 samples had low salinity (TDS

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Synthesis and Biological Evaluation of Novel Jatrorrhizine Derivatives with Amino Groups Linked at the 3-Position as Inhibitors of Acetylcholinesterase

Jatrorrhizine was considered as one of the active constituents of Coptis chinensis Franch. Herein, jatrorrhizine derivatives with substituted amino groups linked at the 3-position were designed, synthesized, and biologically evaluated as inhibitors of acetylcholinesterase. Jatrorrhizine derivatives inhibited the activity of acetylcholinesterase (AChE) to a greater extent than the lead compound jatrorrhizine. All these jatrorrhizine derivatives were proved to be potent inhibitors of acetylcholinesterase (AChE) with submicromolar IC50 values, but less sensitive to butyrylcholinesterase (BuChE), which suggests that these jatrorrhizine derivatives are selective for AChE/BuChE. Compound 3g gave the most potent inhibitor activity for AChE (IC50 = 0.301 μM), which is greater than the lead compound jatrorrhizine. All these results demonstrated that these jatrorrhizine derivatives are potential inhibitors for AChE.

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Thunbergia laurifolia Exhibits Antifibrotic Effects in Human Hepatic Stellate Cells

Leaves of Thunbergia laurifolia (TL) have been reported to have antioxidation, anti-inflammatory, detoxifying, and hepatoprotective effects. However, studies relating to antifibrotic activity have not been reported. Currently, there is no standard treatment for hepatic fibrosis. This study aimed to investigate the antifibrotic activity of TL in human hepatic stellate LX-2 cells. Results from cell viability and cell death assays showed that the extract at high concentrations was toxic to LX-2 cells. TL extract reversed the transformation of LX-2 cells to myofibroblast-like characteristics in response to stimulation by transforming growth factor-beta 1. This action may be associated with the effect of TL in suppressing α-SMA and collagen-I production observed by immunofluorescence study and western blot analysis. Additionally, TL extract significantly decreased MMP-9 activity which is consistent with the reduction of MMP-9, MMP-2, and TIMP-1 gene expression. The effect of TL in suppressing fibrosis may be associated with its ability to inhibit the activation of p38 MAPK and Erk1/2 kinases as examined by western blot analysis. Our study provides convincing evidence that TL possesses antifibrotic activity which may be through the suppression of TGF--mediated production of MMPs, collagen-1, and α-SMA in hepatic stellate cells.

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A Study on the Diagnostic Elements of Cold-Heat Pattern Identification by Korean Medicine Doctors: Association with Objective and Subjective Body Temperature

Although the Cold-Heat Pattern is the most important diagnostic factor in Traditional Korean Medicine (TKM), its relationship to body temperature and subjective temperature has not been clearly revealed. In this study, based on clinical data from 551 patients, we classified patients treated with herbal medicines into a Cold-prescription group (CG) and a Heat-prescription group (HG), and we compared the ordinary symptoms between the two groups. Subjective body temperature was higher in the HG than in the CG (OR = 1.68, ) and digestive ability was better in the HG than in the CG (expert’s questionnaire, OR = 1.91, ). However, objectively measured body temperature did not show any significant difference between the HG and CG in both gender groups ( and 0.181 for males and females, resp.). Our study suggests that the subjective body temperature and digestive ability may be the principal diagnostic elements of Cold-Heat Pattern identification by Korean Medicine Doctors. These findings may contribute to the investigation of an objective method to measure the Cold-Heat Pattern.

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Clinical Phenotype of Diabetic Peripheral Neuropathy and Relation to Symptom Patterns: Cluster and Factor Analysis in Patients with Type 2 Diabetes in Korea

Objectives. Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods. A hierarchical cluster analysis and factor analysis were performed to identify relevant subgroups of patients with DPN () and symptom patterns. Results. Patients with DPN were divided into three clusters: asymptomatic (cluster 1, , 33.5%), moderate symptoms with disturbed sleep (cluster 2, , 42.0%), and severe symptoms with decreased quality of life (cluster 3, , 24.5%). Patients in cluster 3, compared with clusters 1 and 2, were characterized by higher levels of HbA1c and more severe pain and physical impairments. Patients in cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those in cluster 3. The frequency of symptoms on each item of MNSI by “painful” symptom pattern showed a similar distribution pattern with increasing intensities along the three clusters. Conclusions. Cluster and factor analysis endorsed the use of comprehensive and symptomatic subgrouping to individualize the evaluation of patients with DPN.

