Παρασκευή, 12 Ιανουαρίου 2018

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Cost and lack of insurance coverage are prohibitive to having dental implants after resections for benign mandibular neoplasms

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Table of Contents



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The T1 shine through effect on susceptibility weighted imaging: an under recognized phenomenon



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The T1 shine through effect on susceptibility weighted imaging: an under recognized phenomenon



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Gadolinium Retention, Brain T1 Hyperintensity, and Endogenous Metals: A Comparative Study of Macrocyclic Versus Linear Gadolinium Chelates in Renally Sensitized Rats

Objectives This preclinical study was designed to compare gadolinium (Gd) brain uptake after repeated injections of a macrocyclic Gd-based contrast agent (GBCA) (gadoterate meglumine) or 2 linear GBCAs (L-GBCAs) (gadobenate dimeglumine or gadodiamide) on a translational model of moderate renal impairment in rats. Methods The study was carried out in subtotally nephrectomized rats. Animals received 4 intravenous injections per week of GBCA (gadoterate meglumine, gadobenate dimeglumine, or gadodiamide) for 5 weeks, resulting in a cumulative dose of 12 mmol/kg, followed by a 1-month injection-free period. T1 hyperintensity in the deep cerebellar nuclei (DCNs) was investigated, and brain structures were carefully dissected to determine elemental Gd, iron (Fe), copper (Cu), and zinc (Zn) distribution by mass spectrometry. Urinary excretion of endogenous metals was also investigated soon after GBCA administration and several days later in order to assess a potential transmetalation phenomenon. Results Unlike gadoterate, repeated injections of L-GBCAs gadobenate and gadodiamide both induced T1 hyperintensity in the DCNs. Fine dissection of cerebral and cerebellar structures demonstrated very low levels or absence of Gd after repeated injections of gadoterate, in contrast to the two L-GBCAs, for which the highest total Gd concentration was demonstrated in the DCNs (Gd concentration in DCNs after 4.5 weeks of injection-free period: 27.1 ± 6.5 nmol/g for gadodiamide [P

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Comparison of Iodine Density Measurement Among Dual-Energy Computed Tomography Scanners From 3 Vendors

Objectives The aims of this study were to analyze the effect of dual-energy computed tomography (DECT) scanners and fluid characteristics on iodine quantification and to calculate the measurement variability range induced by those variables. Methods We performed an experimental phantom study with 4 mediastinal iodine phantoms. Each phantom contained 6 tubes of different iodine concentrations (0, 1.0, 2.5, 5.0, 10.0, and 20.0 mg/mL) diluted in a specific solvent, which was water, 10% amino acid solution, 20% lipid emulsion, or 18% calcium solution, respectively. Mediastinal phantoms were inserted into an anthropomorphic chest phantom and were scanned with 3 different DECT scanners from 3 vendors using 2 radiation dosage settings. Iodine density (IoD) and computed tomography (CT) attenuation at virtual monoenergetic 70-keV images and virtual nonenhanced images were measured for the iodine phantoms. The effects of DECT scanners, solvents, and radiation dosage on the absolute measurement error of IoD and on the CT attenuation profiles were investigated using linear mixed-effects models. Measurement variability range of IoD was also determined. Results Absolute error of IoD was not significantly affected by the DECT systems, kind of solvents, and radiation dosage settings. However, CT attenuation profiles were significantly different among the DECT vendors and simulated body fluids. Measurement variability range of IoD was from −0.6 to 0.4 mg/mL for the true iodine concentration 0 mg/mL. Conclusions Dual-energy CT systems and fluid characteristics did not have a significant effect on the IoD measurement accuracy. A cutoff of IoD for the determination of a truly enhancing lesion on DECT would be 0.4 mg/mL. Received for publication September 27, 2017; and accepted for publication, after revision, November 23, 2017. Conflicts of interest and sources of funding: none declared. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2kq7jVD). Correspondence to: Jin Mo Goo, MD, PhD, Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 110-744, Korea. E-mail: jmgoo@plaza.snu.ac.kr. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Gadolinium Retention, Brain T1 Hyperintensity, and Endogenous Metals: A Comparative Study of Macrocyclic Versus Linear Gadolinium Chelates in Renally Sensitized Rats

Objectives This preclinical study was designed to compare gadolinium (Gd) brain uptake after repeated injections of a macrocyclic Gd-based contrast agent (GBCA) (gadoterate meglumine) or 2 linear GBCAs (L-GBCAs) (gadobenate dimeglumine or gadodiamide) on a translational model of moderate renal impairment in rats. Methods The study was carried out in subtotally nephrectomized rats. Animals received 4 intravenous injections per week of GBCA (gadoterate meglumine, gadobenate dimeglumine, or gadodiamide) for 5 weeks, resulting in a cumulative dose of 12 mmol/kg, followed by a 1-month injection-free period. T1 hyperintensity in the deep cerebellar nuclei (DCNs) was investigated, and brain structures were carefully dissected to determine elemental Gd, iron (Fe), copper (Cu), and zinc (Zn) distribution by mass spectrometry. Urinary excretion of endogenous metals was also investigated soon after GBCA administration and several days later in order to assess a potential transmetalation phenomenon. Results Unlike gadoterate, repeated injections of L-GBCAs gadobenate and gadodiamide both induced T1 hyperintensity in the DCNs. Fine dissection of cerebral and cerebellar structures demonstrated very low levels or absence of Gd after repeated injections of gadoterate, in contrast to the two L-GBCAs, for which the highest total Gd concentration was demonstrated in the DCNs (Gd concentration in DCNs after 4.5 weeks of injection-free period: 27.1 ± 6.5 nmol/g for gadodiamide [P

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Comparison of Iodine Density Measurement Among Dual-Energy Computed Tomography Scanners From 3 Vendors

Objectives The aims of this study were to analyze the effect of dual-energy computed tomography (DECT) scanners and fluid characteristics on iodine quantification and to calculate the measurement variability range induced by those variables. Methods We performed an experimental phantom study with 4 mediastinal iodine phantoms. Each phantom contained 6 tubes of different iodine concentrations (0, 1.0, 2.5, 5.0, 10.0, and 20.0 mg/mL) diluted in a specific solvent, which was water, 10% amino acid solution, 20% lipid emulsion, or 18% calcium solution, respectively. Mediastinal phantoms were inserted into an anthropomorphic chest phantom and were scanned with 3 different DECT scanners from 3 vendors using 2 radiation dosage settings. Iodine density (IoD) and computed tomography (CT) attenuation at virtual monoenergetic 70-keV images and virtual nonenhanced images were measured for the iodine phantoms. The effects of DECT scanners, solvents, and radiation dosage on the absolute measurement error of IoD and on the CT attenuation profiles were investigated using linear mixed-effects models. Measurement variability range of IoD was also determined. Results Absolute error of IoD was not significantly affected by the DECT systems, kind of solvents, and radiation dosage settings. However, CT attenuation profiles were significantly different among the DECT vendors and simulated body fluids. Measurement variability range of IoD was from −0.6 to 0.4 mg/mL for the true iodine concentration 0 mg/mL. Conclusions Dual-energy CT systems and fluid characteristics did not have a significant effect on the IoD measurement accuracy. A cutoff of IoD for the determination of a truly enhancing lesion on DECT would be 0.4 mg/mL. Received for publication September 27, 2017; and accepted for publication, after revision, November 23, 2017. Conflicts of interest and sources of funding: none declared. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2kq7jVD). Correspondence to: Jin Mo Goo, MD, PhD, Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 110-744, Korea. E-mail: jmgoo@plaza.snu.ac.kr. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Treatment of Bone Metastasis with Bone-Targeting Radiopharmaceuticals

Abstract

Bone is a common metastatic site of cancer. Bone metastasis reduces life expectancy and results in serious symptoms and complications such as bone pain, pathological fractures, and spinal cord compression, decreasing quality of life by restricting sleep and mobility. Treatment for bone metastasis includes drugs (pure analgesics, hormones, cytotoxic chemotherapy, and bisphosphonates, among others), external radiation therapy, surgery, and radionuclide therapy using bone-targeting radiopharmaceuticals. Particulate radiation with α- or β-rays is used as a bone-targeting radiopharmaceutical in radionuclide therapy. β-Emitters have lower energy and a longer range than α-emitters and have less tumoricidal activity and deliver more radiation to adjacent normal tissue. Therefore, the main therapeutic effect of bone-targeting β-emitters such as 89Sr-dichloride is bone pain palliation rather than enhanced survival. In contrast, α-emitters such as 223Ra-dichloride have high energy and a short range, resulting in greater tumoricidal activity and less radiation damage to adjacent normal tissue. Treatment with bone-targeting α-emitters can improve survival and decrease bone pain. This review focuses on the principles and clinical utility of several clinically available bone-targeting radiopharmaceuticals in metastatic bone disease.



