Σάββατο, 23 Δεκεμβρίου 2017

Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen

Publication date: Available online 23 December 2017
Source:Radiotherapy and Oncology
Author(s): Lauren Henke, Rojano Kashani, Clifford Robinson, Austen Curcuru, Todd DeWees, Jeffrey Bradley, Olga Green, Jeff Michalski, Sasa Mutic, Parag Parikh, Jeffrey Olsen
Purpose/objectivesSBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.Materials/methodsTwenty patients with oligometastatic or unresectable primary liver (n = 10) and non-liver (n = 10) abdominal malignancies underwent SMART. Initial plans prescribed 50 Gy/5 fractions (BED 100 Gy) with goal 95% PTV coverage by 95% of prescription, subject to hard OAR constraints. Daily real-time online-adaptive plans were created as needed, based on daily setup MR-image-set tumor/OAR "anatomy-of-the-day" to preserve hard OAR constraints, escalate PTV dose, or both. Treatment times, patient outcomes, and dosimetric comparisons between initial and adaptive plans were prospectively recorded.ResultsOnline adaptive plans were created at time of treatment for 81/97 fractions, due to initial plan violation of OAR constraints (61/97) or observed opportunity for PTV dose escalation (20/97). Plan adaptation increased PTV coverage in 64/97 fractions. Zero Grade ≥ 3 acute (<6 months) treatment-related toxicities were observed.DiscussionSMART is clinically deliverable and safe, allowing PTV dose escalation and/or simultaneous OAR sparing compared to non-adaptive abdominal SBRT.



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MRI evaluation of sacral chordoma treated with carbon ion radiotherapy alone

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Publication date: Available online 23 December 2017
Source:Radiotherapy and Oncology
Author(s): Lorenzo Preda, Davide Stoppa, Maria Rosaria Fiore, Giulia Fontana, Sofia Camisa, Roberto Sacchi, Michele Ghitti, Gisela Viselner, Piero Fossati, Francesca Valvo, Viviana Vitolo, Maria Bonora, Alberto Iannalfi, Barbara Vischioni, Alessandro Vai, Edoardo Mastella, Guido Baroni, Roberto Orecchia
Background and purposeTo compare RECIST 1.1 with volume modifications in patients with sacral chordoma not suitable for surgery treated with carbon ions radiotherapy (CIRT) alone. To evaluate patients pain before and after CIRT. To detect if baseline Apparent Diffusion Coefficient values (ADC) from Diffusion Weighted sequences could predict response to treatment.Material and methodsPatients included had one cycle of CIRT and underwent MRI before and after treatment. For each MRI, lesion maximum diameter and volume were obtained, and ADC values were analyzed within the whole lesion volume. Patients pain was evaluated with Numerical Rating Scale (NRS), considering the upper tumor level at baseline MRIs.Results39 patients were studied (mean follow-up 18 months). Considering RECIST 1.1 there was not a significant reduction in tumor diameters (p = 0.19), instead there was a significant reduction in tumor volume (p < 0.001), with a significant reduction in pain (p = 0.021) if the tumors were above vertebrae S2–S3 at baseline MRIs. The assessment of baseline ADC maps demonstrated higher median values and more negative skewness values in progressive disease (PD) patients versus both partial response (PR) and stable disease (SD).ConclusionsLesion volume measurement is more accurate than maximum diameter to better stratify the response of sacral chordoma treated with CIRT. Preliminary results suggest that baseline ADC values could be predictive of response to CIRT.



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Future trials on endovascular stroke treatment: the not-so-easy-to-pluck fruits



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MRI evaluation of sacral chordoma treated with carbon ion radiotherapy alone

To compare RECIST 1.1 with volume modifications in patients with sacral chordoma not suitable for surgery treated with carbon ions radiotherapy (CIRT) alone. To evaluate patients pain before and after CIRT. To detect if baseline Apparent Diffusion Coefficient values (ADC) from Diffusion Weighted sequences could predict response to treatment.

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Clinical factors related to the efficacy of tyrosine kinase inhibitor therapy in radioactive iodine refractory recurrent differentiated thyroid cancer patients.

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Clinical factors related to the efficacy of tyrosine kinase inhibitor therapy in radioactive iodine refractory recurrent differentiated thyroid cancer patients.

Endocr J. 2017 Dec 21;:

Authors: Sugino K, Nagahama M, Kitagawa W, Ohkuwa K, Uruno T, Matsuzu K, Suzuki A, Masaki C, Akaishi J, Hames KY, Tomoda C, Ogimi Y, Ito K

Abstract
New insights in thyroid cancer biology propelled the development of targeted therapies as salvage treatment for radioiodine-refractory differentiated thyroid cancer (RR-DTC), and the tyrosine kinase inhibitor (TKI) lenvatinib has recently become available as a new line of therapy for RR-DTC. The aim of this study is to investigate clinical factors related to the efficacy of TKI therapy in recurrent RR-DTC patients and identify the optimal timing for the start of TKI therapy. The subjects consisted of 29 patients with progressive RR-DTC, 9 males and 20 females, median age 66 years. A univariate analysis was conducted in relation to progression free survival (PFS) and overall survival (OS) by the Kaplan-Meier method for the following variables: age, sex, histology of the primary tumor, thyroglobulin doubling time before the start of lenvatinib therapy, site of the target lesions, presence of a tumor-mediated symptom at the start of lenvatinib therapy, and baseline tumor size of the target lesions. Median duration of lenvatinib therapy was 14.7 months and median drug intensity was 9.5 mg. At the time of the data cut-off for the analysis, 9 patients (31.0%) have died of their disease (DOD), and a PR (partial response), SD (stable disease), and PD (progressive disease) were observed in 20 patients (69%), 6 patients (20.7%), 3 patients (10.3%), respectively. Univariate analyses showed that the presence of a symptom was the only factor significantly related to poorer PFS and OS. Clinical benefit of TKI therapy will be possibly limited when the therapy starts after tumor-mediated symptoms appear.

PMID: 29269689 [PubMed - as supplied by publisher]



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Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study.

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Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium, or 131-cesium: Results of a prospective phase II study.

Brachytherapy. 2017 Dec 18;:

Authors: Blanchard P, Pugh TJ, Swanson DA, Mahmood U, Chen HC, Wang X, Graber WJ, Kudchadker RJ, Bruno T, Feeley T, Frank SJ

Abstract
PURPOSE: To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes.
METHODS AND MATERIALS: Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs.
RESULTS: From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively.
CONCLUSIONS: The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.

PMID: 29269207 [PubMed - as supplied by publisher]



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Utility of Dual-Energy CT-based Monochromatic Imaging in the Assessment of Myocardial Delayed Enhancement in Patients with Cardiomyopathy.

Utility of Dual-Energy CT-based Monochromatic Imaging in the Assessment of Myocardial Delayed Enhancement in Patients with Cardiomyopathy.

Radiology. 2017 Dec 22;:162945

Authors: Chang S, Han K, Youn JC, Im DJ, Kim JY, Suh YJ, Hong YJ, Hur J, Kim YJ, Choi BW, Lee HJ

Abstract
Purpose To investigate the diagnostic utility of dual-energy computed tomography (CT)-based monochromatic imaging for myocardial delayed enhancement (MDE) assessment in patients with cardiomyopathy. Materials and Methods The institutional review board approved this prospective study, and informed consent was obtained from all participants who were enrolled in the study. Forty patients (27 men and 13 women; mean age, 56 years ± 15 [standard deviation]; age range, 22-81 years) with cardiomyopathy underwent cardiac magnetic resonance (MR) imaging and dual-energy CT. Conventional (120-kV) and monochromatic (60-, 70-, and 80-keV) images were reconstructed from the dual-energy CT acquisition. Subjective quality score, contrast-to-noise ratio (CNR), and beam-hardening artifacts were compared pairwise with the Friedman test at post hoc analysis. With cardiac MR imaging as the reference standard, diagnostic performance of dual-energy CT in MDE detection and its predictive ability for pattern classification were compared pairwise by using logistic regression analysis with the generalized estimating equation in a per-segment analysis. The Bland-Altman method was used to find agreement between cardiac MR imaging and CT in MDE quantification. Results Among the monochromatic images, 70-keV CT images resulted in higher subjective quality (mean score, 3.38 ± 0.54 vs 3.15 ± 0.43; P = .0067), higher CNR (mean, 4.26 ± 1.38 vs 3.93 ± 1.33; P = .0047), and a lower value for beam-hardening artifacts (mean, 3.47 ± 1.56 vs 4.15 ± 1.67; P < .0001) when compared with conventional CT. When compared with conventional CT, 70-keV CT showed improved diagnostic performance for MDE detection (sensitivity, 94.6% vs 90.4% [P = .0032]; specificity, 96.0% vs 94.0% [P = .0031]; and accuracy, 95.6% vs 92.7% [P < .0001]) and improved predictive ability for pattern classification (subendocardial, 91.5% vs 84.3% [P = .0111]; epicardial, 94.3% vs 73.5% [P = .0001]; transmural, 93.0% vs 77.7% [P = .0018]; mesocardial, 85.4% vs 69.2% [P = .0047]; and patchy. 84.4% vs 78.4% [P = .1514]). For MDE quantification, 70-keV CT showed a small bias 0.1534% (95% limits of agreement: -4.7013, 5.0080). Conclusion Dual-energy CT-based 70-keV monochromatic images improve MDE assessment in patients with cardiomyopathy via improved image quality and CNR and reduced beam-hardening artifacts when compared with conventional CT images. © RSNA, 2017 Online supplemental material is available for this article.

PMID: 29272215 [PubMed - as supplied by publisher]



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Role of Cerebellar Dentate Functional Connectivity in Balance Deficits in Patients with Multiple Sclerosis.