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Distributed Image Compression Architecture over Wireless Multimedia Sensor Networks

In a wireless multimedia sensor network (WMSN), the minimization of network energy consumption is a crucial task not just for scalar data but also for multimedia. In this network, a camera node (CN) captures images and transmits them to a base station (BS). Several sensor nodes (SNs) are also placed throughout the network to facilitate the proper functioning of the network. Transmitting an image requires a large amount of energy due to the image size and distance; however, SNs are resource constrained. Image compression is used to scale down image size; however, it is accompanied by a computational complexity trade-off. Moreover, direct image transmission to a BS requires more energy. Thus, in this paper, we present a distributed image compression architecture over WMSN for prolonging the overall network lifetime (at high throughput). Our scheme consists of three subtasks: determining the optimal camera radius for prolonging the CN lifetime, distributing image compression tasks among the potential SNs to balance the energy, and, finally, adopting a multihop hierarchical routing scheme to reduce the long-distance transmission energy. Simulation results show that our scheme can prolong the overall network lifetime and achieve high throughput, in comparison with a traditional routing scheme and its state-of-the-art variants.

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HIF1α-Induced Glycolysis Metabolism Is Essential to the Activation of Inflammatory Macrophages

Hypoxia-inducible factor (HIF) 1α is a metabolic regulator that plays an important role in immunologic responses. Previous studies have demonstrated that HIF1α participates in the M1 polarization of macrophages. To clarify the mechanism of HIF1α-induced polarization of M1 macrophage, myeloid-specific HIF1α overexpression (Lysm HIF1α lsl) mice were employed and the bone marrow-derived and peritoneal macrophages were isolated. RT-PCR results revealed that HIF1α overexpression macrophage had a hyperinflammatory state characterized by the upregulation of M1 markers. Cellular bioenergetics analysis showed lower cellular oxygen consumption rates in the Lysm HIF1α lsl mice. Metabolomics studies showed that HIF1α overexpression led to increased glycolysis and pentose phosphate pathway intermediates. Further results revealed that macrophage M1 polarization, induced by HIF1α overexpression, was via upregulating the mRNA expression of the genes related to the glycolysis metabolism. Our results indicate that HIF1α promoted macrophage glycolysis metabolism, which induced M1 polarization in mice.

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Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report

This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal ...

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Osteomas of Temporal Bone: A Retrospective Study

Abstract

Osteomas of temporal bone are rare, slow growing benign tumours and they are reported in all parts of temporal bone. This study is a retrospective study of the clinical presentation, management and complications of temporal bone osteoma done from January 1999 through January 2017. The study population is thirteen patients, all who has been radiologically and histopathologically proven to be a case of osteoma. Total number of patients were 13 of which 7 were females and rest 6 were male. Presenting complaints included swelling behind the ear (6 cases), reduced hearing in 4 cases, 2 cases had ear discharge, 3 of them were asymptomatic in whom it was diagnosed accidently. The duration of symptoms ranged from 1 month to 10 years. Of total 13 patients 7 had external auditory canal involvement and 4 cases had mastoid region. Two patients were managed conservatively, one refused surgery and rest ten cases underwent excision. The specimen was sent for histopathological examination and diagnosis of osteoma was confirmed. The decision regarding whether to operate or not depends on each case depending on its size, symptoms and more importantly the complications. Excision of osteoma remains the treatment of choice.