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Magnetresonanz-Zisternographie

Zusammenfassung

Klinisches/methodisches Problem

Bei bestimmten Fragestellungen, die Pathologien des Liquorraums betreffen, kann die konventionelle MRT-Bildgebung an ihre Grenzen stoßen.

Radiologische Standardverfahren

Dünnschichtige 3‑D-T2-Sequenzen und die Phasenkontrastbildgebung können die Liquorräume und den Liquorfluss mit hoher Auflösung darstellen, sind aber zum Teil anfällig für Artefakte.

Methodische Innovationen/Leistungsfähigkeit

Die Magnetresonanz(MR)-Zisternographie erlaubt die genaue Darstellung des Liquorraums und stellt Verbindungen einzelner Kompartimente direkt dar.



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New biomarkers for colorectal cancer

Researchers from the University of Luxembourg found a new biomarker for colorectal cancer (CRC) that might improve therapy and survival rates of patients. Biomarkers are measurable biological indicators for a specific disease, such as changes in the...

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Tense and plural formation in Welsh–English bilingual children with and without language impairment

Abstract

Background

Grammatical morphology has been shown to be problematic for children with specific language impairment (SLI) or developmental language disorder (DLD). Most research on this topic comes from widely spoken languages, such as English. Despite Welsh being the most extensively spoken indigenous in the UK after English, and Wales being the only official bilingual country in the UK, our knowledge about the morphosyntactic areas of Welsh that may pose problems for Welsh-speaking children with SLI is limited. Currently, Welsh-speaking speech and language therapists (SLTs) are heavily reliant on the use of informally translated English assessments. This can inadvertently result in a failure to take aspects of Welsh morphosyntax into account that are critical for the assessment and treatment of Welsh-speaking children.

Aims

This is the first study to examine how Welsh–English bilingual children of early school age with typical development (bi-TD) and with SLI (bi-SLI) perform on production tasks targeting verbal and nominal morphology in Welsh. We targeted areas of Welsh morphosyntax that could potentially be vulnerable for Welsh-speaking children with or at risk of language impairment, such as tense marking and plural formation, and assessed their diagnostic potential.

Methods & Procedures

Twenty-eight Welsh-dominant bilingual children participated in the study: 10 bi-SLI and 18 bi-TD. They were administered three elicitation tasks targeting the production of verbal (compound and synthetic past tense) and nominal (plural) morphology in Welsh.

Outcomes & Results

The bi-SLI children performed worse than their bi-TD peers across all three tasks. They produced more uninflected verbs in the elicited-production task and were less likely to be prompted to produce the synthetic past, which is a concatenating, low-frequency form of the past tense. They also over-regularized less in the context of plural nouns, and when they did, they opted for high-frequency suffixes.

Conclusions & Implications

By focusing on aspects of morphosyntactic development which are unique to Welsh, we have increased existing about how verbal and nominal morphology are acquired in Welsh-speaking bi-SLI and bi-TD children. The present results point towards productivity problems for Welsh-speaking bi-SLI children who are adversely influenced by low-frequency structures and fail to over-regularize in the context of verbal and nominal concatenating morphology. From a clinical perspective, targeting synthetic past-tense forms through a prompting task may be a promising assessment and intervention tool that future studies could explore further.



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What is needed to prepare speech pathologists to work in adult palliative care?

Abstract

Background

Speech pathologists have a pivotal role in palliative care, assisting patients with swallowing and communication disorders, yet very little is known about the preparedness of speech pathologists to work in this field.

Aims

To investigate the preparedness of speech pathologists for working in palliative care. The term ‘palliative care’ was viewed as an encompassing umbrella term incorporating the management/reduction of symptoms and improvement in a person's quality of life at any point of the disease progression.

Methods & Procedures

Participants were Australian-trained speech pathologists who provided adult palliative care services. An online questionnaire was used to gather both quantitative and qualitative data from practising speech pathologists. Qualitative data were analysed and interpreted using conventional content analysis. Descriptive statistics were analysed via the Statistical Package for the Social Sciences (SPSS) for Windows Version 22. Non-parametric tests (chi-square and Mann–Whitney U-test) were used for further analysis.

Outcomes & Results

The majority (70%) of participants indicated that their university training did not prepare them to practice in palliative care. Participants who received palliative care education at the tertiary level were significantly more prepared to work with palliative patients than those who had not; however, only a minority (27%) had received such training. Just over half (57%) reported having completed post-university professional development in palliative care. The speech pathologist's role in palliative care was also highlighted, with speech pathologists outlining their contribution to the assessment of patients’ communication and swallowing abilities. In addition, recommendations for palliative care content to be incorporated into university curriculum were suggested.

Conclusions & Implications

Speech pathologists can make important contributions to end-of-life care, but there is much scope for improving the availability and quality of university and post-university palliative care training opportunities so that people receiving palliative care are best supported.



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Speech characteristics in the congenital and childhood-onset forms of myotonic dystrophy type 1

Abstract

Background

Myotonic dystrophy type 1 (DM1) is a slowly progressive multi-systemic disease with an autosomal-dominant inheritance caused by a mutation on chromosome 19 (19q13.3).

Aims

To explore speech characteristics in a group of individuals with the congenital and childhood-onset forms of DM1 in terms of intelligibility, speech-sound production, nasality and compensatory articulation. A further aim was to analyse whether speech characteristics were correlated to subforms of DM1 and if speech outcome could be related to muscle strength.

Methods & Procedures

Fifty native Swedish speakers (7–29 years old) with the congenital and childhood-onset forms of DM1 and 13 healthy controls participated in the study. The intelligibility of spontaneous speech, speech-sound production — single-word and sentence repetition — including percentage consonants correct (PCC) and compensatory articulation, were evaluated by speech–language pathologists from video recordings. A nasometer and lip-force meter were used for objective evaluations of nasality and orofacial strength.

Outcomes & Results

In severe (n = 9) and mild congenital DM1 (n = 13), all participants had impaired intelligibility to some degree, while this applied to 79% of those with childhood DM1 (n = 28). PCC for bilabials were 53.9% in severe congenital DM1, 57.4% in mild congenital DM1 and 85.3% in childhood DM1; the corresponding results for dentals were 69.3%, 59.2% and 87.3%. Bilabials were most often compensated for with interdental or labiodental articulation. Dentals were substituted with interdental articulation. Velars were seldom affected. The mean nasalance score was high in the study group compared with controls and with normative data and the majority had weak lips. Maximum lip force, as well as the mean nasalance score, correlated significantly with the intelligibility score.

Conclusions & Implications

The deviant production of bilabial consonants, interdental articulation and hypernasal speech are characteristic features of dysarthria in congenital and childhood DM1. Dysarthria is more frequent and more severe in congenital DM1 compared with childhood DM1. Most individuals with congenital DM1 and childhood-onset DM1 will need speech therapy from a young age. For some children with incomprehensible speech or severe neurodevelopmental disorders, alternative and augmentative ways of communication will be part of the treatment.



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A randomised trial comparing the pharmacokinetics and safety of the biosimilar CT-P6 with reference trastuzumab

Abstract

Purpose

Access to trastuzumab, a valuable anti-cancer treatment, can be limited by cost. The primary aim of this study was to evaluate and compare the PK profiles of CT-P6, a biosimilar of trastuzumab, and US-licensed reference trastuzumab (Herceptin®) in healthy subjects. Secondary study aims included comparison of the safety and immunogenicity of CT-P6 and reference trastuzumab in these subjects.

Methods

We performed a single-dose, randomised, double-blind, parallel group study (NCT02665637) comparing CT-P6 with reference trastuzumab (6 mg/kg, 90 min intravenous infusion) in 70 healthy adult males. Pharmacokinetics, safety and immunogenicity were evaluated up to 10 weeks post-dose. Primary endpoints were area under the serum concentration–time curve (AUC) from time 0 to infinity (AUCinf); AUC from time 0 to last quantifiable concentration (AUClast); and observed maximum serum concentration (Cmax). The pre-determined equivalence criterion was a 90% confidence interval of 80–125% for ratios of geometric least squares (LS) means.

Results

Equivalence of CT-P6 and reference trastuzumab was demonstrated. Ratios (CT-P6/reference trastuzumab) of geometric LS means (90% confidence interval) were: AUCinf 99.05 (93.00, 105.51); AUClast 99.30 (92.85, 106.20); Cmax 96.58 (90.93, 102.59). Safety profiles were similar; treatment-emergent adverse events occurred in ten subjects (28.6%) in the CT-P6 group and 11 (31.4%) in the reference trastuzumab group. No serious adverse events or deaths occurred. No subjects tested positive for anti-drug antibodies.