Role of Cerebellar Dentate Functional Connectivity in Balance Deficits in Patients with Multiple Sclerosis.

Radiology. 2017 Dec 22;:170311

Authors: Tona F, De Giglio L, Petsas N, Sbardella E, Prosperini L, Upadhyay N, Giannì C, Pozzilli C, Pantano P

Abstract
Purpose To prospectively investigate, by using resting-state functional magnetic resonance (MR) imaging, cerebellar dentate nuclei (DNs) functional connectivity abnormalities in multiple sclerosis (MS) to explore their impact on balance impairment in patients with MS, considering the role of DNs and their projections in maintaining balance, posture, and muscle tone, Materials and Methods All subjects provided written informed consent, and the protocol was approved by the university institutional review board. Twenty-five patients with relapsing-remitting MS and 20 healthy control subjects underwent a 3-T resting-state functional MR imaging and static posturography. The seed-based method was applied to identify the cerebellar DNs resting-state network; first-level and high-level analyses were performed by using software tools. Results Compared with control subjects, patients had worse postural stability and altered patterns of cerebellar DNs connectivity network, with decreased connectivity in caudate nuclei and thalami and increased connectivity in the cerebellum, pons, left amygdala, and orbitofrontal cortices (cluster level, family-wise error corrected, P < .05, z threshold > 2.3). In patients, the decreased connectivity in the left caudate nucleus was related with worse balance performance (cluster level, family-wise error corrected P < .05, z threshold > 1.96) regardless of age, lesion burden, and global clinical disability. Conclusion These results reveal abnormalities of corticocerebellar circuit connectivity in patients with MS as compared with control subjects and suggest that the decreased connectivity between the DN and the left caudate nucleus could play a role in balance impairment in MS. © RSNA, 2017.

PMID: 29272214 [PubMed - as supplied by publisher]



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Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers.

Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers.

Radiology. 2017 Dec 22;:171148

Authors: Bahl M, Gaffney S, McCarthy AM, Lowry KP, Dang PA, Lehman CD

Abstract
Purpose To determine whether the rates and tumor characteristics of screening-detected and interval cancers differ for two-dimensional digital mammography (DM) versus digital breast tomosynthesis (DBT) mammography. Materials and Methods Consecutive screening mammograms from January 2009 to February 2011 (DM group, before DBT integration) and from January 2013 to February 2015 (DBT group, after complete DBT integration) were reviewed. Cancers were considered screening detected if diagnosed within 365 days of a positive screening examination and interval if diagnosed within 365 days of a negative screening examination. Z tests were used to compare cancers on DM versus DBT examinations. Results A total of 948 breast cancers were diagnosed after 78 385 DM and 76 896 DBT examinations. Although the overall rate of screening-detected cancers was similar with DM and DBT (5.0 vs 5.0 per 1000 examinations, P = .98), a higher proportion of screening-detected cancers were invasive rather than in situ with DBT (74.2% [287 of 387] vs 66.0% [260 of 394], P = .01). There were no significant differences in tumor characteristics, including size at pathologic examination, grade, hormone receptor status, and nodal status, between the screening-detected invasive cancers on DM versus DBT (P = .09-.99). The rate of interval cancers was similar with DM and DBT (1.1 vs 1.1 per 1000 examinations, P = .84). Compared with symptomatic interval cancers, magnetic resonance imaging-detected interval cancers were more likely to be minimal cancers. Conclusion The overall rates of screening-detected and interval cancers are similar with DM and DBT, but a higher proportion of screening-detected cancers are invasive rather than in situ with DBT. © RSNA, 2017.

PMID: 29272213 [PubMed - as supplied by publisher]



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Ablative Chemoembolization for Hepatocellular Carcinoma: A Prospective Phase I Case-Control Comparison with Conventional Chemoembolization.

Ablative Chemoembolization for Hepatocellular Carcinoma: A Prospective Phase I Case-Control Comparison with Conventional Chemoembolization.

Radiology. 2017 Dec 22;:170154

Authors: Yu SCH, Chan SL, Lee KF, Hui JWY, Hui EP, Chu CM, Chan AW, Cheung S, Li L, Wong J, Yeo WMM

Abstract
Purpose To evaluate the feasibility, safety, and treatment effectiveness of ablative chemoembolization (ACE) in the treatment of hepatocellular carcinoma (HCC) and compare with a similar patient cohort who underwent conventional transarterial chemoembolization (cTACE). Materials and Methods This was a prospective phase I nonrandomized study conducted between March 2013 and October 2016 in accordance to the Declaration of Helsinki and Declaration Good Clinical Practice with written informed consent. There were 36 men and eight women (median age, 64 years [interquartile range, 58-74] and 74.5 years [interquartile range, 70-80], respectively). The primary end points were treatment safety and tumor response. The secondary end points were time to progression, progression-free survival, conversion to partial hepatectomy, and viable HCC within the tumor specimen. The end points of the study group (n = 22) were compared with those of a case-matched control group (n = 22) of patients who underwent conventional cTACE during the same period by using a Pearson χ2 test. Results Treatment with ACE was successfully completed in all patients without adverse effects. The complete response (CR) rates by patient or by tumor were both 100%. The median time to progression and median progression-free survival were significantly longer in the study group than in the control group (both were 28 months vs 10 months, respectively; P < .001). The number of patient conversions to hepatectomy was seven for ACE and three for cTACE. In the tumor specimens, viable tumor was found in two of eight specimens that underwent ACE and three of three that underwent cTACE. Conclusion ACE is a feasible, safe, and well-tolerated treatment for patients with HCC; it is highly effective and may be more effective than cTACE in achieving CR. © RSNA, 2017 Online supplemental material is available for this article.

PMID: 29272212 [PubMed - as supplied by publisher]



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Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study.

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Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study.

Ann Oncol. 2016 Oct;27(10):1909-15

Authors: Nestoriuc Y, von Blanckenburg P, Schuricht F, Barsky AJ, Hadji P, Albert US, Rief W

Abstract
BACKGROUND: This study aims to determine the role of patient expectations as potentially modifiable factor of side-effects, quality of life, and adherence to endocrine treatment of breast cancer.
PATIENTS AND METHODS: A 2-year prospective clinical cohort study was conducted in routine primary care with postoperative patients with hormone-receptor-positive breast cancer, scheduled to start adjuvant endocrine treatment. Structured patient-reported assessments of side-effects, side-effect expectations, quality of life, and adherence took place during the first week post-surgery and after 3 and 24 months of endocrine treatment.
RESULTS: Of 111 enrolled patients, at 3 and 24 months, 107 and 88 patients, respectively, were assessed. After 2 years of endocrine treatment, patients reported high rates of side-effects (arthralgia: 71.3%, weight gain: 53.4%, hot flashes: 46.5%), including symptoms not directly attributable to the medication (breathing problems: 28.1%, dizziness: 25.6%). Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life in multivariate models controlling for relevant medical and psychological variables. Relative risk of side-effects after 2 years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations (RR = 1.833, CI 95%, 1.032-3.256). A significant interaction confirmed this expectation effect to be particularly evident in patients with high side-effects at 3 months. Furthermore, baseline expectations were associated with adherence at 24 months (r = -0.25, P = 0.006).
CONCLUSIONS: Expectations are a genuine factor of clinical outcome from endocrine treatment for breast cancer. Negative expectations increase the risk of treatment-specific side-effects, nocebo side-effects, and non-adherence. Yet, controlled studies are needed to analyze potential causal relationships. Optimizing individual expectations might be a promising strategy to improve side-effect burden, quality of life, and adherence during longer-term drug intake.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02088710.

PMID: 27551051 [PubMed - indexed for MEDLINE]



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Pragmatic randomized controlled trial of an allergy intervention for children aged 6-16 with asthma and rhinitis in general practice.

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Pragmatic randomized controlled trial of an allergy intervention for children aged 6-16 with asthma and rhinitis in general practice.

Clin Exp Allergy. 2016 Sep;46(9):1227-35

Authors: Smith H, Horney D, Jones C, Goubet S, Mukhopadhyay S, Frew A

Abstract
BACKGROUND: It is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitized to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child's sensitivities.
OBJECTIVE: To ascertain whether allergy assessment and tailored advice in general practice enhances outcomes of children with asthma and rhinitis.
METHOD: Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) vs. usual care in children with asthma and/or rhinoconjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were healthcare utilization, days unable to pursue usual activities and self-rated improvement.
RESULTS: A total of 335 participants were randomized to formal allergy assessment or normal care. There were no differences in participants' demographic or clinical characteristics at baseline (all P > 0.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD - 3.14, 95% CI - 6.01, - 0.81) and an improvement in QoL (MD - 0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, healthcare utilization or number of days unable to pursue usual activities.
CONCLUSION: Amongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL.

PMID: 27438431 [PubMed - indexed for MEDLINE]



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Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal.

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Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal.

J Trauma Dissociation. 2016 Oct-Dec;17(5):527-544

Authors: Gómez JM, Smith CP, Gobin RL, Tang SS, Freyd JJ

Abstract
The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA's behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA's institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to "advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives" (APA, 2016).

PMID: 27427782 [PubMed - indexed for MEDLINE]



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Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma.

http:--linkinghub.elsevier.com-ihub-imag Related Articles

Role of Sleep Apnea and Gastroesophageal Reflux in Severe Asthma.

Immunol Allergy Clin North Am. 2016 Aug;36(3):461-71

Authors: Rogers L

Abstract
Gastroesophageal reflux and obstructive sleep apnea syndrome are conditions that practitioners have been encouraged to evaluate and treat as part of a comprehensive approach to achieving asthma control. In this review, the author looks at the evidence linking these two conditions as factors that may impact difficult-to-control asthma and looks critically at the evidence suggesting that evaluation and treatment of these conditions when present impacts asthma control.