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Genes, Vol. 8, Pages 384: The Tumor Suppressor p53 in Mucosal Melanoma of the Head and Neck

Genes, Vol. 8, Pages 384: The Tumor Suppressor p53 in Mucosal Melanoma of the Head and Neck

Genes doi: 10.3390/genes8120384

Authors: Marie Fritsche Andreas Knopf

Despite worldwide prevention programs, the incidence for cutaneous melanoma is continuously increasing. Mucosal melanoma (MM) represents a rare but highly aggressive phenotype of common melanoma with predilection in the sinonasal system. Far away from ultraviolet sun exposure, the molecular mechanisms underlying tumorigenesis and the highly aggressive clinical behavior are poorly understood. In many solid malignomas of the head and neck region, p53 tumor suppressor functions as oncogene due to p53 protein stabilizing mutation. Interestingly, the vast majority of MM demonstrates constitutively expressed p53 protein, with protein stabilizing mutations being rare. Abrogated activation of p53 target genes results in derogation of the apoptotic signal cascade and contributes to the strong resistance against chemotherapeutic agents activating p53 dependent apoptosis. The current review illustrates the role of p53 and its pathway in MM.



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Dietary patterns and risk of recurrence and progression in non-muscle-invasive bladder cancer

Abstract

The association of dietary factors with urinary bladder cancer prognosis has scarcely been investigated, and results of studies conducted to date are inconsistent. We investigated whether empirically derived dietary patterns are associated with risks of recurrence and progression in non-muscle invasive bladder cancer patients. Data from 595 newly diagnosed non-muscle-invasive bladder cancer patients from an ongoing prospective cohort study were used to derive dietary patterns using exploratory factor analysis. Factor scores were calculated and then categorized in sex-specific tertiles. Multivariable adjusted proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals for the associations between tertiles of adherence to the dietary patterns and risks of recurrence and progression. We identified four dietary patterns: “fruits and vegetables”, “Western”, “low-fat”, and “Tex-Mex”. Patients in the highest tertile of adherence to the Western pattern experienced a 1.48 times higher risk of recurrence (95% CI 1.06-2.06) compared to patients in the lowest tertile. No statistically significant associations of a Western diet with risk of progression, or of the other dietary patterns with risk of recurrence and progression were found. Overall, we found that adherence to a Western diet was associated with a higher risk of recurrence but further studies are needed to confirm our findings. This article is protected by copyright. All rights reserved.



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Heat shock protein 70 and tumor-infiltrating NK cells as prognostic indicators for patients with squamous cell carcinoma of the head and neck after radiochemotherapy: A multicentre retrospective study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

Abstract

Tumor cells frequently overexpress heat shock protein 70 (Hsp70) and present it on their cell surface, where it can be recognized by pre-activated NK cells. In this retrospective study the expression of Hsp70 was determined in relation to tumor-infiltrating CD56+ NK cells in formalin-fixed paraffin embedded (FFPE) tumor specimens of patients with SCCHN (N=145) as potential indicators for survival and disease recurrence. All patients received radical surgery and postoperative cisplatinum-based radiochemotherapy (RCT). In general, Hsp70 expression was stronger, but with variable intensities, in tumor compared to normal tissues. Patients with high Hsp70 expressing tumors (scores 3-4) showed significantly decreased overall survival (OS; p=0.008), local progression-free survival (LPFS; p=0.034) and distant metastases-free survival (DMFS; p=0.044), compared to those with low Hsp70 expression (scores 0-2), which remained significant after adjustment for relevant prognostic variables. The adverse prognostic value of a high Hsp70 expression for OS was also observed in patient cohorts with p16- (p=0.001), p53- (p=0.0003), and HPV16 DNA-negative (p=0.001) tumors. The absence or low numbers of tumor-infiltrating CD56+ NK cells also correlated with significantly decreased OS (p=0.0001), LPFS (p=0.0009) and DMFS (p=0.0001). A high Hsp70 expression and low numbers of tumor-infiltrating NK cells have the highest negative predictive value (p=0.00004). In summary, a strong Hsp70 expression and low numbers of tumor-infiltrating NK cells correlate with unfavourable outcome following surgery and RCT in patients with SCCHN, and thus serve as negative prognostic markers. This article is protected by copyright. All rights reserved.