Conclusions

These data add to the totality of evidence required to demonstrate biosimilarity. A phase III study of CT-P6—in which equivalent neoadjuvant efficacy to reference trastuzumab has been demonstrated—is ongoing.



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Comparing measures of species diversity from incomplete inventories: an update

1. Measuring biodiversity quantitatively is a key component to its investigation, but many methods are known to be biased by undersampling (i.e. incomplete inventories), a common situation in ecological field studies. 2. Following a long tradition of comparing measures of alpha diversity to judge their usefulness, we used simulated data to assess bias of nine diversity measures – some of them proposed fairly recently, such as estimating true species richness depending on the completeness of inventories (Brose, U. & Martinez, N.D. Oikos (2004) 105, 292), bias-corrected Shannon diversity (Chao, A. & Shen, T.-J. Environmental and Ecological Statistics (2003) 10, 429), while others are commonly applied (e.g. Shannon’s entropy, Fisher’s a) or long known but rarely used (estimating Shannon’s entropy fromFisher’s a). 3. We conclude that the ‘effective number of species’ based on bias-corrected Shannon’s entropy is an unbiased estimator of diversity at sample completeness c. >0Æ5, while below that it is still less biased than, e.g., estimated species richness (Brose, U. & Martinez, N.D. Oikos (2004) 105, 292). 4. Fisher’s a cannot be tested with the same rigour because it cannot measure the diversity of completely inventoried communities, and we present simulations illustrating this effect when sample completeness approaches high values. However, we can show that Fisher’s a produces relatively stable values at low sample completeness (an effect previously shown only in empirical data), and we tentatively conclude that it may still be considered a good (possibly superior) measure of diversity if completeness is very low.

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Rhetorics of Authority: Leviticus and the Analects Compared



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A randomised trial comparing the pharmacokinetics and safety of the biosimilar CT-P6 with reference trastuzumab

Abstract

Purpose

Access to trastuzumab, a valuable anti-cancer treatment, can be limited by cost. The primary aim of this study was to evaluate and compare the PK profiles of CT-P6, a biosimilar of trastuzumab, and US-licensed reference trastuzumab (Herceptin®) in healthy subjects. Secondary study aims included comparison of the safety and immunogenicity of CT-P6 and reference trastuzumab in these subjects.

Methods

We performed a single-dose, randomised, double-blind, parallel group study (NCT02665637) comparing CT-P6 with reference trastuzumab (6 mg/kg, 90 min intravenous infusion) in 70 healthy adult males. Pharmacokinetics, safety and immunogenicity were evaluated up to 10 weeks post-dose. Primary endpoints were area under the serum concentration–time curve (AUC) from time 0 to infinity (AUCinf); AUC from time 0 to last quantifiable concentration (AUClast); and observed maximum serum concentration (Cmax). The pre-determined equivalence criterion was a 90% confidence interval of 80–125% for ratios of geometric least squares (LS) means.

Results

Equivalence of CT-P6 and reference trastuzumab was demonstrated. Ratios (CT-P6/reference trastuzumab) of geometric LS means (90% confidence interval) were: AUCinf 99.05 (93.00, 105.51); AUClast 99.30 (92.85, 106.20); Cmax 96.58 (90.93, 102.59). Safety profiles were similar; treatment-emergent adverse events occurred in ten subjects (28.6%) in the CT-P6 group and 11 (31.4%) in the reference trastuzumab group. No serious adverse events or deaths occurred. No subjects tested positive for anti-drug antibodies.

Conclusions

These data add to the totality of evidence required to demonstrate biosimilarity. A phase III study of CT-P6—in which equivalent neoadjuvant efficacy to reference trastuzumab has been demonstrated—is ongoing.



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Age is not a risk factor for complications after surgery in older patients, review finds

Age is not a prognostic risk factor for complications after elective surgery in older patients, whereas frailty, cognitive impairment, and smoking are, a review has found.1“Older adults are a diverse...
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Quantification and varietal variation of low molecular weight glutenin subunits (LMW-GS) using size exclusion chromatography

Abstract

Crude glutenin of four commercial wheat varieties viz. C 306, HI 977, HW 2004 and PBW 550 of diverse origin and breadmaking quality were fractionated by size-exclusion chromatography into three fractions of decreasing molecular weights. The relative quantity of peak II, containing LMW-GS specifically, varied considerably among the varieties as reflected from their discrete SEC profiles. The area % of peak II, containing protein of interest, was maximal for C 306 (22.08%) followed by PBW 550 (15.86%). The least proportion of LMW-GS were recovered from variety HW 2004 (9.68%). As the concentration of the sample extract injected to the column increased, the resolution of the peak declined in association with the slight shifting of retention time to the higher values. The best results were obtained for variety C 306 at 100 mg protein concentration with 3 M urea buffer. Consequently, the optimized conditions for purification of LMW-GS in appreciable amounts using SEC were established.



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Non-destructive and rapid evaluation of aflatoxins in brown rice by using near-infrared and mid-infrared spectroscopic techniques

Abstract

The applicability of near-infrared (NIR) and mid-infrared (MIR) spectroscopy combined with chemometrics was explored in this study to develop rapid, low-cost and non-destructive spectroscopic methods for classification and quantification of aflatoxins in brown rice. A total of 132 brown rice samples within the aflatoxin concentration range of 0–2435.8 μg/kg were prepared by artificially inoculated with A. flavus and A. parasiticus strains of fungus. For the classification of samples at varying levels of aflatoxin B1, the linear discriminant analysis model obtained correct classification rate of 96.9 and 90.6% for NIR and MIR spectroscopy, respectively. For the simultaneous determination of aflatoxins B1, B2, G1, G2 and the total aflatoxins, partial least squares regression also showed good predictive accuracy for both NIR (rv  = 0.936–0.973, RPD = 2.5–4.0) and MIR spectroscopy (rv  = 0.922–0.970, RPD = 2.5–4.0). The overall results indicated that the two spectroscopic techniques offered the feasibility to be used as alternative tools for rapid detection of various aflatoxin contaminations in grain.



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The Boston Naming Test as a Measure of Performance Validity

Abstract

This study was designed to evaluate the potential of the Boston Naming Test (BNT) as a performance validity test (PVT). The classification accuracy of the BNT was examined against several criterion PVTs in a mixed clinical sample of 214 adult outpatients physician referred for neuropsychological assessment. Mean age was 46.7 (SD = 12.5); mean education was 13.5 (SD = 2.5). All participants were native speakers of English. A BNT raw score ≤ 50 produced high specificity (.87–.95), but low and variable sensitivity (.15–.41). Similarly, a T score ≤ 37 was specific (.87–.95), but not very sensitive (.15–.35) to psychometrically defined non-credible responding. Ipsative analyses (i.e., case-by-case review of individual PVT profiles) suggest that failing these cutoffs was associated with zero false positives when all available PVTs were taken into account. Results are consistent with previous reports that the validity cutoffs on the BNT have high positive predictive power, but low negative predictive power. As such, they are useful in ruling in invalid performance, but they cannot be used to rule it out.



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Confucianizing Socrates and Socratizing Confucius: On Comparing Analects 13:18 and the Euthyphro

An apparently quite specific question that was addressed by both Confucius and Socrates has attracted much attention in Sino-Hellenistic comparative philosophy. Their respective responses to the question of how a son should respond if his father commits a crime are found in Confucius' Analects 13:18 and in Plato's Euthyphro. This essay assesses three comparative analyses of these responses with particular reference to their underlying assertions of commonality, that is, the assumptions or presuppositions of commonality that serve to justify the comparative exercise in the first instance. The authors suggest that two of the analyses assert commonality between their two responses from a Confucian standpoint, while the third constructs commonality from a Socratic standpoint. The authors argue that the response of Confucius focuses specifically on the issue of xiao (filial piety) in the concrete situation presented to him, whereas Socrates uses the issue to investigate the different question known as the "Euthyphro dilemma." Some brief conclusions are drawn regarding comparative philosophical analysis in general and about comparing the responses of Confucius and Socrates in these passages in particular.

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Attitudes toward younger and older adults: The German Aging Semantic Differential

The present study used the German Aging Semantic Differential (ASD) to assess attitudes toward younger and older adults in a heterogeneous sample of n = 151 younger and n = 143 older adults. The questionnaire was administered in two versions, one referring to the evaluation of younger adults, the other to the evaluation of older adults. Multiple-group confirmatory factor analysis replicated the four-factor solution reported in the literature. Younger compared to older adults were rated as higher in terms of instrumentality (i.e., more active, adaptive to change) and integrity (i.e., more personally satisfied, at peace with oneself), whereas older adults were described as more autonomous and self-sufficient than younger adults. Younger participants reported more negative attitudes toward younger and older adults in some of the factors than did older participants. Structural equation modeling furthermore showed that attitudes correlated with personality characteristics and positive and negative affect, in that more agreeable, extraverted, and positively tempered participants reported less negative attitudes toward younger and older adults. Results are discussed in the context of multidimensional assessment of age stereotypes.