PMID: 27401619 [PubMed - indexed for MEDLINE]



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Life With Type 1 Diabetes: Views of Hispanic Adolescents and Their Clinicians.

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Life With Type 1 Diabetes: Views of Hispanic Adolescents and Their Clinicians.

Diabetes Educ. 2016 Aug;42(4):408-17

Authors: Reitblat L, Whittemore R, Weinzimer SA, Tamborlane WV, Sadler LS

Abstract
PURPOSE: The purpose of this study was to describe the experience of Hispanic adolescents with type 1 diabetes (T1DM) from the perspectives of adolescents and their diabetes clinicians.
METHODS: Nine Hispanic adolescents with T1DM and 7 clinicians at a tertiary academic medical center participated in in-depth individual semistructured interviews. Adolescents were purposively sampled to obtain a range in age and metabolic control. Based on interpretive descriptive methodology, data were coded and combined into themes, which were constructed separately for the 2 groups and then compared across groups. Data were analyzed concurrently with data collection.
RESULTS: Adolescents and clinicians reported similar themes related to (1) cultural aspects of living with T1DM; (2) finding the balance of: food, insulin, and exercise; being "perfect at diabetes" versus being a "normal teenager"; and being independent versus needing support, and (3) ways to improve life for Hispanic adolescents with T1DM. Although there were some key cultural distinctions, Hispanic adolescents with T1DM and their clinicians described life and daily management issues as being similar to those of their non-Hispanic peers.
CONCLUSIONS: Hispanic adolescents with T1DM have unique experiences and beliefs that affect their living with T1DM, but in many respects, their experiences are similar to those of their non-Hispanic peers with T1DM. Hispanic adolescents with T1DM want their clinicians to learn about their personal lives. Preferably, clinicians and parents should speak the same language. If not possible, interpreters should be used instead of having adolescents translate during clinic appointments.

PMID: 27161932 [PubMed - indexed for MEDLINE]



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Thorax protocol review: working with trialists to improve trial quality.

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Thorax protocol review: working with trialists to improve trial quality.

Thorax. 2016 06;71(6):491-2

Authors: Shyamsundar M, Smyth AR, McAuley DF

PMID: 27048198 [PubMed - indexed for MEDLINE]



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Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI.

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Pressure Mapping and Hemodynamic Assessment of Intracranial Dural Sinuses and Dural Arteriovenous Fistulas with 4D Flow MRI.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Rivera-Rivera LA, Johnson KM, Turski PA, Wieben O

Abstract
The feasibility of 4D flow MR imaging to visualize flow patterns and generate relative pressure maps in the dural venous sinus in healthy subjects (n = 60) and patients with dural arteriovenous fistulas (n = 7) was investigated. Dural venous drainage was classified based on torcular Herophili anatomy by using 4D flow MR imaging-derived angiograms and magnitude images. Subjects were scanned in a 3T clinical MR imaging system. 4D flow MR imaging enabled noninvasive characterization of dural sinus anatomy and mapping of relative pressure differences.

PMID: 29269408 [PubMed - as supplied by publisher]



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Better Than Nothing: A Rational Approach for Minimizing the Impact of Outflow Strategy on Cerebrovascular Simulations.

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Better Than Nothing: A Rational Approach for Minimizing the Impact of Outflow Strategy on Cerebrovascular Simulations.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Chnafa C, Brina O, Pereira VM, Steinman DA

Abstract
BACKGROUND AND PURPOSE: Computational fluid dynamics simulations of neurovascular diseases are impacted by various modeling assumptions and uncertainties, including outlet boundary conditions. Many studies of intracranial aneurysms, for example, assume zero pressure at all outlets, often the default ("do-nothing") strategy, with no physiological basis. Others divide outflow according to the outlet diameters cubed, nominally based on the more physiological Murray's law but still susceptible to subjective choices about the segmented model extent. Here we demonstrate the limitations and impact of these outflow strategies, against a novel "splitting" method introduced here.
MATERIALS AND METHODS: With our method, the segmented lumen is split into its constituent bifurcations, where flow divisions are estimated locally using a power law. Together these provide the global outflow rate boundary conditions. The impact of outflow strategy on flow rates was tested for 70 cases of MCA aneurysm with 0D simulations. The impact on hemodynamic indices used for rupture status assessment was tested for 10 cases with 3D simulations.
RESULTS: Differences in flow rates among the various strategies were up to 70%, with a non-negligible impact on average and oscillatory wall shear stresses in some cases. Murray-law and splitting methods gave flow rates closest to physiological values reported in the literature; however, only the splitting method was insensitive to arbitrary truncation of the model extent.
CONCLUSIONS: Cerebrovascular simulations can depend strongly on the outflow strategy. The default zero-pressure method should be avoided in favor of Murray-law or splitting methods, the latter being released as an open-source tool to encourage the standardization of outflow strategies.

PMID: 29269407 [PubMed - as supplied by publisher]



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Prenatal Factors Associated with Postnatal Brain Injury in Infants with Congenital Diaphragmatic Hernia.

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Prenatal Factors Associated with Postnatal Brain Injury in Infants with Congenital Diaphragmatic Hernia.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Radhakrishnan R, Merhar SL, Su W, Zhang B, Burns P, Lim FY, Kline-Fath BM

Abstract
BACKGROUND AND PURPOSE: Approximately 60% of infants with congenital diaphragmatic hernia have evidence of brain injury on postnatal MR imaging. It is unclear whether any brain injury is present before birth. In this study, we evaluated fetal MR imaging findings of brain injury and the association of congenital diaphragmatic hernia severity with postnatal brain injury.
MATERIALS AND METHODS: Fetal MR imaging and postnatal brain MR imaging were retrospectively evaluated in 36 cases of congenital diaphragmatic hernia (from 2009 to 2014) by 2 pediatric neuroradiologists. Brain injury on postnatal MR imaging and brain injury and congenital diaphragmatic hernia severity on fetal MR imaging were recorded. Correlations between brain abnormalities on fetal and postnatal brain MR imaging were analyzed. Postnatal brain injury findings correlating with the severity of congenital diaphragmatic hernia were also assessed.
RESULTS: On fetal MR imaging, enlarged extra-axial spaces (61%), venous sinus distention (21%), and ventriculomegaly (6%) were identified. No maturational delay, intracranial hemorrhage, or brain parenchymal injury was identified on fetal MR imaging. On postnatal MR imaging, 67% of infants had evidence of abnormality, commonly, enlarged extra-axial spaces (44%). Right-sided congenital diaphragmatic hernia was associated with a greater postnatal brain injury score (P = .05). Low observed-to-expected lung volume was associated with postnatal white matter injury (P = .005) and a greater postnatal brain injury score (P = .008). Lack of liver herniation was associated with normal postnatal brain MR imaging findings (P = .03).
CONCLUSIONS: Fetal lung hypoplasia is associated with postnatal brain injury in congenital diaphragmatic hernia, suggesting that the severity of lung disease and associated treatments affect brain health as well. We found no evidence of prenatal brain parenchymal injury or maturational delay.

PMID: 29269406 [PubMed - as supplied by publisher]



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White Matter Changes Related to Subconcussive Impact Frequency during a Single Season of High School Football.

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White Matter Changes Related to Subconcussive Impact Frequency during a Single Season of High School Football.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Kuzminski SJ, Clark MD, Fraser MA, Haswell CC, Morey RA, Liu C, Choudhury KR, Guskiewicz KM, Petrella JR

Abstract
BACKGROUND AND PURPOSE: The effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period.
MATERIALS AND METHODS: Seventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis.
RESULTS: The mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory.
CONCLUSIONS: Our findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.

PMID: 29269405 [PubMed - as supplied by publisher]



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MR Imaging-Based Evaluations of Olfactory Bulb Atrophy in Patients with Olfactory Dysfunction.

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MR Imaging-Based Evaluations of Olfactory Bulb Atrophy in Patients with Olfactory Dysfunction.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Chung MS, Choi WR, Jeong HY, Lee JH, Kim JH

Abstract
BACKGROUND AND PURPOSE: Although the olfactory bulb volume as assessed with MR imaging is known to reflect olfactory function, it is not always measured during olfactory pathway assessments in clinical settings. We aimed to evaluate the utility of visual olfactory bulb atrophy and neuropathy analyses using MR imaging in patients with olfactory dysfunction.
MATERIALS AND METHODS: Thirty-four patients who presented with subjective olfactory loss between March 2016 and February 2017 were included. Patients underwent a nasal endoscopic examination, olfactory testing with the Korean Version of the Sniffin' Sticks test, and MR imaging. All patients completed the Sino-Nasal Outcome Test and Questionnaire of Olfactory Disorders. Olfactory bulb atrophy and neuropathy were evaluated on MR images by 2 head and neck radiologists.
RESULTS: The etiology of olfactory loss was chronic rhinosinusitis with/without nasal polyps in 15 (44.1%) patients, respiratory viral infection in 7 (20.6%), trauma in 2 (5.9%), and idiopathic in 10 (29.4%) patients. Although 10 (29.4%) of the 34 patients were normosmic according to the Sniffin' Sticks test, their scores on the other tests were like those of patients who were hyposmic/anosmic according to the Sniffin' Sticks test. However, the detection rate of olfactory bulb atrophy was significantly higher in patients with hyposmia/anosmia than it was in patients with normosmia (P = .002). No difference in olfactory bulb neuropathy was identified among patients with normosmia and hyposmia/anosmia (P = .395).
CONCLUSIONS: MR imaging evaluations of olfactory bulb atrophy can be used to objectively diagnose olfactory dysfunction in patients with subjective olfactory loss.