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Eukaryotic elongation factor 2 kinase up-regulates the expression of proteins implicated in cell migration and cancer cell metastasis

Abstract

Eukaryotic elongation factor 2 kinase (eEF2K) negative regulates the elongation phase of mRNA translation and hence protein synthesis. Increasing evidence indicates that eEF2K plays an important role in the survival and migration of cancer cells and in tumour progression.

As demonstrated by two-dimensional wound-healing and three-dimensional transwell invasion assays, knocking down or inhibiting eEF2K in cancer cells impairs migration and invasion of cancer cells. Conversely, exogenous expression of eEF2K or knocking down eEF2 (the substrate of eEF2K) accelerates wound healing and invasion.

Importantly, using LC-HDMSE analysis, we identify 150 proteins whose expression is decreased and 73 proteins which are increased upon knocking down eEF2K in human lung carcinoma cells. Of interest, 34 down-regulated proteins include integrins and other proteins implicated in cell migration, suggesting that inhibiting eEF2K may help prevent cancer cell mobility and metastasis. Interestingly, eEF2K promotes the association of integrin mRNAs with polysomes, providing a mechanism by which eEF2K may enhance their cellular levels. Consistent with this, genetic knock down or pharmacological inhibition of eEF2K reduces the protein expression levels of integrins.

Notably, pharmacological or genetic inhibition of eEF2K almost completely blocked tumour growth and effectively prevented the spread of tumour cells in vivo. High levels of eEF2K expression were associated with invasive carcinoma and metastatic tumours. These data provide the evidence that eEF2K is a new potential therapeutic target for preventing tumour metastasis. This article is protected by copyright. All rights reserved.



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Initial results of population based cervical cancer screening program using hpv testing in one million turkish women

Abstract

Objective: To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women.

Methods: Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories.

Results: The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4-5-fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3,5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19,1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC-US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico-pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap-smear program could miss 45.9% of ≥CIN3 cases

Conclusion: The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings in order to have a high coverage rated screening program and is very effective compared to conventional pap-smear. This article is protected by copyright. All rights reserved.



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Das trojanische Pferd der Scholastik. Antoine de Chandieu († 1591) über Sophistereien, Syllogistik – und Rhetorik



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Relationships of serum 25-hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery

Summary

Objective

The high prevalence of secondary hyperparathyroidism (SHPT) after obesity surgery is a concern for long-term bone health. Limited knowledge exists about optimal vitamin D and suppression of parathyroid hormone (PTH) after these procedures. The aim of this study was to investigate the prevalence of SHPT and its relation to vitamin D status.

Design

A cross-sectional study at Oslo University Hospital, Norway.

Patients

502 consecutive patients, age 22-64 years, attending 2-year follow-up after Roux-en-Y gastric bypass.

Measurements

A serum intact PTH >7.0 pmol/l in the absence of elevated serum ionized calcium (iCa) was considered as SHPT. Vitamin D status was defined by serum concentrations of 25-hydroxyvitamin D (S-25(OH)D).

Results

Altogether, 171 patients (34%) had SHPT. The prevalence of SHPT varied across the range of S-25(OH)D (P<0.001), being highest (71%) with S-25(OH)D <25 nmol/l. Compared with S-25(OH)D <50 nmol/l, the prevalence of SHPT was lower with S-25(OH)D ≥50 nmol/l (29.0%; RR=0.64 (95%-CI:0.50-0.81)) and S-25(OH)D ≥75 nmol/l (27.7%; RR=0.61 (95%-CI:0.44-0.84)). S-25(OH)D ≥100 nmol/l was associated with the lowest PTH and the lowest prevalence of SHPT (16.0%; RR=0.35 (95%-CI:0.14-0.88) compared with S-25(OH)D <50 nmol/l), and the most normal calcium distribution. These associations were most pronounced with iCa in the lower range. A synergistic association was found for S-25(OH)D and iCa on SHPT.