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Classification of solutions to the higher order Liouville’s equation on {\mathbb{R}^{2m}}

We classify the solutions to the equation (−Δ) m u = (2m − 1)!e 2mu on {\mathbb{R}^{2m}} giving rise to a metric {g=e^{2u}g_{\mathbb{R}^{2m}}} with finite total Q-curvature in terms of analytic and geometric properties. The analytic conditions involve the growth rate of u and the asymptotic behaviour of Δu at infinity. As a consequence we give a geometric characterization in terms of the scalar curvature of the metric {e^{2u}g_{\mathbb{R}^{2m}}} at infinity, and we observe that the pull-back of this metric to S 2m via the stereographic projection can be extended to a smooth Riemannian metric if and only if it is round.

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The structure of common mental disorders: A replication study in a community sample of adolescents and young adults

Previous research suggests that patterns of comorbidity of common mental disorders among adults are best reflected by a hierarchical three-factor structure with two correlated factors ('anxious-misery' and 'fear') summarized in a second-order 'internalizing' factor and one 'externalizing' factor. This three-factor structure has not been examined yet in a sample of adolescents and young adults.A representative sample of 3021 adolescents and young adults (baseline age 14-24) were prospectively followed over 10 years. Mental disorders were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by using the standardized Munich Composite International Diagnostic Interview. Ten mental disorders (major depressive episode, dysthymia, generalized anxiety disorder, social phobia, specific phobia, agoraphobia, panic disorder, alcohol dependence, drug dependence, antisocial personality) were fitted to a series of Confirmatory Factor Analysis models using: (1) 12-month data, and (2) lifetime data from a person-year data set.The three-factor model showed good fit to the observed data in our sample both when 12-month diagnoses and lifetime-to-date diagnoses from a person-year data file were used; yet the higher-order 'internalizing' factor summarizing 'anxious misery' and 'fear' had to be omitted.The three-factor model could be replicated in a sample of adolescents and young adults with the exception that the second-order 'internalizing' factor was not consistent with the data. Further research is necessary to provide more complete insight into the structure of mental disorders by examining the stability of the structure of mental disorders in different developmental stages (ages) and by using a more extensive set of mental disorders.

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Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder

BACKGROUND: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). METHODS: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. RESULTS: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. CONCLUSION: This is the first study to show that a stand-alone exposure in sensu technique--WE--is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD.

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Comparing Japanese international college students’ and U.S. college students’ mental health related stigmatizing attitudes

This study examined differences between Japanese international college students and U.S. college students on stigma toward people with psychological disorders, stigma tolerance in help seeking, and self-concealment. Japanese international students had greater stigma toward individuals with psychological disorders than did their U.S. counterparts. No interrelationships between these variables, however, were found in the Japanese international student group. Este estudio examinó las diferencias entre estudiantes universitarios internacionales japoneses y estudiantes universitarios estadounidenses en lo concerniente al estigma hacia las personas con trastornos psicológicos, la tolerancia del estigma al buscar ayuda y la auto-ocultación. Los estudiantes internacionales japoneses mostraron un mayor estigma hacia los individuos con trastornos psicológicos que sus homólogos estadounidenses. Sin embargo, no se encontró ninguna interrelación entre estas variables en el grupo de estudiantes internacionales japoneses.

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The position of anxiety disorders in structural models of mental disorders

It has been suggested that the relationship between mental disorders can be summarized by a 3-factor model consisting of "anxious-misery," "fear," and "externalizing." This article examines the assumptions and predictions of this model, with particular emphasis on the anxiety disorders. Results indicate that the 3-factor model is not robust when additional diagnoses are included or when developmental factors are considered. Further, the assumption of a higher-order internalizing factor could not be consistently confirmed. Other factor solutions might fit the data equally as well. Further, the anxiety disorders did not load onto predicted factors as postulated in the 3-factor model. The authors results and considerations strongly suggest that caution is needed with this factor analytic approach in general and its use with classificatory issues. Extant results are not stable enough to form the basis of clinical diagnostic classification systems such as DSM and the International Classification of Diseases.

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Commercial influence in control of non-communicable diseases

Non-communicable diseases (NCDs) are a threat to health and development globally, accounting for 72% of all deaths in 2016.1 The UN sustainable development goals (SDGs) include a target to reduce...
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Fernando “Ferdie” Pacheco

bmj;360/jan12_2/k117/FAF1faFerdie Pacheco and Muhammad Ali. Credit: Luisita Sevilla PachecoIn 2002 Ferdie Pacheco met up with an old friend, the legendary boxer Muhammad Ali. Pacheco spent 15...
recent?d=yIl2AUoC8zA recent?d=dnMXMwOfBR0 recent?i=u_Vk85ZmYn0:ZTifoPqSPe8:V_sGLiP recent?d=qj6IDK7rITs recent?i=u_Vk85ZmYn0:ZTifoPqSPe8:gIN9vFw recent?d=l6gmwiTKsz0 recent?d=7Q72WNTAKBA recent?i=u_Vk85ZmYn0:ZTifoPqSPe8:F7zBnMy recent?i=u_Vk85ZmYn0:ZTifoPqSPe8:-BTjWOF


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The Role of Preoperative Steroids for Hearing Preservation Cochlear Implantation: Results of a Randomized Controlled Trial

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Objectives: To determine whether preoperative steroids can improve hearing outcomes in cochlear implantation (CI). Methods: This is a randomized controlled trial involving 30 postlingual deaf CI patients. Subjects had preoperative thresholds of better than or equal to 80 dB at 125 and 250 Hz, and better than or equal to 90 dB at 500 and 1,000 Hz. The subjects were randomized to a control group, an oral steroid group (receiving 1 mg/kg/day of prednisolone for 6 days prior to surgery), or a transtympanic steroid group (receiving a single dose of 0.5 mL of 10 mg/mL dexamethasone at 24 h prior to surgery). Results: The subjects receiving transtympanic steroids had a significant decrease in the pure tone average over 3 months compared to the control and oral steroid group, which persisted over 12 months (p Conclusion: A single dose of preoperative transtympanic steroids prior to CI appears to have a beneficial effect, at least in the short term, with minimal effects seen in the longer term.
Audiol Neurotol 2017;22:292-302

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Ultrasound-mediated cavitation does not decrease the activity of small molecule, antibody or viral-based medicines

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Micelle-templated, poly(lactic-co-glycolic acid) nanoparticles for hydrophobic drug delivery

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Selection against BALB/c strain cells in mouse chimaeras [RESEARCH ARTICLE]

Pin-Chi Tang, Gillian E. MacKay, Jean H. Flockhart, Margaret A. Keighren, Anna Kopakaki, and John D. West

It has been shown previously that BALB/c strain embryos tend to contribute poorly to mouse aggregation chimaeras. In the present study we showed that BALB/c cells were not preferentially allocated to any extraembryonic lineages of mouse aggregation chimaeras, but their contribution decreased during the early postimplantation period and they were significantly depleted by E8.5. The development of BALB/c strain preimplantation embryos lagged behind embryos from some other strains and the contribution that BALB/c and other embryos made to chimaeras correlated with their developmental stage at E2.5. This relationship suggests that the poor contribution of BALB/c embryos to aggregation chimaeras is at least partly a consequence of generalised selection related to slow or delayed preimplantation development. The suitability of BALB/c embryos for maximising the ES cell contribution to mouse ES cell chimaeras is also discussed.



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Begutachtung der Fahreignung aus schlafmedizinischer Sicht

Zusammenfassung

In den deutschen Begutachtungsleitlinien zur Kraftfahreignung von 2016 wird die Begutachtung bei Tagesschläfrigkeit und beim obstruktiven Schlafapnoe-Syndrom (OSAS) geregelt. Bei messbarer auffälliger Tagesschläfrigkeit ist die Fahreignung eingeschränkt; unbehandelte oder therapieresistente Tagesschläfrigkeit mit hohem Ausprägungsgrad schließt die Fahreignung grundsätzlich aus. Bei der Abklärung sollte eine schlafmedizinische bzw. somnologische Qualifikation vorhanden sein. Neben subjektiven Verfahren wie Fragebögen sollten mehrdimensionale objektive Verfahren eingesetzt werden, insbesondere leistungsbezogene Messmethoden. Gemäß den Leitlinien erfolgt die Begutachtung der Fahreignung bei messbarer auffälliger Tagesschläfrigkeit über ein gestuftes Vorgehen. Bei Kraftfahrern mit erhöhten Anforderungen (Fahrerlaubnisgruppe 2) werden strengere Kriterien angelegt. Durch eine geeignete Behandlung kann bei vielen Fahrern mit Tagesschläfrigkeit zumindest eine bedingte Fahreignung unter bestimmten Auflagen erreicht werden.