PMID: 29269404 [PubMed - as supplied by publisher]



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Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go?

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Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go?

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Tozakidou M, Reisinger C, Harder D, Lieb J, Szucs-Farkas Z, Müller-Gerbl M, Studler U, Schindera S, Hirschmann A

Abstract
BACKGROUND AND PURPOSE: While the use of cervical spine CT in trauma settings has increased, the balance between image quality and dose reduction remains a concern. The purpose of our study was to compare the image quality of CT of the cervical spine of cadaveric specimens at different radiation dose levels.
MATERIALS AND METHODS: The cervical spine of 4 human cadavers (mean body mass index; 30.5 ± 5.2 kg/m2; range, 24-36 kg/m2) was examined using different reference tube current-time products (45, 75, 105, 135, 150, 165, 195, 275, 355 mAs) and a tube voltage of 120 kV(peak). Data were reconstructed with filtered back-projection and iterative reconstruction. Qualitative image noise and morphologic characteristics of bony structures were quantified on a Likert scale. Quantitative image noise was measured. Statistics included analysis of variance and the Tukey test.
RESULTS: Compared with filtered back-projection, iterative reconstruction provided significantly lower qualitative (mean noise score: iterative reconstruction = 2.10/filtered back-projection = 2.18; P = .003) and quantitative (mean SD of Hounsfield units in air: iterative reconstruction = 30.2/filtered back-projection = 51.8; P < .001) image noise. Image noise increased as the radiation dose decreased. Qualitative image noise at levels C1-4 was rated as either "no noise" or as "acceptable noise." Any shoulder position was at level C5 and caused more artifacts at lower levels. When we analyzed all spinal levels, scores for morphologic characteristics revealed no significant differences between 105 and 355 mAs (P = .555), but they were worse in scans at 75 mAs (P = .025).
CONCLUSIONS: Clinically acceptable image quality of cervical spine CTs for evaluation of bony structures of cadaveric specimens with different body habitus can be achieved with a reference mAs of 105 at 120 kVp with iterative reconstruction. Pull-down of shoulders during acquisition could improve image quality but may not be feasible in trauma patients with unknown injuries.

PMID: 29269403 [PubMed - as supplied by publisher]



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Does the Volume of CSF Removed Affect the Response to a Tap in Normal Pressure Hydrocephalus?

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Does the Volume of CSF Removed Affect the Response to a Tap in Normal Pressure Hydrocephalus?

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Onder H, Hanalioglu S

PMID: 29269402 [PubMed - as supplied by publisher]



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Reply.

Related Articles

Reply.

AJNR Am J Neuroradiol. 2017 Dec 21;:

Authors: Thakur SK, Serulle Y, Miskin NP, Rusinek H, Golomb J, George AE

PMID: 29269401 [PubMed - as supplied by publisher]



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Sleep deprivation affects fear memory consolidation: Bi-stable amygdala connectivity with insula and ventromedial prefrontal cortex.

Sleep deprivation affects fear memory consolidation: Bi-stable amygdala connectivity with insula and ventromedial prefrontal cortex.

Soc Cogn Affect Neurosci. 2017 Dec 20;:

Authors: Feng P, Becker B, Zheng Y, Feng T

Abstract
Sleep plays an important role for successful fear memory consolidation. Growing evidence suggests that sleep disturbances might contribute to the development and the maintenance of posttraumatic stress disorder (PTSD), a disorders characterized by dysregulations in fear learning mechanisms, as well as exaggerated arousal and salience processing. Against this background, the present study examined the effects of sleep deprivation (SD) on the acquisition of fear and the subsequent neural consolidation. To this end, the present study assessed fear acquisition and associated changes in fMRI-based amygdala-functional connectivity following 24h of SD. Relative to non-sleep deprived controls, SD subjects demonstrated increased fear ratings and skin conductance responses (SCR) during fear acquisition. During fear consolidation SD inhibited increased amygdala-ventromendial prefrontal cortex (vmPFC) connectivity and concomitantly increased changes in amygdala-insula connectivity. Importantly, whereas in controls fear indices during acquisition were negatively associated with amygdala-vmPFC connectivity during consolidation, fear indices were positively associated with amygdala-insula coupling following SD. Together the findings suggest that SD may interfere with vmPFC control of the amygdala and increase bottom-up arousal signaling in the amygdala-insula pathway during fear consolidation, which might mediate the negative impact of sleep disturbances on PSTD symptomatology.

PMID: 29272546 [PubMed - as supplied by publisher]



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A Multimethod, Case-Controlled Study of Sleep-Wake Disturbances in Adolescents With Spina Bifida.

A Multimethod, Case-Controlled Study of Sleep-Wake Disturbances in Adolescents With Spina Bifida.

J Pediatr Psychol. 2017 Dec 20;:

Authors: Murray CB, Palermo TM, Holmbeck GN

Abstract
Objective: This study aimed to compare sleep-wake disturbances in adolescents with spina bifida (SB) to typically developing (TD) peers. Exploratory analyses examined sex as moderator of disrupted sleep.
Methods: Adolescents with SB (ages 12-18 years; N = 37) and a demographically matched sample of TD adolescents (N = 37) completed validated sleep questionnaires and underwent 10 days of actigraphy monitoring.
Results: Adolescents with SB evidenced worse sleep quality, shorter sleep duration, greater sleep maintenance difficulties, and higher levels of fatigue compared with their TD peers. Exploratory analyses revealed females with SB were particularly vulnerable to developing sleep disturbances.
Conclusions: Adolescents with SB are at risk for nighttime sleep disturbances and daytime fatigue. Additional research will need to identify mechanisms and adverse consequences of poor sleep to develop interventions addressing sleep deficiency. Sex-specific disparities in sleep patterns in pediatric SB is a novel finding that requires assessment of etiological underpinnings to clarify clinical implications.

PMID: 29272431 [PubMed - as supplied by publisher]



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Evaluation of the noradrenergic system in Parkinson's disease: an 11C-MeNER PET and neuromelanin MRI study.

Evaluation of the noradrenergic system in Parkinson's disease: an 11C-MeNER PET and neuromelanin MRI study.

Brain. 2017 Dec 18;:

Authors: Sommerauer M, Fedorova TD, Hansen AK, Knudsen K, Otto M, Jeppesen J, Frederiksen Y, Blicher JU, Geday J, Nahimi A, Damholdt MF, Brooks DJ, Borghammer P

Abstract
Pathological involvement of the noradrenergic locus coeruleus occurs early in Parkinson's disease, and widespread noradrenaline reductions are found at post-mortem. Rapid eye movement sleep behaviour disorder (RBD) accompanies Parkinson's disease and its presence predicts an unfavourable disease course with a higher propensity to cognitive impairment and orthostatic hypotension. MRI can detect neuromelanin in the locus coeruleus while 11C-MeNER PET is a marker of noradrenaline transporter availability. Here, we use both imaging modalities to study the association of RBD, cognition and autonomic dysfunction in Parkinson's disease with loss of noradrenergic function. Thirty non-demented Parkinson's disease patients [16 patients with RBD and 14 without RBD, comparable across age (66.6 ± 6.7 years), sex (22 males), and disease stage (Hoehn and Yahr, 2.3 ± 0.5)], had imaging of the locus coeruleus with neuromelanin sensitive MRI and brain noradrenaline transporter availability with 11C-MeNER PET. RBD was confirmed with polysomnography; cognitive function was assessed with a neuropsychological test battery, and blood pressure changes on tilting were documented; results were compared to 12 matched control subjects. We found that Parkinson's disease patients with RBD showed decreased locus coeruleus neuromelanin signal on MRI (P < 0.001) and widespread reduced binding of 11C-MeNER (P < 0.001), which correlated with amount of REM sleep without atonia. Parkinson's disease with RBD was also associated with a higher incidence of cognitive impairment, slowed EEG activity, and orthostatic hypotension. Reduced 11C-MeNER binding correlated with EEG slowing, cognitive performance, and orthostatic hypotension. In conclusion, reduced noradrenergic function in Parkinson's disease was linked to the presence of RBD and associated with cognitive deterioration and orthostatic hypotension. Noradrenergic impairment may contribute to the high prevalence of these non-motor symptoms in Parkinson's disease, and may be of relevance when treating these conditions in Parkinson's disease.

PMID: 29272343 [PubMed - as supplied by publisher]



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Gender differences in the relationship between walking activity and sleep disturbance among community-dwelling older adult with diabetes in Taiwan.

Gender differences in the relationship between walking activity and sleep disturbance among community-dwelling older adult with diabetes in Taiwan.

J Women Aging. 2017 Dec 22;:1-9

Authors: Cheng HP, Chen CH, Lin MH, Wang CS, Yang YC, Lu FH, Wu JS, Lin SI

Abstract
This study explored the gender differences in the relationship between walking activity and sleep disturbances. A cross-sectional study of 201 community-dwelling older adults with diabetes was conducted in southern Taiwan. Using the Taiwanese version of the International Physical Activity Questionnaire, self-administered short version (IPAQ-SS), information on physical activity and sleep disturbance conditions was collected. Among older female adults with diabetes, 54.2% reported sleep disturbance significantly higher than males (38.1%). Logistic regression analysis suggested that for women, in addition to the active group, older adults in the low-active, high-walking group exhibited a significantly lower rate of sleep disturbance than did those who walked less.

PMID: 29272219 [PubMed - as supplied by publisher]



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Sleep Disturbance, Activities of Daily Living, and Depressive Symptoms among Older Adults.