Conclusions

Vitamin D deficient patients had the highest prevalence of SHPT two years after gastric bypass. PTH and the prevalence of SHPT were notably lower with S-25(OH)D ≥100 nmol/l, compared with lower target levels.

This article is protected by copyright. All rights reserved.



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Sex hormone binding globulin is associated with androgen deficiency features independently of total testosterone

Summary

Objective

It is recognized that total testosterone (TT) does not sufficiently describe androgen status when sex hormone binding globulin (SHBG) is altered. However, in humans, evidence supporting the existence of a hypogonadism due to low T bioactivity is scanty. The aim of the study was to assess whether changes in SHBG levels, independently of TT, are associated with subjective and objective androgen dependent parameters.

Design

Cross-sectional observation.

Patients

2622 men (aged 51.1±13.5 years) attending a Sexual Medicine and Andrology Outpatient Clinic for sexual dysfunctions.

Measurements

All patients underwent a standardized diagnostic protocol before starting any treatment. Clinical and biochemical parameters have been collected. Higher ANDROTEST score has been used as a comprehensive marker of more severe hypogonadal symptoms. Prostate specific antigen (PSA) and hematocrit have been used as objective surrogate markers of T bioactivity.

Results

After adjusting for TT and lifestyle, SHBG showed a significant positive association with ANDROTEST score (B=0.79 [0.61;0.96], p<0.0001). Conversely, higher SHBG, independently of TT, was negatively related to PSA (B=-0.86 [-0.83;-0.89]; p<0.0001) and hematocrit (B=-0.64 [-0.88;-0.40]; p<0.0001), after adjustment for the aforementioned confounders along with age and body mass index. Furthermore, a relationship between SHBG and lipids or blood pressure was found, with lower SHBG levels associated with a worse metabolic profile, independently of TT.

Conclusions

Higher SHBG, independently of TT, is associated with either subjective or objective androgen deficiency features. This indicates that besides a hypogonadism due to an impaired T production, a hypogonadism due to a lower biological activity of T does exist.

This article is protected by copyright. All rights reserved.



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Pediatric High-flow Pial Arteriovenous Fistula (AVF) for Glue Embolization: An Anesthetic Challenge

No abstract available

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Norway makes radical changes to training system

2016_10_24_11_41_29_114_parkar_anagha_40Three months ago, responsibility for training in radiology and all other medical...


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Repeated Combined Chemotherapy with Cisplatin Lowers Carnitine Levels in Gastric Cancer Patients

Background/Aims: Carnitine plays an important role in the metabolism of fatty acids. It has also been reported that the administration of anticancer drugs may lead to reductions in serum carnitine levels due to decreased activity of organic cation transporter novel 2, which plays a role in the reabsorption of carnitine in the tubules of the kidney. We therefore studied the change in carnitine levels when chemotherapy was administered repeatedly to patients with gastric cancer. Methods: Ten patients with upper gastrointestinal cancer were enrolled in this study between December 2014 and August 2015. All patients were administered chemotherapy consisting of TS-1 and cisplatin every 3 weeks: 3 received it as adjuvant therapy post resection, the remaining 7 received it as treatment for unresectable tumors. Before the start of each chemotherapy cycle, serum was collected. Results: The mean total carnitine level was 54.5 ± 13.7 μmol/L prior to commencing chemotherapy; it was 46.7 ± 13.5 and 41.4 ± 14.8 μmol/L at the second and third cycles respectively. The total carnitine level was decreased in a statistically significant manner (p = 0.0039). The serum level of total protein and cholinesterase was also decreased significantly (p = 0.0218 and p = 0.0418). Conclusion: Carnitine levels decreased during repeated chemotherapy in patients with gastric cancer, and they are associated with the nutritional status.
Ann Nutr Metab

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Anaesthetic considerations in a patient with methylmalonyl-coenzyme A mutase deficiency