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Mechanism of Action in CBT (MAC): Methods of a multi-center randomized controlled trial in 369 patients with Panic Disorder and Agoraphobia

Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.

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Article de restitution de l’atelier européen de doctorants n° 1 intitulé « Les méthodes dans la construction de l’Espace européen de liberté, de sécurité et de justice



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Exploring the dynamics of the yeast proteome by means of 2-DE

In this study we combined pulse chase experiments and 2-DE in order to investigate how newly synthesized proteins are processed or modified to yield a functional yeast proteome. This approach allowed us to follow the fate of 560 native yeast proteins from the time they were synthesized up to several hours later. Among these, 81 were observed to vary during the chase, either increasing or decreasing. In addition, 60 were found to be modified immediately after their synthesis. Taking advantage of protein identifications, we characterized a wide variety of post-translational events responsible for these changes, such as protein turnover, protein maturation and different types of PTMs. These events operate over very different time scales, ranging from the brief period required for co-translational modifications to one generation time or more. In light of these results, the functional proteome of exponentially growing cells appears to be the product of a permanent remodelling process that modifies native proteins far beyond the time they have been synthesized. This study also allowed us to obtain information on the half-lives of 260 abundant yeast proteins.

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Proteomic expression profile of injured rat peripheral nerves revealed biological networks and processes associated with nerve regeneration

Abstract

Peripheral nerve regeneration is regulated through the coordinated spatio-temporal activation of multiple cellular pathways. In this work, an integrated proteomics and bioinformatics approach was employed to identify differentially expressed proteins at the injury-site of rat sciatic nerve at 20 days after damage. By a label-free liquid chromatography mass-spectrometry (LC-MS/MS) approach, we identified 201 differentially proteins that were assigned to specific canonical and disease and function pathways. These include proteins involved in cytoskeleton signaling and remodeling, acute phase response, and cellular metabolism. Metabolic proteins were significantly modulated after nerve injury to support a specific metabolic demand. In particular, we identified a group of proteins involved in lipid uptake and lipid storage metabolism. Immunofluorescent staining for acyl-CoA diacylglycerol acyltransferase 1 (DGAT1) and DAGT2 expression provided evidence for the expression and localization of these two isoforms in Schwann cells at the injury site in the sciatic nerve. This further supports a specific local regulation of lipid metabolism in peripheral nerve after damage. This article is protected by copyright. All rights reserved



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Multivariate analysis of variations in intrinsic foot musculature among hominoids

Abstract

Comparative analysis of the foot muscle architecture among extant great apes is important for understanding the evolution of the human foot and, hence, human habitual bipedal walking. However, to our knowledge, there is no previous report of a quantitative comparison of hominoid intrinsic foot muscle dimensions. In the present study, we quantitatively compared muscle dimensions of the hominoid foot by means of multivariate analysis. The foot muscle mass and physiological cross-sectional area (PCSA) of five chimpanzees, one bonobo, two gorillas, and six orangutans were obtained by our own dissections, and those of humans were taken from published accounts. The muscle mass and PCSA were respectively divided by the total mass and total PCSA of the intrinsic muscles of the entire foot for normalization. Variations in muscle architecture among human and extant great apes were quantified based on principal component analysis. Our results demonstrated that the muscle architecture of the orangutan was the most distinctive, having a larger first dorsal interosseous muscle and smaller abductor hallucis brevis muscle. On the other hand, the gorilla was found to be unique in having a larger abductor digiti minimi muscle. Humans were distinguished from extant great apes by a larger quadratus plantae muscle. The chimpanzee and the bonobo appeared to have very similar muscle architecture, with an intermediate position between the human and the orangutan. These differences (or similarities) in architecture of the intrinsic foot muscles among humans and great apes correspond well to the differences in phylogeny, positional behavior, and locomotion.



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#BRCA gene presence 'doesn't affect #breastcancer survival' in latest @TheLancetOncol https://t.co/X7lMttLukB https://t.co/u7Ektytp2a

#BRCA gene presence 'doesn't affect #breastcancer survival' in latest @TheLancetOncol https://t.co/X7lMttLukB https://t.co/u7Ektytp2a

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Oxidized phospholipids stimulate production of stem cell factor via NRF2-dependent mechanisms

Abstract

Receptor tyrosine kinase c-Kit and its ligand stem cell factor (SCF) regulate resident vascular wall cells and recruit circulating progenitors. We tested whether SCF may be induced by oxidized palmitoyl-arachidonoyl-phosphatidylcholine (OxPAPC) known to accumulate in atherosclerotic vessels. Gene expression analysis demonstrated OxPAPC-induced upregulation of SCF mRNA and protein in different types of endothelial cells (ECs). Elevated levels of SCF mRNA were observed in aortas of ApoE−/− knockout mice. ECs produced biologically active SCF because conditioned medium from OxPAPC-treated cells stimulated activation (phosphorylation) of c-Kit in naïve ECs. Induction of SCF by OxPAPC was inhibited by knocking down transcription factor NRF2. Inhibition or stimulation of NRF2 by pharmacological or molecular tools induced corresponding changes in SCF expression. Finally, we observed decreased levels of SCF mRNA in aortas of NRF2 knockout mice. We characterize OxPLs as a novel pathology-associated stimulus inducing expression of SCF in endothelial cells. Furthermore, our data point to transcription factor NRF2 as a major mediator of OxPL-induced upregulation of SCF. This mechanism may represent one of the facets of pleiotropic action of NRF2 in vascular wall.



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Hospital nurses’ information retrieval behaviours in relation to evidence based nursing: a literature review

Abstract

Objective

The purpose of this literature review is to provide an overview of the information retrieval behaviour of clinical nurses, in terms of the use of databases and other information resources and their frequency of use.

Methods

Systematic searches carried out in five databases and handsearching were used to identify the studies from 2010 to 2016, with a populations, exposures and outcomes (PEO) search strategy, focusing on the question: In which databases or other information resources do hospital nurses search for evidence based information, and how often?

Results

Of 5272 titles retrieved based on the search strategy, only nine studies fulfilled the criteria for inclusion. The studies are from the United States, Canada, Taiwan and Nigeria. The results show that hospital nurses’ primary choice of source for evidence based information is Google and peers, while bibliographic databases such as PubMed are secondary choices. Data on frequency are only included in four of the studies, and data are heterogenous.

Conclusions

The reasons for choosing Google and peers are primarily lack of time; lack of information; lack of retrieval skills; or lack of training in database searching. Only a few studies are published on clinical nurses’ retrieval behaviours, and more studies are needed from Europe and Australia.



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JFB, Vol. 9, Pages 5: Acknowledgement to Reviewers of Journal of Functional Biomaterials in 2017

JFB, Vol. 9, Pages 5: Acknowledgement to Reviewers of Journal of Functional Biomaterials in 2017

Journal of Functional Biomaterials doi: 10.3390/jfb9010005

Authors: Journal of Functional Biomaterials Editorial Office

Peer review is an essential part in the publication process, ensuring that Journal of Functional Biomaterials maintains high quality standards for its published papers[...]



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Beta HPV38 oncoproteins act with a hit-and-run mechanism in ultraviolet radiation-induced skin carcinogenesis in mice

plos_pathogens.pngCutaneous beta human papillomavirus (HPV) types are suspected to be involved, together with ultraviolet (UV) radiation, in the development of non-melanoma skin cancer, the most common form of human cancer. A new study by researchers from the International Agency for Research on Cancer (IARC) and the German Cancer Research Center (DKFZ), published today in PLoS Pathogens, used a transgenic mouse model in which the expression of beta HPV38 oncogenes can be modulated in the skin. Their findings support the concept that beta HPV types act only at an initial stage of carcinogenesis, by potentiating the deleterious effects of UV radiation.
Viarisio D, Muller-Decker K, Accardi R, Robitaille A, Durst M, Beer K, et al. Beta HPV38 oncoproteins act with a hit-and-run mechanism in ultraviolet radiation-induced skin carcinogenesis in mice
PLoS Pathog, Published online 11 January 2018
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IJMS, Vol. 19, Pages 227: Development of a Cytocompatible Scaffold from Pig Immature Testicular Tissue Allowing Human Sertoli Cell Attachment, Proliferation and Functionality

IJMS, Vol. 19, Pages 227: Development of a Cytocompatible Scaffold from Pig Immature Testicular Tissue Allowing Human Sertoli Cell Attachment, Proliferation and Functionality

International Journal of Molecular Sciences doi: 10.3390/ijms19010227

Authors: Maxime Vermeulen Federico Del Vento Francesca de Michele Jonathan Poels Christine Wyns