Sleep Disturbance, Activities of Daily Living, and Depressive Symptoms among Older Adults.

Clin Gerontol. 2017 Dec 11;:1-9

Authors: Webb CA, Cui R, Titus C, Fiske A, Nadorff MR

Abstract
OBJECTIVE: Research suggests sleep disturbance plays a role in depression and risk for suicidal behavior (i.e., ideation, attempts, death by suicide). How sleep disturbance affects suicide risk is unclear and one's ability to perform activities of daily living (ADLs) may help explain this relation. This study examined associations between sleep problems, ADLs, and either depressive symptoms or suicide risk among older adults. We hypothesized that ADLs would mediate relations between sleep problems and depressive symptoms and suicide risk.
METHOD: Participants (N = 134; age ≥65) were recruited through Amazon's Mechanical Turk. Participants completed questionnaires that assessed insomnia symptoms, nightmares, ADLs, depressive symptoms, and suicidal behaviors.
RESULTS: Nightmares were associated with depressive symptoms and suicide risk but not independently associated with ADLs. Insomnia symptoms were associated with depressive symptoms, suicide risk, and ADLs. ADLs mediated the relation between insomnia symptoms and depressive symptoms. The insomnia symptom-suicidal behavior relation and the nightmare-suicidal behavior relation were significantly mediated by a pathway containing ADLs and depressive symptoms.
DISCUSSION: ADLs help explain how insomnia symptoms and nightmares confer suicide risk among older adults, either independently or in association with depressive symptoms.
CLINICAL IMPLICATIONS: Practitioners should attend to ADL performance when treating older adults with insomnia and depression.

PMID: 29272210 [PubMed - as supplied by publisher]



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COLLABORATION AND CULTURAL SAFETY: SAFE SLEEP SPACE ALTERNATIVES WITH ABORIGINAL FAMILIES.

COLLABORATION AND CULTURAL SAFETY: SAFE SLEEP SPACE ALTERNATIVES WITH ABORIGINAL FAMILIES.

Aust Nurs Midwifery J. 2017 Apr;24(9):40

Authors: Grant J, Deverix J, Nottage C, Sivertsen N, Spurrier N, Steeb A, Stuart-Butler D

Abstract
Despite a marked reduction in Aboriginal and Torres Strait Islander infant deaths from 1998 to 2012 (AIHW 2015) Aboriginal and Torres Strait Islander infants remain over-represented in sudden and unexpected infant death rates.

PMID: 29272093 [PubMed - as supplied by publisher]



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UNITING CULTURAL PRACTICES AND SAFE SLEEP ENVIRONMENTS FOR VULNERABLE INDIGENOUS AUSTRALIAN INFANTS.

UNITING CULTURAL PRACTICES AND SAFE SLEEP ENVIRONMENTS FOR VULNERABLE INDIGENOUS AUSTRALIAN INFANTS.

Aust Nurs Midwifery J. 2017 Apr;24(9):37

Authors: Young J, Watson K, Craigie L, Cowan S, Kearney L

Abstract
Sudden unexpected death in infancy (SUDI) is four times higher for Aboriginal and Torres Strait Islander babies compared to non-indigenous babies (Commission for Children and Young People and Child Guardian 2014). Co-sleeping is a culturally valued practice used by many indigenous families however is associated with an increased risk of infant death in hazardous circumstances (Venneman et al. 2012; Blair et al. 2014).

PMID: 29272090 [PubMed - as supplied by publisher]



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Effect of Rehabilitation on Sleep Quality After Ablation for Atrial Fibrillation: Data From a Randomized Trial.

Effect of Rehabilitation on Sleep Quality After Ablation for Atrial Fibrillation: Data From a Randomized Trial.

J Cardiovasc Nurs. 2017 Dec 22;:

Authors: Risom SS, Fevejle Cromhout P, Overgaard D, Hastrup Svendsen J, Kikkenborg Berg S

Abstract
BACKGROUND: Low sleep quality is common in patients with atrial fibrillation (AF). Positive effects of cardiac rehabilitation on patients treated for AF with ablation have been found, but whether cardiac rehabilitation affects sleep quality is unknown. The objectives of this study were to investigate (1) differences in sleep quality between cardiac rehabilitation and usual care groups and (2) whether other factors could affect sleep quality.
METHODS: From the randomized CopenHeartRFA trial, 210 patients treated for AF with ablation were included. A rehabilitation program consisting of physical exercise and psychoeducational consultations was tested. Sleep quality was measured with the Pittsburg Sleep Quality Index (PSQI) questionnaire before intervention and at the end of intervention. Anxiety, depression, and European Heart Rhythm Association scores were assessed.
RESULTS: No difference between groups in sleep quality was found (PSQI global mean [SD] score, 6.60 [3.61] points for the cardiac rehabilitation group [n = 83] and 6.08 [3.60] points for the usual care group [n = 90]; P = .34), although improvements in sleep quality were noted in both groups. Sleep latency, duration, and efficiency were significant by type of AF at 1 month. Anxiety, depression, and higher European Heart Rhythm Association scores at 4 months were associated with a higher PSQI global mean score at the end of intervention.
CONCLUSION: The rehabilitation program showed no effect on sleep quality. A large proportion of patients reported poor sleep quality, and patients reporting anxiety, depression, or AF symptoms described worse sleep quality compared with patients who did not experience anxiety, depression, or AF symptoms. More research in the field is warranted.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PMID: 29271795 [PubMed - as supplied by publisher]



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Central sleep apnoea in heart failure with reduced ejection fraction, adaptive servo-ventilation, and left ventricular ejection fraction: the (still) missing link.

Central sleep apnoea in heart failure with reduced ejection fraction, adaptive servo-ventilation, and left ventricular ejection fraction: the (still) missing link.

Eur J Heart Fail. 2017 Dec 22;:

Authors: Ramalho SHR, Shah AM

PMID: 29271551 [PubMed - as supplied by publisher]



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Peripapillary retina nerve fiber layer thickness and macular ganglion cell layer thickness in patients with obstructive sleep apnea syndrome.

Peripapillary retina nerve fiber layer thickness and macular ganglion cell layer thickness in patients with obstructive sleep apnea syndrome.

Eye (Lond). 2017 Dec 22;:

Authors: Kara N, Sayin N, Bayramoglu SE, Savas AU

Abstract
PurposeTo investigate the association of the severity of obstructive sleep apnea syndrome (OSAS) with peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL).Materials and methodsIn this cross-sectional study, 145 patients with OSAS and 40 healthy subjects were enrolled. OSAS patients were further divided into mild (n=50), moderate (n=36), and severe (n=59) OSAS groups according to their apnea-hypopnea index (AHI) values. Spectral-domain optical coherence tomography was used to measure the peripapillary RNFL and GC-IPL thicknesses.ResultsThere was no statistical difference between the RNFL thickness in OSAS and control groups (P>0.05). Both average GC-IPL and minimum GC-IPL thicknesses were significantly lower in severe OSAS group than in healthy controls (P<0.05 for both). There was a significant negative correlation between AHI and both average GC-IPL (r=-0.232, P=0.005) and minimum GC-IPL (r=-0.233, P=0.005) thicknesses.ConclusionsOur study results suggest that although RNFL thickness did not differ significantly between OSAS and control groups, ganglion cell layer thickness in OSAS patients is much lower than in healthy population. Ganglion cell thickness showed a significant correlation with the severity of OSAS.Eye advance online publication, 22 December 2017; doi:10.1038/eye.2017.279.

PMID: 29271421 [PubMed - as supplied by publisher]



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[Obesity: lack of moral fibre of doctors, patients or politicians?]

[Obesity: lack of moral fibre of doctors, patients or politicians?]

Ned Tijdschr Geneeskd. 2017;161(0):D2356

Authors: de Brauw M

Abstract
Obesity is the most important avoidable cause of death. It is associated with many chronic illnesses, such as diabetes, hypertension, sleep apnoea and several cancers. Although bariatric surgery is effective in treating obesity and associated health problems, it is not the solution of this health issue. What should doctors do to prevent obesity in our society? Politics and the government play a leading role in any necessary behavioural change in society. Other countries have taken effective measures, such as better information on food and food products, sugar and fat taxes and stimulating walking or cycling instead of driving.

PMID: 29271320 [PubMed - in process]



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Usefulness of psychoeducational intervention in chronic insomnia: an actigraphic study.

Usefulness of psychoeducational intervention in chronic insomnia: an actigraphic study.

J Ment Health. 2017 Dec 22;:1-7

Authors: Quintiliani MI, Imperatori C, Testani E, Losurdo A, Tamburello S, Contardi A, Della Marca G, Farina B

Abstract
BACKGROUND: Chronic Insomnia is a severe and disabling condition characterized by difficulty in initiating or maintaining sleep, waking up too early, despite adequate opportunity and circumstances for sleep. Maladaptive thoughts and dysfunctional beliefs about sleep are considered crucial factors in developing and perpetuating this disorder.
AIMS: The aim of the study was to explore the usefulness, in patients with chronic insomnia, of a one-session psychoeducational intervention on sleep-related maladaptive thoughts and beliefs, and on sleep perception.
METHODS: Thirty-eight patients with chronic insomnia were enrolled in the study and randomly assigned to receive psychoeducational intervention (PI+) or to act as controls (PI-). Patients wore an actigraph and compiled a sleep diary for 14 d. After the first 7 d, only PI+ patients received one session of psychoeducational intervention.
RESULTS: A significant reduction of sleep related preoccupations, a reduction of dysfunctional beliefs about sleep, and an improvement of subjective perception of sleep were observed in the PI+ group, but not in the PI- group. No significant modification was observed for objective total sleep time.
CONCLUSIONS: Our results suggest that one-session psychoeducational intervention is associated with a decrease of sleep-related maladaptive thoughts and beliefs, and with an improvement on subjective sleep perception.