Nabila Shaikh, Mukhtadir Gulam Hashmi, Chandrakant Shah, Tasneem Dhansura

Indian Journal of Anaesthesia 2017 61(12):1018-1020



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Anaesthesia for fixation of repeated pathological fractures in a patient with multiple myeloma

Sriraam Kalingarayar, Amar Nandhakumar, Arumugam S Thennavan

Indian Journal of Anaesthesia 2017 61(12):1009-1011

The introduction of new chemotherapeutic agents for the treatment of multiple myeloma (MM) has improved the life expectancy and quality of life for these patients in the last decade. Therefore, more patients with MM are being treated for repeated pathological fractures. The anaesthesiologist should continue the optimum supportive care received by these patients in the perioperative period also, by understanding the pathophysiology of the disease, the adverse effects of the chemotherapeutic agents and the guidelines for their supportive care. We report the perioperative management of a patient with MM and discuss the perioperative anaesthetic considerations.

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The brain-dead donor: An anaesthesiologist's perspective

Vijay L Shetty, Shivaji S Mali, Sangeeta V Shetty, Prajakta D Shinde

Indian Journal of Anaesthesia 2017 61(12):952-956

The brain-dead organ donation programme is slowly gathering momentum in India. There is a long way to go before our cadaver donor numbers, currently at 0.35 per million reaches 35 per million as is the case in countries like Spain. Each donor, therefore, has to be managed immaculately. The anaesthesiologists will be well served by familiarising themselves with the challenges during the crucial period preceding and during the actual harvest of organs in a brain-dead donor. There are significant opportunities for anaesthesiologists to make great contributions in this cause due to their unique skill sets and perspective. A robust brain-dead cadaver programme will go a long way in saving numerous lives as well as reduce the requirements of the living donor programme. A well-managed harvest will ensure good quality organs and an overall superior outcome in the recipients.

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Cutaneous innervations encountered during mastectomy: A perplexing circuitry

Abhijit S Nair

Indian Journal of Anaesthesia 2017 61(12):1026-1027



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An institutional study of awareness of brain-death declaration among resident doctors for cadaver organ donation

Vaishali Mohod, Bharati Kondwilkar, Rohit Jadoun

Indian Journal of Anaesthesia 2017 61(12):957-963

Background and Aims: Brain death is defined as irreversible and complete cessation of all brain function including that of the brainstem. The aim of this study was to assess the level of knowledge and awareness about brain-death declaration among resident doctors. Methods: This was an observational questionnaire-based study conducted in single institute in which 112 junior residents and 46 senior resident doctors in various medical specialities were included by universal sampling method. A prevalidated questionnaire consisting of questions related to knowledge, attitude and performance of brain-death declaration were distributed among residents as per the inclusion criteria to fill in the time limit of 30 min. Statistical tools used were mean and standard deviation, proportion and Chi-square test. Results: A total 87 resident doctors consisting of 71.26% males and 28.73% females responded to the questionnaire. About 91.95% correctly defined it as complete cessation of brain activity including brainstem reflexes. Most of the resident doctors (80.45%) knew about the documentation of absence of brainstem reflexes at 6 h intervals and 64.36% were aware about positive apnoea test. When asked about whether there is legal sanction for disconnecting life support in India, 56.32% said no, and 43.67% said yes. Only 12.64% of resident doctors were aware about a panel of 4 physicians are mandatory to declare brain death in India. Conclusion: Awareness and attitude towards the identification of brain death and possible deceased donor organ transplantation were lacking amongst resident doctors.