Cryopreservation of immature testicular tissue before chemo/radiotherapy is the only option to preserve fertility of cancer-affected prepubertal boys. To avoid reintroduction of malignant cells, development of a transplantable scaffold by decellularization of pig immature testicular tissue (ITT) able to support decontaminated testicular cells could be an option for fertility restoration in these patients. We, therefore, compared decellularization protocols to produce a cytocompatible scaffold. Fragments of ITT from 15 piglets were decellularized using three protocols: sodium dodecyl sulfate (SDS)-Triton (ST), Triton-SDS-Triton (TST) and trypsin 0.05%/ethylenediaminetetraacetic acid (EDTA) 0.02%-Triton (TET) with varying detergent concentrations. All protocols were able to lower DNA levels. Collagen retention was demonstrated in all groups except ST 1%, and a significant decrease in glycosaminoglycans was observed in the TST 1% and TET 1% groups. When Sertoli cells (SCs) were cultured with decellularized tissue, no signs of cytotoxicity were detected. A higher SC proliferation rate and greater stem cell factor secretion were observed than with SCs cultured without scaffold. ST 0.01% and TET 3% conditions offered the best compromise in terms of DNA elimination and extracellular matrix (ECM) preservation, while ensuring good attachment, proliferation and functionality of human SCs. This study demonstrates the potential of using decellularized pig ITT for human testicular tissue engineering purposes.



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Flavor characteristics and chemical compositions of oolong tea processed using different semi-fermentation times

Abstract

Flavor characteristics and chemical compositions of Tieguanyin oolong tea processed using different semi-fermentation times were investigated. Six flavor attributes of the teas, namely, astringency, bitterness, umami, sweet aftertaste, floral flavor, and green fruity flavor, were analysed. With extended semi-fermentation time, the taste intensity of sweet aftertaste increased, and the aroma intensity of floral and green fruity flavors increased, while the intensities of astringency, bitterness, and umami showed no clear trend. With increasing semi-fermentation time, the concentrations of gallated catechins, myricetin-rhamnose, quercetin-rutinoside, myricetin, and theanine greatly decreased, while those of total theaflavins, vitexin-rhamnose, kaempferol-galactose, kaempferol-rutinoside, vitexin, quercetin, and kaempferol increased significantly. The intensity of bitter taste was positively correlated with the concentrations of total catechins and gallated catechins. The intensity of astringent taste strongly correlated with the flavonoid concentrations, and that of sweet aftertaste positively correlated with the concentrations of (−)-epigallocatechin and (−)-epicatechin. However, dose-over-threshold analysis revealed that catechins, theaflavin, flavonol glycosides, and caffeine are the main taste-active compounds contributing to the taste of Tieguanyin oolong tea. The concentrations of total volatiles and most of the esters increased markedly with the semi-fermentation time, while the concentrations of low aldehydes showed a significant decrease. The flavor index was consistent with the intensity of floral aroma, increasing from 0.59 (12 h) to 0.84 (24 h) and then decreasing to 0.63 (32 h). Results of this work suggest that the flavor change is mainly due to the variation of taste-active and aroma-active compounds in oolong tea.



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Viruses, Vol. 10, Pages 33: Causation of Acute Flaccid Paralysis by Myelitis and Myositis in Enterovirus-D68 Infected Mice Deficient in Interferon αβ/γ Receptor Deficient Mice

Viruses, Vol. 10, Pages 33: Causation of Acute Flaccid Paralysis by Myelitis and Myositis in Enterovirus-D68 Infected Mice Deficient in Interferon αβ/γ Receptor Deficient Mice

Viruses doi: 10.3390/v10010033

Authors: John Morrey Hong Wang Brett Hurst Katherine Zukor Venkatraman Siddharthan Arnaud Van Wettere Donal Sinex E. Tarbet

Enterovirus D68 (EV-D68) caused a large outbreak in the summer and fall of 2014 in the United States. It causes serious respiratory disease, but causation of associated paralysis is controversial, because the virus is not routinely identified in cerebrospinal fluid. To establish clinical correlates with human disease, we evaluated EV-D68 infection in non-lethal paralysis mouse models. Ten-day-old mice lacking interferon responses were injected intraperitoneally with the virus. Paralysis developed in hindlimbs. After six weeks of paralysis, the motor neurons were depleted due to viral infection. Hindlimb muscles were also infected and degenerating. Even at the earliest stage of paralysis, muscles were still infected and were degenerating, in addition to presence of virus in the spinal cord. To model natural respiratory infection, five-day-old mice were infected intranasally with EV-D68. Two of the four infected mice developed forelimb paralysis. The affected limbs had muscle disease, but no spinal cord infection was detected. The unique contributions of this study are that EV-D68 causes paralysis in mice, and that causation by muscle disease, with or without spinal cord disease, may help to resolve the controversy that the virus can cause paralysis, even if it cannot be identified in cerebrospinal fluid.



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Viruses, Vol. 10, Pages 30: Metagenomic Virome Analysis of Culex Mosquitoes from Kenya and China

Viruses, Vol. 10, Pages 30: Metagenomic Virome Analysis of Culex Mosquitoes from Kenya and China

Viruses doi: 10.3390/v10010030

Authors: Evans Atoni Yujuan Wang Samuel Karungu Cecilia Waruhiu Ali Zohaib Vincent Obanda Bernard Agwanda Morris Mutua Han Xia Zhiming Yuan

Many blood-feeding arthropods are known vectors of viruses that are a source of unprecedented global health concern. Mosquitoes are an integral part of these arthropod vectors. Advancements in next-generation sequencing and bioinformatics has expanded our knowledge on the richness of viruses harbored by arthropods. In the present study, we applied a metagenomic approach to determine the intercontinental virome diversity of Culex quinquefasciatus and Culex tritaeniorhynchus in Kwale, Kenya and provinces of Hubei and Yunnan in China. Our results showed that viromes from the three locations were strikingly diverse and comprised 30 virus families specific to vertebrates, invertebrates, plants, and protozoa as well as unclassified group of viruses. Though sampled at different times, both Kwale and Hubei mosquito viromes were dominated by vertebrate viruses, in contrast to the Yunnan mosquito virome, which was dominated by insect-specific viruses. However, each virome was unique in terms of virus proportions partly influenced by type of ingested meals (blood, nectar, plant sap, environment substrates). The dominant vertebrate virus family in the Kwale virome was Papillomaviridae (57%) while in Hubei it was Herpesviridae (30%) and the Yunnan virome was dominated by an unclassified viruses group (27%). Given that insect-specific viruses occur naturally in their hosts, they should be the basis for defining the viromes. Hence, the dominant insect-specific viruses in Kwale, Hubei, and Yunnan were Baculoviridae, Nimaviridae and Iflaviridae, respectively. Our study is preliminary but contributes to growing and much needed knowledge, as mosquito viromes could be manipulated to prevent and control pathogenic arboviruses.



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IJERPH, Vol. 15, Pages 123: A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services

IJERPH, Vol. 15, Pages 123: A Cross-Sectional Study of the Association between Infant Hepatitis B Vaccine Exposure in Boys and the Risk of Adverse Effects as Measured by Receipt of Special Education Services

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010123

Authors: David Geier Janet Kern Kristin Homme Mark Geier

The National Center for Education Statistics reported that between 1990–2005 the number of children receiving special education services (SES) rose significantly, and then, from 2004–2012, the number declined significantly. This coincided with the introduction of Thimerosal-containing hepatitis B vaccine in 1991, and the subsequent introduction of Thimerosal-reduced hepatitis B vaccine in the early 2000s. This study examined the potential relationship between infant exposure to mercury from three doses of Thimerosal-containing hepatitis B vaccine and the risk of boys being adversely affected (as measured by receipt of SES). This cross-sectional study examined 1192 boys (weighted n = 24,537,123) 7–8 years of age (born: 1994–2007) from the combined 2001–2014 National Health and Nutritional Examination Survey (NHANES). Survey logistic regression modeling revealed that an exposed population receiving three doses of infant Thimerosal-containing hepatitis B vaccine (weighted n = 11,186,579), in comparison to an unexposed population (weighted n = 704,254), were at an increased risk of receipt of SES. This association was robust (crude odds ratio = 10.143, p = 0.0232), even when considering covariates, such as race and socioeconomic status (adjusted odds ratio = 9.234, p = 0.0259). Survey frequency modeling revealed that receipt of SES for the population that was exposed to three doses of Thimerosal-containing hepatitis B vaccine in infancy (12.91%) was significantly higher than the unexposed population (1.44%) (prevalence ratio = 8.96, p = 0.006, prevalence attributable rate = 0.1147). Despite the limitation of this cross-sectional study not being able to ascribe a direct cause-and-effect relationship between exposure and outcome, it is estimated that an additional 1.2 million boys received SES with excess education costs of about United States (US) $180 billion associated with exposure to Thimerosal-containing hepatitis B vaccine. By contrast, exposure to Thimerosal-reduced hepatitis B vaccine was not associated with an increased risk of receiving SES. Therefore, routine childhood vaccination is important to reduce the morbidity and mortality of infectious diseases, but every effort should be made to eliminate Thimerosal from all vaccines.