PMID: 29271275 [PubMed - as supplied by publisher]



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The effect of daytime napping and full-night sleep on the consolidation of declarative and procedural information.

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The effect of daytime napping and full-night sleep on the consolidation of declarative and procedural information.

J Sleep Res. 2017 Dec 22;:

Authors: van Schalkwijk FJ, Sauter C, Hoedlmoser K, Heib DPJ, Klösch G, Moser D, Gruber G, Anderer P, Zeitlhofer J, Schabus M

Abstract
Many studies investigating sleep and memory consolidation have evaluated full-night sleep rather than alternative sleep periods such as daytime naps. This multi-centre study followed up on, and was compared with, an earlier full-night study (Schabus et al., 2004) investigating the relevance of daytime naps for the consolidation of declarative and procedural memory. Seventy-six participants were randomly assigned to a nap or wake group, and performed a declarative word-pair association or procedural mirror-tracing task. Performance changes from before to after a 90-min retention interval filled with sleep or quiet wakefulness were evaluated between groups. Associations between performance changes, sleep architecture, spindles, and slow oscillations were investigated. For the declarative task we observed a trend towards stronger forgetting across a wake period compared with a nap period, and a trend towards memory increase over the full-night. For the procedural task, accuracy was significantly decreased following daytime wakefulness, showed a trend to increase with a daytime nap, and significantly increased across full-night sleep. For the nap protocol, neither sleep stages, spindles, nor slow oscillations predicted performance changes. A direct comparison of day and nighttime sleep revealed that daytime naps are characterized by significantly lower spindle density, but higher spindle activity and amplitude compared with full-night sleep. In summary, data indicate that daytime naps protect procedural memories from deterioration, whereas full-night sleep improves performance. Given behavioural and physiological differences between day and nighttime sleep, future studies should try to characterize potential differential effects of full-night and daytime sleep with regard to sleep-dependent memory consolidation.

PMID: 29271015 [PubMed - as supplied by publisher]



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Sleep Disorders in Pregnancy.

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Sleep Disorders in Pregnancy.

Semin Neurol. 2017 Dec;37(6):661-668

Authors: Bazalakova M

Abstract
Sleep and pregnancy are dynamic processes with unique and evolving physiological substrates. Given the "restorative hypothesis" of sleep as an anabolic process essential for cellular and tissue regeneration, the largely unexplored role of sleep in gestational physiology and pregnancy outcomes promises to be a fascinating topic. Emerging literature suggests that objectively measured or self-reported short sleep duration may be a risk for adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), gestational hypertension, and cesarean delivery. In this review, we discuss obstructive sleep apnea (OSA) and restless legs syndrome (RLS), two sleep disorders prevalent in pregnancy. OSA is especially likely in high-risk pregnancy where it is associated with comorbid cardiovascular and metabolic disturbances. We review new data strongly suggesting that OSA is an independent risk factor for GDM and gestational hypertension. It remains to be seen if sleep disruption, whether or not in the context of gestational RLS and gestational OSA, is a modifiable factor for adverse pregnancy outcomes. Clinicians are encouraged to query sleep symptoms in pregnant women and to have a low threshold to pursue investigations for OSA, including the subjective symptoms of snoring, witnessed apneas, and daytime sleepiness, and also medical comorbidities, such as chronic hypertension.

PMID: 29270939 [PubMed - in process]



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Pathways linking racial/ethnic discrimination and sleep among U.S.-born and foreign-born Latinxs.

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Pathways linking racial/ethnic discrimination and sleep among U.S.-born and foreign-born Latinxs.

J Behav Med. 2017 Dec 21;:

Authors: Garcini LM, Chirinos DA, Murdock KW, Seiler A, LeRoy AS, Peek K, Cutchin MP, Fagundes C

Abstract
This study examined the association between racial/ethnic discrimination and sleep through psychological distress and body mass index (BMI), and determined whether the aforementioned associations vary between U.S. and foreign-born Latinxs. Participants were 1332 Latinx adults enrolled in the Texas City Stress and Health Study. Multistage sampling methods were used to select participants. A model linking racial/ethnic discrimination with sleep disturbances through direct and indirect (i.e., psychological distress and BMI) paths demonstrated good fit. Greater racial/ethnic discrimination was associated with greater psychological distress and higher BMI. Psychological distress and BMI were also significant predictors of sleep disturbances. The indirect path from racial/ethnic discrimination to sleep disturbances via psychological distress was significant. A model with parameters constrained to be equal between U.S.-born and foreign-born Latinxs suggested associations were comparable between these groups. Our study demonstrated the relevance of racial/ethnic discrimination to sleep disturbances, particularly its association via psychological distress among Latinxs.

PMID: 29270888 [PubMed - as supplied by publisher]



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Australian Utility Weights for the EORTC QLU-C10D, a Multi-Attribute Utility Instrument Derived from the Cancer-Specific Quality of Life Questionnaire, EORTC QLQ-C30.

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Australian Utility Weights for the EORTC QLU-C10D, a Multi-Attribute Utility Instrument Derived from the Cancer-Specific Quality of Life Questionnaire, EORTC QLQ-C30.

Pharmacoeconomics. 2017 Dec 21;:

Authors: King MT, Viney R, Simon Pickard A, Rowen D, Aaronson NK, Brazier JE, Cella D, Costa DSJ, Fayers PM, Kemmler G, McTaggart-Cowen H, Mercieca-Bebber R, Peacock S, Street DJ, Young TA, Norman R, MAUCa Consortium

Abstract
BACKGROUND: The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the widely used cancer-specific quality-of-life (QOL) questionnaire, EORTC QLQ-C30. The QLU-C10D contains ten dimensions (Physical, Role, Social and Emotional Functioning; Pain, Fatigue, Sleep, Appetite, Nausea, Bowel Problems), each with four levels. To be used in cost-utility analysis, country-specific valuation sets are required.
OBJECTIVE: The aim of this study was to provide Australian utility weights for the QLU-C10D.
METHODS: An Australian online panel was quota-sampled to ensure population representativeness by sex and age (≥ 18 years). Participants completed a discrete choice experiment (DCE) consisting of 16 choice-pairs. Each pair comprised two QLU-C10D health states plus life expectancy. Data were analysed using conditional logistic regression, parameterised to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each QOL dimension-level coefficient to the coefficient on life expectancy.
RESULTS: A total of 1979 panel members opted in, 1904 (96%) completed at least one choice-pair, and 1846 (93%) completed all 16 choice-pairs. Dimension weights were generally monotonic: poorer levels within each dimension were generally associated with greater utility decrements. The dimensions that impacted most on choice were, in order, Physical Functioning, Pain, Role Functioning and Emotional Functioning. Oncology-relevant dimensions with moderate impact were Nausea and Bowel Problems. Fatigue, Trouble Sleeping and Appetite had relatively small impact. The value of the worst health state was -0.096, somewhat worse than death.
CONCLUSIONS: This study provides the first country-specific value set for the QLU-C10D, which can facilitate cost-utility analyses when applied to data collected with the EORTC QLQ-C30, prospectively and retrospectively.

PMID: 29270835 [PubMed - as supplied by publisher]



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Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty.

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Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty.

Eur Arch Otorhinolaryngol. 2017 Dec 21;:

Authors: Steinbichler TB, Bender B, Giotakis AI, Dejaco D, Url C, Riechelmann H

Abstract
BACKGROUND: Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture.
METHODS: Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded.
RESULTS: During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures.
CONCLUSION: The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

PMID: 29270682 [PubMed - as supplied by publisher]



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Hypercoagulability and Severe Obstructive Sleep Apnea.

Related Articles

Hypercoagulability and Severe Obstructive Sleep Apnea.

JAMA Otolaryngol Head Neck Surg. 2017 Dec 28;:

Authors: Ghadami MR

PMID: 29270623 [PubMed - as supplied by publisher]



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Novel Therapies for Acute Kidney Injury.

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Novel Therapies for Acute Kidney Injury.

Kidney Int Rep. 2017 Sep;2(5):785-799

Authors: Chen H, Busse LW

Abstract
Acute kidney injury (AKI) is a common disease with a complex pathophysiology. The old paradigm of identifying renal injury based on location-prerenal, intrarenal, and postrenal-is now being supplanted with a new paradigm based on observable kidney injury patterns. The pathophysiology of AKI on a molecular and microanatomical level includes inflammation, immune dysregulation, oxidative injury, and impaired microcirculation. Treatment has traditionally been supportive, including the avoidance of nephrotoxins, judicious volume and blood pressure management, hemodynamic monitoring, and renal replacement therapy. Fluid overload and chloride-rich fluids are now implicated in the development of AKI, and resuscitation with a balanced, buffered solution at a conservative rate will mitigate risk. Novel therapies, which address specific observable kidney injury patterns include direct oxygen-free radical scavengers such as α-lipoic acid, curcumin, sodium-2-mercaptoethane sulphonate, propofol, and selenium. In addition, angiotensin II and adenosine receptor antagonists hope to ameliorate kidney injury via manipulation of renal hemodynamics and tubulo-glomerular feedback. Alkaline phosphatase, sphingosine 1 phosphate analogues, and dipeptidylpeptidase-4 inhibitors counteract kidney injury via manipulation of inflammatory pathways. Finally, genetic modifiers such as 5INP may mitigate AKI via transcriptive processes.