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Robotic-assisted abdominal surgery in post-renal transplant patient-protect the transplanted organ

Sohan Lal Solanki, Anuja Jain, Vandana Agarwal, Avanish P Saklani

Indian Journal of Anaesthesia 2017 61(12):1015-1016



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Revisiting the applicability of adult early post-operative nausea and vomiting risk factors for the paediatric patient: A prospective study using cotinine levels in children undergoing adenotonsillectomies

Destiny F Chau, Arundathi Reddy, Patrick Breheny, Anna Rebecca Young, Eric Ashford, Megan Song, Christina Zhang, Tammy Taylor, Abbas Younes, Turaj Vazifedan

Indian Journal of Anaesthesia 2017 61(12):964-971

Background and Aims: Post-operative vomiting (POV) in children remains a significant clinical problem. This prospective study aims to investigate the applicability of well-established adult early post-operative nausea and vomiting (PONV) risk factors on paediatric POV after adenotonsillectomies under regulated anaesthetic conditions. Methods: After Institutional Review Board approval, 213 children aged 3–10-year-old were enrolled. The participants had pre-operative questionnaires completed, followed protocolised anaesthetic plans and had saliva analysed for cotinine. The primary outcomes were POV as correlated with age, gender, family or personal history of PONV, motion sickness history, opioid use, surgical time, anaesthetic time and environmental tobacco smoke (ETS) exposure, as assessed by cotinine levels and questionnaire reports. Data on analgesics, antiemetics and POV incidence before post-anaesthesia care unit discharge were collected. Statistical analysis was done through multiple logistic regression. Results: A total of 200 patients finalised the study. Early POV occurred in 32%. Family history of PONV (odds ratio [OR] = 5.3, P < 0.01) and motion sickness history (OR = 4.4, P = 0.02) were highly significant risk factors. Age reached borderline statistical significance (OR = 1.4, P = 0.05). None of the other factors reached statistical significance. Conclusion: Early POV occurs frequently in paediatric patients undergoing adenotonsillectomies. In this paediatric-aged group, the incidence of POV was affected by the family history of PONV, and history of motion sickness. Age, female gender, opioid use, surgical and anaesthetic times did not affect the incidence of POV. ETS exposure, as assessed by cotinine levels and questionnaire reports, had no protective effect on early paediatric POV.

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Brainstem anaesthesia following intranasal packing with lignocaine and adrenaline

Madhuri S Kurdi, Sushma K Sannaboraiah, Raghavendra B Bhosale, Vinod D Gasti

Indian Journal of Anaesthesia 2017 61(12):1021-1023



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A randomised controlled trial comparing ProSeal laryngeal mask airway, i-gel and Laryngeal Tube Suction-D under general anaesthesia for elective surgical patients requiring controlled ventilation

Bikramjit Das, Rahul Varshney, Subhro Mitra

Indian Journal of Anaesthesia 2017 61(12):972-977

Background and Aims: The ProSeal™ laryngeal mask airway (PLMA), i-gel™ and Laryngeal Tube Suction-D (LTS-D™) have previously been evaluated alone or in pair-wise comparisons but differing study designs make it difficult to compare the results. The aim of this study was to compare the clinical performance of these three devices in terms of efficacy and safety in patients receiving mechanical ventilation during elective surgical procedures. Methods: This prospective, randomised, double-blind study was conducted on 150 American Society of Anesthesiologists physical status I–II patients, randomly allocated into 3 groups, undergoing elective surgical procedures under general anaesthesia. PLMA, i-gel™ or LTS-D™ appropriate for weight or/and height was inserted. Primary outcome measured was airway sealing pressure. Insertion time, ease of insertion, number of attempts, overall success rate and the incidence of airway trauma and complications were also recorded. Intergroup differences were compared using one-way analysis of variance with post hoc correction for continuous data and Chi-square test for categorical variables. Results: Overall success rate was comparable between the three devices (i-gel™ 100%, LTS-D™ 94%, PLMA 96%). Airway sealing pressure was lower with i-gel™ (23.38 ± 2.06 cm H2O) compared to LTS-D™ (26.06 ± 2.11 cm H2O) and PLMA (28.5 ± 2.8 cm H2O; P < 0.0005). The mean insertion time was significantly more in PLMA (38.77 ± 3.2 s) compared to i-gel™ (27.9 ± 2.53 s) and LTS-D™ (21.66 ± 2.31 s; P < 0.0005). Conclusion: Airway sealing pressure and insertion time were significantly higher in PLMA compared to i-gel™ and LTS-D™.