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IJERPH, Vol. 15, Pages 122: Analysis of Emission Effects Related to Drivers’ Compliance Rates for Cooperative Vehicle-Infrastructure System at Signalized Intersections

IJERPH, Vol. 15, Pages 122: Analysis of Emission Effects Related to Drivers’ Compliance Rates for Cooperative Vehicle-Infrastructure System at Signalized Intersections

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010122

Authors: Ruohua Liao Xumei Chen Lei Yu Xiaofei Sun

Unknown remaining time of signal phase at a signalized intersection generally results in extra accelerations and decelerations that increase variations of operating conditions and thus emissions. A cooperative vehicle-infrastructure system can reduce unnecessary speed changes by establishing communications between vehicles and the signal infrastructure. However, the environmental benefits largely depend on drivers’ compliance behaviors. To quantify the effects of drivers’ compliance rates on emissions, this study applied VISSIM 5.20 (Planung Transport Verkehr AG, Karlsruhe, Germany) to develop a simulation model for a signalized intersection, in which light duty vehicles were equipped with a cooperative vehicle-infrastructure system. A vehicle-specific power (VSP)-based model was used to estimate emissions. Based on simulation data, the effects of different compliance rates on VSP distributions, emission factors, and total emissions were analyzed. The results show the higher compliance rate decreases the proportion of VSP bin = 0, which means that the frequencies of braking and idling were lower and light duty vehicles ran more smoothly at the intersection if more light duty vehicles complied with the cooperative vehicle-infrastructure system, and emission factors for light duty vehicles decreased significantly as the compliance rate increased. The case study shows higher total emission reductions were observed with higher compliance rate for all of CO2, NOx, HC, and CO emissions. CO2 was reduced most significantly, decreased by 16% and 22% with compliance rates of 0.3 and 0.7, respectively.



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Genes, Vol. 9, Pages 37: An Introduction to Integrative Genomics and Systems Medicine in Cancer

Genes, Vol. 9, Pages 37: An Introduction to Integrative Genomics and Systems Medicine in Cancer

Genes doi: 10.3390/genes9010037

Authors: Xiaolong Cheng Victor Jin

In this Special Issue (SI), with a theme of “Integrative Genomics and Systems Medicine in Cancer”, we have collected a total of 12 research and review articles from researchers in the field of genomics and systems medicine[...]



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Early Life Stress Activates Glial Cells in the Hippocampus but Attenuates Cytokine Secretion in Response to an Immune Challenge in Rat Pups

Objective: Early life stress (ELS) increases the vulnerability to developing psychopathological disorders in adulthood that are accompanied by brain inflammatory processes. However, it is not known how a combined double hit (stress and immune) at an early age affects the response of the neuroimmune system. Here we investigated the effect of periodic maternal separation (MS) followed by administration of lipopolysaccharide (LPS) on glial cells in the CA3 region and hilus of the hippocampus and on cytokine release on postnatal day (PN) 15. Methods: Male rat pups were subjected to MS (3 h/day, PN1-14). MS and control pups received a single LPS injection (1 mg/kg of body weight) on PN14. They were subjected to an open field test 1 h later. The pups were sacrificed 90 min after LPS injection (PN14) or on PN15 for cytokine or immunohistological analyses, respectively. Results: LPS reduced the locomotion and induced high corticosterone levels in treated pups. MS or LPS reduced microglial density and activated microglial cells in the hippocampal CA3 and hilus regions. Microglial activation was highest in MS-LPS pups. The astrocyte density was mildly reduced by MS or LPS in the CA3 region and hilus, but the reduction was maximal in MS-LPS pups. LPS increased the secretion of plasmatic interleukin (IL)-1β, tumor necrosis factor-α, and IL-6, and of hippocampal IL-1β protein, but these were attenuated in MS-LPS pups. Conclusion: Although MS and LPS activate neuroimmune cells, stress attenuates the hippocampal and peripheral cytokine response to LPS through an as-yet unidentified adaptive mechanism. These results provide information regarding the neurobiology of stress and inflammation.
Neuroimmunomodulation

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Impact of RNA virus infection on plant cell function and evolution

Viruses are obligate symbionts that tightly interact with their hosts to complete their life cycle. Each infected cell is confronted with the accumulation of viral products and activities that have evolved to support the replication and spread of the virus in the context of host cell functions and defense responses. Tobacco mosaic virus encodes replicase proteins and coat protein, to replicate and protect the RNA genome, and a movement protein (MP) that binds viral RNA and manipulates the size exclusion limit of plasmodesmata to facilitate the spread of the viral genomic RNA (vRNA). The MP and replicase also interfere with the cellular RNA silencing machinery that influences plant gene expression and development. Moreover, virus-infected cells stimulate the production of a systemic signal ahead of the virus front that triggers genomic recombination leading to heritable genetic changes. Thus viruses can interact with their hosts through diverse molecular interactions. Given the highmutation rate of viruses, these interactions have implications for evolutionary processes and adaptations at the virus-host interface that may contribute to eukaryotic evolution.

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Inhibition of Tobacco mosaic virus movement by expression of an actin-binding protein

The tobacco mosaic virus (TMV) movement protein (MP) required for the cell-to-cell spread of viral RNA interacts with the endoplasmic reticulum (ER) as well as with the cytoskeleton during infection. Whereas associations of MP with ER and microtubules have been intensely investigated, research on the role of actin has been rather scarce. We demonstrate that Nicotiana benthamiana plants transgenic for the actin-binding domain 2 of Arabidopsis (Arabidopsis thaliana) fimbrin (AtFIM1) fused to green fluorescent protein (ABD2:GFP) exhibit a dynamic ABD2:GFP-labeled actin cytoskeleton and myosin-dependent Golgi trafficking. These plants also support the movement of TMV. In contrast, both myosin-dependent Golgi trafficking and TMV movement are dominantly inhibited when ABD2:GFP is expressed transiently. Inhibition is mediated through binding of ABD2:GFP to actin filaments, since TMV movement is restored upon disruption of the ABD2:GFP-labeled actin network with latrunculin B. Latrunculin B shows no significant effect on the spread of TMV infection in either wild-type plants or ABD2:GFP transgenic plants under our treatment conditions. We did not observe any binding of MP along the length of actin filaments. Collectively, these observations demonstrate that TMV movement does not require an intact actomyosin system. Nevertheless, actin-binding proteins appear to have the potential to exert control over TMV movement through the inhibition of myosinassociated protein trafficking along the ER membrane.

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Approaching the cellular mechanism that supports the intercellular spread of Tobacco mosaic virus

Plant viruses spread cell-to-cell in infected plants by exploiting plasmodesmata (PD), gatable channels in the cell wall that provide cytoplasmic passageways for the trafficking of informational macromolecules. Since it became known that the intercellular spread of Tobacco mosaic virus (TMV) depends on virus-encoded movement protein (MP), the mechanism by which this protein mediates in the targeting of this virus to PD is subject to intense studies. TMV movement occurs in a non-encapsidated form and thus promises to reveal important host functions involved in the intra-and intercellular trafficking of RNA molecules. We have recently presented new evidence that the cell-to-cell trafficking of TMV RNA (vRNA) involves the formation and intracellular trafficking of distinct MP particles. Upon assembly, these particles detach from cortical microtubule (MT) sites and then move with the flow of ER through the cell. During passage the particles continue to undergo transient interactions with MT which may guide the particles to their destination. The comprehensive analysis of particle composition may lead to important insights into the regulation of RNA transport in plants and may also reveal potential similarities to RNA transport mechanisms in animals and humans.

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A comprehensive metabolite profiling of Isatis tinctoria leaf extracts

A broad-based characterisation of a pharmacologically active dichloromethane extract from Isatis tinctoria leaves was carried out. For a comprehensive picture we also included the polar constituents of I. tinctoria (MeOH extract) and for comparative purposes, the taxonomically closely related plant I. indigotica. Diode array detector, evaporative light scattering detector, atmospheric pressure chemical ionisation and electrospray ionisation mass spectrometry, and electrospray ionisation time-of-flight mass spectrometry detectors were used in parallel to ensure a wide coverage of secondary metabolites with highly diverging analytical properties. Off-line microprobe nuclear magnetic resonance spectroscopy after peak purification by semi-preparative high-pressure liquid chromatography served for structure elucidation of some minor constituents. More than 65 compounds belonging to various structural classes such as alkaloids, flavonoids, fatty acids, porphyrins, lignans, carotenoids, glucosinolates and cyclohexenones were unambiguously identified, and tentative structures were proposed for additional compounds. Numerous compounds were identified for the first time in the genus Isatis, and an indolic alkaloid was discovered.