PMID: 29270486 [PubMed]



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IJERPH, Vol. 15, Pages 24: Concept of Aided Phytostabilization of Contaminated Soils in Postindustrial Areas

IJERPH, Vol. 15, Pages 24: Concept of Aided Phytostabilization of Contaminated Soils in Postindustrial Areas

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010024

Authors: Maja Radziemska Eugeniusz Koda Ayla Bilgin Mgdalena Vaverková

The experiment was carried out in order to evaluate the effects of trace element immobilizing soil amendments, i.e., chalcedonite, dolomite, halloysite, and diatomite on the chemical characteristics of soil contaminated with Cr and the uptake of metals by plants. The study utilized analysis of variance (ANOVA), principal component analysis (PCA) and Factor Analysis (FA). The content of trace elements in plants, pseudo-total and extracted by 0.01 M CaCl2, were determined using the method of spectrophotometry. All of the investigated element contents in the tested parts of Indian mustard (Brassica juncea L.) differed significantly in the case of applying amendments to the soil, as well as Cr contamination. The greatest average above-ground biomass was observed when halloysite and dolomite were amended to the soil. Halloysite caused significant increases of Cr concentrations in the roots. The obtained values of bioconcentration and translocation factors observed for halloysite treatment indicate the effectiveness of using Indian mustard in phytostabilization techniques. The addition of diatomite significantly increased soil pH. Halloysite and chalcedonite were shown to be the most effective and decreased the average Cr, Cu and Zn contents in soil.



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IJERPH, Vol. 15, Pages 20: Forecasting the Amount of Waste-Sewage Water Discharged into the Yangtze River Basin Based on the Optimal Fractional Order Grey Model

IJERPH, Vol. 15, Pages 20: Forecasting the Amount of Waste-Sewage Water Discharged into the Yangtze River Basin Based on the Optimal Fractional Order Grey Model

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010020

Authors: Shuliang LI Wei Meng Yufeng Xie

With the rapid development of the Yangtze River economic belt, the amount of waste-sewage water discharged into the Yangtze River basin increases sharply year by year, which has impeded the sustainable development of the Yangtze River basin. The water security along the Yangtze River basin is very important for China, It is something aboutwater security of roughly one-third of China’s population and the sustainable development of the 19 provinces, municipalities and autonomous regions among the Yangtze River basin. Therefore, a scientific prediction of the amount of waste-sewage water discharged into Yangtze River basin has a positive significance on sustainable development of industry belt along with Yangtze River basin. This paper builds the fractional DWSGM(1,1)(DWSGM(1,1) model is short for Discharge amount of Waste Sewage Grey Model for one order equation and one variable) model based on the fractional accumulating generation operator and fractional reducing operator, and calculates the optimal order of “r” by using particle swarm optimization(PSO)algorithm for solving the minimum average relative simulation error. Meanwhile, the simulation performance of DWSGM(1,1)model with the optimal fractional order is tested by comparing the simulation results of grey prediction models with different orders. Finally, the optimal fractional order DWSGM(1,1)grey model is applied to predict the amount of waste-sewage water discharged into the Yangtze River basin, and corresponding countermeasures and suggestions are put forward through analyzing and comparing the prediction results. This paper has positive significance on enriching the fractional order modeling method of the grey system.



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IJERPH, Vol. 15, Pages 25: Endocrine Disrupting Chemicals Mediated through Binding Androgen Receptor Are Associated with Diabetes Mellitus

IJERPH, Vol. 15, Pages 25: Endocrine Disrupting Chemicals Mediated through Binding Androgen Receptor Are Associated with Diabetes Mellitus

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010025

Authors: Sugunadevi Sakkiah Tony Wang Wen Zou Yuping Wang Bohu Pan Weida Tong Huixiao Hong

Endocrine disrupting chemicals (EDCs) can mimic natural hormone to interact with receptors in the endocrine system and thus disrupt the functions of the endocrine system, raising concerns on the public health. In addition to disruption of the endocrine system, some EDCs have been found associated with many diseases such as breast cancer, prostate cancer, infertility, asthma, stroke, Alzheimer’s disease, obesity, and diabetes mellitus. EDCs that binding androgen receptor have been reported associated with diabetes mellitus in in vitro, animal, and clinical studies. In this review, we summarize the structural basis and interactions between androgen receptor and EDCs as well as the associations of various types of diabetes mellitus with the EDCs mediated through androgen receptor binding. We also discuss the perspective research for further understanding the impact and mechanisms of EDCs on the risk of diabetes mellitus.



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IJERPH, Vol. 15, Pages 22: Exposure to Ambient Fine Particulate Air Pollution in Utero as a Risk Factor for Child Stunting in Bangladesh

IJERPH, Vol. 15, Pages 22: Exposure to Ambient Fine Particulate Air Pollution in Utero as a Risk Factor for Child Stunting in Bangladesh

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010022

Authors: Nihit Goyal David Canning

Pregnant mothers in Bangladesh are exposed to very high and worsening levels of ambient air pollution. Maternal exposure to fine particulate matter has been associated with low birth weight at much lower levels of exposure, leading us to suspect the potentially large effects of air pollution on stunting in children in Bangladesh. We estimate the relationship between exposure to air pollution in utero and child stunting by pooling outcome data from four waves of the nationally representative Bangladesh Demographic and Health Survey conducted between 2004 and 2014, and calculating children’s exposure to ambient fine particulate matter in utero using high resolution satellite data. We find significant increases in the relative risk of child stunting, wasting, and underweight with higher levels of in utero exposure to air pollution, after controlling for other factors that have been found to contribute to child anthropometric failure. We estimate the relative risk of stunting in the second, third, and fourth quartiles of exposure as 1.074 (95% confidence interval: 1.014–1.138), 1.150 (95% confidence interval: 1.069–1.237, and 1.132 (95% confidence interval: 1.031–1.243), respectively. Over half of all children in Bangladesh in our sample were exposed to an annual ambient fine particulate matter level in excess of 46 µg/m3; these children had a relative risk of stunting over 1.13 times that of children in the lowest quartile of exposure. Reducing air pollution in Bangladesh could significantly contribute to the Sustainable Development Goal of reducing child stunting.



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IJERPH, Vol. 15, Pages 23: Preparation and Optimisation of Cross-Linked Enzyme Aggregates Using Native Isolate White Rot Fungi Trametes versicolor and Fomes fomentarius for the Decolourisation of Synthetic Dyes

IJERPH, Vol. 15, Pages 23: Preparation and Optimisation of Cross-Linked Enzyme Aggregates Using Native Isolate White Rot Fungi Trametes versicolor and Fomes fomentarius for the Decolourisation of Synthetic Dyes

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010023

Authors: Martina Vršanská Stanislava Voběrková Ana Jiménez Jiménez Vladislav Strmiska Vojtěch Adam

The key to obtaining an optimum performance of an enzyme is often a question of devising a suitable enzyme and optimisation of conditions for its immobilization. In this study, laccases from the native isolates of white rot fungi Fomes fomentarius and/or Trametes versicolor, obtained from Czech forests, were used. From these, cross-linked enzyme aggregates (CLEA) were prepared and characterised when the experimental conditions were optimized. Based on the optimization steps, saturated ammonium sulphate solution (75 wt.%) was used as the precipitating agent, and different concentrations of glutaraldehyde as a cross-linking agent were investigated. CLEA aggregates formed under the optimal conditions showed higher catalytic efficiency and stabilities (thermal, pH, and storage, against denaturation) as well as high reusability compared to free laccase for both fungal strains. The best concentration of glutaraldehyde seemed to be 50 mM and higher efficiency of cross-linking was observed at a low temperature 4 °C. An insignificant increase in optimum pH for CLEA laccases with respect to free laccases for both fungi was observed. The results show that the optimum temperature for both free laccase and CLEA laccase was 35 °C for T. versicolor and 30 °C for F. fomentarius. The CLEAs retained 80% of their initial activity for Trametes and 74% for Fomes after 70 days of cultivation. Prepared cross-linked enzyme aggregates were also investigated for their decolourisation activity on malachite green, bromothymol blue, and methyl red dyes. Immobilised CLEA laccase from Trametes versicolor showed 95% decolourisation potential and CLEA from Fomes fomentarius demonstrated 90% decolourisation efficiency within 10 h for all dyes used. These results suggest that these CLEAs have promising potential in dye decolourisation.



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IJMS, Vol. 19, Pages 46: Inhibition of Aquaporin-4 Improves the Outcome of Ischaemic Stroke and Modulates Brain Paravascular Drainage Pathways

IJMS, Vol. 19, Pages 46: Inhibition of Aquaporin-4 Improves the Outcome of Ischaemic Stroke and Modulates Brain Paravascular Drainage Pathways

International Journal of Molecular Sciences doi: 10.3390/ijms19010046

Authors: Ionica Pirici Tudor Adrian Balsanu Catalin Bogdan Claudiu Margaritescu Tamir Divan Vacaras Vitalie Laurentiu Mogoanta Daniel Pirici Roxana Octavia Carare Dafin Fior Muresanu

Aquaporin-4 (AQP4) is the most abundant water channel in the brain, and its inhibition before inducing focal ischemia, using the AQP4 inhibitor TGN-020, has been showed to reduce oedema in imaging studies. Here, we aimed to evaluate, for the first time, the histopathological effects of a single dose of TGN-020 administered after the occlusion of the medial cerebral artery (MCAO). On a rat model of non-reperfusion ischemia, we have assessed vascular densities, albumin extravasation, gliosis, and apoptosis at 3 and 7 days after MCAO. TGN-020 significantly reduced oedema, glial scar, albumin effusion, and apoptosis, at both 3 and 7 days after MCAO. The area of GFAP-positive gliotic rim decreased, and 3D fractal analysis of astrocytic processes revealed a less complex architecture, possibly indicating water accumulating in the cytoplasm. Evaluation of the blood vessels revealed thicker basement membranes colocalizing with exudated albumin in the treated animals, suggesting that inhibition of AQP4 blocks fluid flow towards the parenchyma in the paravascular drainage pathways of the interstitial fluid. These findings suggest that a single dose of an AQP4 inhibitor can reduce brain oedema, even if administered after the onset of ischemia, and AQP4 agonists/antagonists might be effective modulators of the paravascular drainage flow.