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Brain death and organ donation in India

Rahul Anil Pandit

Indian Journal of Anaesthesia 2017 61(12):949-951



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Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

Arindam Chatterjee, Sandeep Sahu, Mekhala Paul, Tanya Singh, Surendra Singh, Prabhaker Mishra

Indian Journal of Anaesthesia 2017 61(12):978-984

Background and Aims: Post-operative nausea and vomiting (PONV) is highly distressing and unpleasant symptom. Dexamethasone and palonosetron are effective antiemetics with minimal side effect profile. This study compares the efficacy of palonosetron or dexamethasone alone and their combination (palonosetron plus dexamethasone) for prevention of PONV after laparoscopic cholecystectomy. Methods: This prospective, randomised, double-blind trial was done on 187 adults, American Society of Anesthesiologists Grade I and II patients, aged 18–75 years undergoing laparoscopic cholecystectomy. They were allocated to three groups which were to receive either of the three treatment regimens: dexamethasone 8 mg (Group D, n = 57), palonosetron 0.075 mg (Group P, n = 66) or dexamethasone 8 mg plus palonosetron 0.075 mg (Group PD, n = 64). The primary outcome was incidence of PONV in 24 h and the secondary outcome was a number of rescue antiemetic required. One-way ANOVA test was used to compare the means amongst three groups. To compare the proportions in the groups, Chi-square test/Fisher's exact test/Two proportions Z-test was applied as appropriate. Results: Overall incidences of PONV in the study 24 h postoperatively were 23.4% in PD, 27.2% in P group and 56.14% in D group (P < 0.001). Requirement of rescue antiemetic was more in dexamethasone group than other two groups (PD = 1 time, P = 1.38 times and D = 1.5 times). Conclusion: Palonosetron alone and palonosetron-dexamethasone combination were equally effective in the prevention of PONV. Dexamethasone alone was least effective amongst the three groups. There is no difference between palonosetron and palonosetron-dexamethasone for PONV prevention.

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Role of superficial cervical plexus block in somatic referred cervical spine pain

Deepak Thapa, Vanita Ahuja, Deepanshu Dhiman

Indian Journal of Anaesthesia 2017 61(12):1012-1014



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Randomised controlled trial of central venous catheterisation through external jugular vein: A comparison of success with or without body manoeuvres

Rohan Magoon, Surender Kumar Malhotra, Vikas Saini, Ridhima Sharma, Jasleen Kaur

Indian Journal of Anaesthesia 2017 61(12):985-989

Background and Aims: The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation (CVC) in view of an unpredictable success rate. There is an encouraging literature on the improved success rate of CVC through EJV with the inclusion of certain body manoeuvres. This prospective randomised controlled study was conducted with the aim of evaluating the efficacy of body manoeuvres in improving the success rate of CVC through EJV. Methods: One hundred patients aged 18–50 years, scheduled for elective surgery requiring CVC, were randomly assigned to either undergo CVC using Seldinger technique with body manoeuvres or a control group undergoing CVC without body manoeuvres. The primary outcome was the success rate of CVC, as observed in the post-procedure chest radiograph. Secondary outcomes included quality of central venous pressure waveform, catheterisation attempts, total time for CVC, complications. Results: CVC was achieved in 98% (49/50) of patients in study group and 80% (40/50) of patients in control group (P = 0.008). Mean catheterisation time was significantly lower in the study group (151.06 ± 40.50 s) compared to control group (173.50 ± 50.66 s) (P = 0.023). The incidence of catheter misplacement and failure to cannulate were lower in the study group (0%, 2% vs. 20%, 12.5%, respectively). Groups did not differ in a number of catheterisation attempts and incidence of haematoma. Conclusion: Inclusion of various body manoeuvres to Seldinger technique significantly improves the success rate of CVC through EJV.

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