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IJMS, Vol. 19, Pages 47: Characterizing Metastatic HER2-Positive Gastric Cancer at the CDH1 Haplotype

IJMS, Vol. 19, Pages 47: Characterizing Metastatic HER2-Positive Gastric Cancer at the CDH1 Haplotype

International Journal of Molecular Sciences doi: 10.3390/ijms19010047

Authors: Laura Caggiari Gianmaria Miolo Angela Buonadonna Debora Basile Davide A. Santeufemia Antonio Cossu Giuseppe Palmieri Mariangela De Zorzi Mara Fornasarig Lara Alessandrini Vincenzo Canzonieri Giovanni Lo Re Fabio Puglisi Agostino Steffan Renato Cannizzaro Valli De Re

The CDH1 gene, coding for the E-cadherin protein, is linked to gastric cancer (GC) susceptibility and tumor invasion. The human epidermal growth factor receptor 2 (HER2) is amplified and overexpressed in a portion of GC. HER2 is an established therapeutic target in metastatic GC (mGC). Trastuzumab, in combination with various chemotherapeutic agents, is a standard treatment for these tumors leading to outcome improvement. Unfortunately, the survival benefit is limited to a fraction of patients. The aim of this study was to improve knowledge of the HER2 and the E-cadherin alterations in the context of GC to characterize subtypes of patients that could better benefit from targeted therapy. An association between the P7-CDH1 haplotype, including two polymorphisms (rs16260A-rs1801552T) and a subset of HER2-positive mGC with better prognosis was observed. Results indicated the potential evaluation of CDH1 haplotypes in mGC to stratify patients that will benefit from trastuzumab-based treatments. Moreover, data may have implications to understanding the HER2 and the E-cadherin interactions in vivo and in response to treatments.



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IJMS, Vol. 19, Pages 45: Influence of Botanical Origin and Chemical Composition on the Protective Effect against Oxidative Damage and the Capacity to Reduce in Vitro Bacterial Biofilms of Monofloral Honeys from the Andean Region of Ecuador

IJMS, Vol. 19, Pages 45: Influence of Botanical Origin and Chemical Composition on the Protective Effect against Oxidative Damage and the Capacity to Reduce in Vitro Bacterial Biofilms of Monofloral Honeys from the Andean Region of Ecuador

International Journal of Molecular Sciences doi: 10.3390/ijms19010045

Authors: Marilyn García-Tenesaca Eillen S. Navarrete Gabriel A. Iturralde Irina M. Villacrés Granda Eduardo Tejera Pablo Beltrán-Ayala Francesca Giampieri Maurizio Battino José M. Alvarez-Suarez

Three types of monofloral honey from the Andean regions of Ecuador (Avocado; Eucalyptus; and, Rapeseed honey) were analyzed to determine their floral origin; physicochemical parameters; chemical composition; antioxidant capacity, and their capacity to reduce in vitro bacterial biofilms. The chemical composition varied considerably depending on floral origin. The highest values of bioactive compounds were found in Avocado honey, classified as dark amber in color, while the lowest values were found in Eucalyptus honey followed by Rapeseed honey, both classified as extra light amber. When compared to Eucalyptus and Rapeseed honey, Avocado honey showed a more effective superoxide scavenging activity, chelating metal ions capacity, and a higher ability to protect human erythrocyte membranes against lipid peroxidation. For antimicrobial activity, the hydrogen peroxide content and the capacity to inhibit the biofilm formation, and to remove preformed biofilm from Staphylococcus aureus and Klebsiella pneumoniae was determined. Avocado honey showed the highest values of hydrogen peroxide content, as well as the highest capacity to reduce in vitro bacterial biofilms. A correlation between color vs vs. phenolics content vs. superoxide scavenging activity vs. chelating metal ions capacity, and the capacity to protect human erythrocyte membranes against lipid peroxidation was found.



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IJMS, Vol. 19, Pages 42: The Origin of Skin Dendritic Cell Network and Its Role in Psoriasis

IJMS, Vol. 19, Pages 42: The Origin of Skin Dendritic Cell Network and Its Role in Psoriasis

International Journal of Molecular Sciences doi: 10.3390/ijms19010042

Authors: Tae-Gyun Kim Sung Kim Min-Geol Lee

Dendritic cells (DCs) are heterogeneous groups of innate immune cells, which orchestrate immune responses by presenting antigens to cognate T cells and stimulating other types of immune cells. Although the term ‘DCs’ generally represent highly mixed subsets with functional heterogeneity, the classical definition of DCs usually denotes conventional DCs (cDCs). Skin contains a unique DC network mainly composed of embryo precursor-derived epidermal Langerhans cells (LCs) and bone marrow-derived dermal cDCs, which can be further classified into type 1 (cDC1) and type 2 (cDC2) subsets. Psoriasis is a chronic inflammatory skin disease, which is principally mediated by IL-23/IL-17 cytokine axis. In the psoriatic skins, DCs are prominent cellular sources for TNF-α and IL-23, and the use of blocking antibodies against TNF-α and IL-23 leads to a significant clinical improvement in psoriatic patients. Recent elegant human and mouse studies have shown that inflammation-induced inflammatory DCs, LCs, dermal cDC2, and monocyte-derived DCs are pivotal DC subsets in psoriatic inflammation. Thus, targeting specific pathogenic DC subsets would be a potential strategy for alleviating and preventing DC-derived IL-23-dependent psoriatic inflammation and other inflammatory dermatoses in the future.



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quality of care; +1091 new citations

1091 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

quality of care

These pubmed results were generated on 2017/12/23

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.



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health technology; +220 new citations

220 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

health technology

These pubmed results were generated on 2017/12/23

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.



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Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program.

Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program.

J Oncol Pract. 2017 Dec 22;:JOP2017027029

Authors: Spinks T, Guzman A, Beadle BM, Lee S, Jones D, Walters R, Incalcaterra J, Hanna E, Hessel A, Weber R, Denney S, Newcomer L, Feeley TW

Abstract
PURPOSE: Despite growing interest in bundled payments to reduce the costs of care, this payment method remains largely untested in cancer. This 3-year pilot tested the feasibility of a 1-year bundled payment for the multidisciplinary treatment of head and neck cancers.
METHODS: Four prospective treatment-based bundles were developed for patients with selected head and neck cancers. These risk-adjusted bundles covered 1 year of care that began with primary cancer treatment. Manual processes were developed for patient identification, enrollment, billing, and payment. Patients were prospectively identified and enrolled, and bundled payments were made at treatment start. Operational metrics tracked incremental effort for pilot processes and average payment cycle time compared with fee-for-service (FFS) payments.
RESULTS: This pilot confirmed the feasibility of a 1-year prospective bundled payment for head and neck cancers. Between November 2014 and October 2016, 88 patients were enrolled successfully with prospective bundled payments. Through September 2017, 94% of patients completed the pilot with 6% still enrolled. Manual pilot processes required more effort than anticipated; claims processing was the most time-consuming activity. The production of a bundle bill took an additional 15 minutes versus FFS billing. The average payment cycle time was 37 days (range, 15 to 141 days) compared with a 15-day average under FFS.
CONCLUSION: Prospective bundled payments were successfully implemented in this pilot. Additional pilots should study this payment method in higher-volume cancers. Robust systems are needed to automate patient identification, enrollment, billing, and payment along with policies that reduce administrative burden and allow for the introduction of novel cancer therapies.

PMID: 29272202 [PubMed - as supplied by publisher]



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Androgen deprivation therapy for androgen receptor-positive advanced salivary duct carcinoma: A nationwide case series of 35 patients in The Netherlands.

Androgen deprivation therapy for androgen receptor-positive advanced salivary duct carcinoma: A nationwide case series of 35 patients in The Netherlands.

Head Neck. 2017 Dec 22;:

Authors: Boon E, van Boxtel W, Buter J, Baatenburg de Jong RJ, van Es RJJ, Bel M, Fiets E, Oosting SF, Slingerland M, Hoeben A, Tesselaar MET, Jonker MA, Flucke UE, Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) Group, van der Graaf WTA, van Herpen CML

Abstract
BACKGROUND: Salivary duct carcinoma, an aggressive subtype of salivary gland cancer, is mostly androgen receptor-positive. Only limited data are available on androgen deprivation therapy (ADT).
METHODS: Patients with advanced androgen receptor-positive salivary duct carcinoma treated with first-line ADT were retrospectively evaluated for clinical benefit (ie, partial response [PR] and stable disease, progression-free survival [PFS] and overall survival [OS]). The OS was compared with patients with advanced salivary duct carcinoma who received best supportive care.
RESULTS: Thirty-four of 35 patients who were ADT-treated were evaluable: 6 patients had a PR (18%) and 11 had stable disease (32%) leading to a clinical benefit ratio of 50%. The median PFS for the ADT-treated patients was 4 months and the median duration of clinical benefit was 11 months. The median OS was 17 months versus 5 months in 43 patients receiving best supportive care (P = .02).
CONCLUSION: We recommend ADT in advanced androgen receptor-positive salivary duct carcinoma given its response and clinical benefit. © 2017 Wiley Periodicals, Inc. Head Neck, 2017.

PMID: 29272069 [PubMed - as supplied by publisher]



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