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RT @oncology_bg : Finally in print. In Jan 2018 issue of @JAMAOnc , please read our viewpoint on the (weak) evidence behind one of the stron…

RT @oncology_bg : Finally in print. In Jan 2018 issue of @JAMAOnc , please read our viewpoint on the (weak) evidence behind one of the stron…

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Use of caudal epidural catheter in a child with cerebral palsy with prior posterior spine (T1-sacrum) fusion

Divya Dixit, Mary C Theroux, Kirk W Dabney, Freeman Miller

Indian Journal of Anaesthesia 2018 62(1):80-82



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From the desk of the New President

V Kuchela Babu

Indian Journal of Anaesthesia 2018 62(1):4-5



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Effect of inhaled budesonide suspension, administered using a metered dose inhaler, on post-operative sore throat, hoarseness of voice and cough

Sunil Rajan, Pulak Tosh, Jerry Paul, Lakshmi Kumar

Indian Journal of Anaesthesia 2018 62(1):66-71

Background and Aims: Post-operative sore throat (POST) is often considered an inevitable consequence of tracheal intubation. This study was performed to compare the effect of inhaled budesonide suspension, administered using a metered dose inhaler, on the incidence and severity of POST. Methods: In this prospective randomised study, 46 patients undergoing laparoscopic surgeries lasting <2 h were randomly allotted into two equal groups. Group A received 200 μg budesonide inhalation suspension, using a metered dose inhaler, 10 min before intubation, and repeated 6 h after extubation. No such intervention was performed in Group B. The primary outcome was the incidence and severity of POST. Secondary outocomes included the incidence of post-operative hoarseness and cough. Pearson's Chi-square test, Fisher's exact test and Independent sample t-test were used as applicable. Results: Compared to Group B, significantly fewer patients had POST in Group A at 2, 6, 12 and 24 h (P < 0.001). Although more patients in Group B had post-operative hoarseness of voice and cough at all-time points, the difference was statistically significant only at 12 h and 24 h for post-operative hoarseness and at 2 h and 12 h for post-operative cough. Severity as well as the incidence of POST showed downward trends in both groups over time, and by 24 h no patient in Group A had sore throat. Conclusion: Inhaled budesonide suspension is effective in significantly reducing the incidence and severity of POST.

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The President's inaugural address during ISACON 2017 on November 26, 2017, at Kolkata

BB Mishra

Indian Journal of Anaesthesia 2018 62(1):6-9



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Comment on 'Sustained intraoperative bradycardia revealing Sengers syndrome'

Sohan Lal Solanki, Swapnil Y Parab

Indian Journal of Anaesthesia 2018 62(1):87-87



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Clinical trial registration: A practical perspective

S Bala Bhaskar

Indian Journal of Anaesthesia 2018 62(1):10-15

The increase in the number of clinical trials, driven mainly for career advancement mandated by regulatory bodies such as Medical Council of India risks output of substandard publications and also wastage of resources. There are also concerns of inadequate reporting and wilful concealment of results. The quality and quantity of the output become questionable evidences for medical practice. Lack of transparency can lead to disillusionment of the public in the medical field. Clinical trials registration seeks to regulate and streamline the clinical trials by mandating registration in various registries, through free for registration sites such as Clinical Trials Registry of India (CTRI). The guidelines are based on the World Health Organisation's International Clinical Trials Registry Platform (ICTRP). This review aims to highlight the types of registries, the registration process, the data that need to be registered, the guide to use the CTRI and the search options in CTRI and ICTRP. The role of International Committee of Medical Journal Editors is also highlighted in regard to not only registration but also on the publication of trial registration number in the manuscript.

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Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane

Sanjib Das Adhikary, Ashlee Pruett, Mauricio Forero, Venkatesan Thiruvenkatarajan

Indian Journal of Anaesthesia 2018 62(1):75-78

Post-operative pain after minimally invasive video-assisted thoracoscopic surgery (VATS) in adults is commonly managed with oral and parenteral opioids and invasive regional techniques such as thoracic epidural blockade. Emerging research has shown that the novel erector spinae plane (ESP) block, can be employed as a simple and safe alternative analgesic technique for acute post-surgical, post-traumatic and chronic neuropathic thoracic pain in adults. We illustrate this by presenting a paediatric case of VATS, in which an ESP block provided better analgesia, due to greater dermatomal coverage, as well as reduced side-effects when compared with a thoracic epidural that had previously been employed on the same patient for a similar procedure on the opposite side.

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Time spent by patients in a pre-anaesthetic clinic and the factors affecting it: An audit from a tertiary care teaching hospital

Justin P James, Suma Mary Thampi

Indian Journal of Anaesthesia 2018 62(1):16-22

Background and Aims: Patient satisfaction from a pre-anaesthetic clinic (PAC) visit is greatly influenced by time spent there. We aimed to determine time spent in a PAC without an appointment system and the factors affecting the same. Methods: Four hundred and eight patients coming to PAC were tracked using a time-motion study model. Time spent in waiting and consultation was recorded. Independent variables potentially affecting time spent were documented. Patients were grouped based on independent variables, and the groups were compared for significant differences using appropriate statistical tests. Workload pending on physicians was calculated on an hourly basis by counting number of patients waiting and number of physicians in PAC. Results: Non-parametric statistical tests were used for analysis because the data were not normally distributed. The median and inter-quartile range for waiting time, consultation time and total time were 60 (30–90) minutes, 17 (12–26) minutes and 79 (53–111) minutes, respectively. There was considerable variation in all three. Waiting time was significantly lower in patients posted for same-day surgery or those arriving on a stretcher or wheelchair. Consultation time was correlated with American Society of Anesthesiologists physical status and grade of surgery. Most patients arrived in the morning rather than at equal intervals. Waiting time and workload were therefore maximum in the midmorning and dropped rapidly in the afternoon. Conclusion: Large variability in waiting time is linked to lack of an appointment system, and to patients being seen out of turn.

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Central core disease with scoliosis for congenital hip dislocation surgery: An anaesthetic demur

Vrushali C Ponde, Vinit Vinod Bedekar, Ashok N Johari, Shalin K Maheshwari

Indian Journal of Anaesthesia 2018 62(1):84-85



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Abnormal routine pre-operative test results and their impact on anaesthetic management: An observational study

Habib Md Reazaul Karim, Avinash Prakash, Sarasa Kumar Sahoo, Anilkumar Narayan, Vidya Vijayan

Indian Journal of Anaesthesia 2018 62(1):23-28

Background and Aims: One of the reasons for continued routine pre-operative testing practice is the identification of hidden problems which may affect perioperative management. This study was aimed to assess the prevalence of abnormal test results, their impact on perioperative management and cost-effectiveness for detecting such abnormalities. Methods: This observational study was conducted by screening the files of the patients attending pre-anaesthetic check-up during December 2016–January 2017. Patients' physical status, surgery grade, normal and abnormal test results and different impacts were noted and expressed in absolute numbers/percentage. Number needed to investigate (NNI) to detect a significant abnormality was calculated. Results: Data of 414 patients (46.3% male) with mean ± standard deviation age 43.78 ± 17.24 years and 58.65 ± 12.93 kg weight were analysed. Patients were mostly American Society of Anesthesiologists II and underwent National Institute of Clinical and Health Excellence Grade 3 surgeries. Totally, 345 (11.6%) test results were abnormal. Only 56 (16.2%) abnormalities had an impact in terms of referral, further investigations or delay. Twenty were significant in terms of changing perioperative anaesthetic management. Laboratory abnormalities with non-significant impact resulted in median delay of 3 days (range 1 to 12 days). The NNI for a significant impact and detecting new abnormality was 21 and 28, respectively. Conclusion: Majority (57.2%) of the patients had at least one abnormal routine test result but only 1.8% abnormalities had significant impact. The NNI to find a significant impact or hidden comorbidity was more than 20.

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Leadership in anaesthesiology through mentoring

J Balavenkat Subramanian, Uma Ravikumar

Indian Journal of Anaesthesia 2018 62(1):1-3



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Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study

Prashant Paul Verghese, Ashu Sara Mathai, Valsamma Abraham, Paramdeep Kaur

Indian Journal of Anaesthesia 2018 62(1):29-35

Background and Aims: Early identification of malnutrition among hospitalised patients is essential to institute appropriate patient-specific nutritional strategies. This study was conducted to evaluate the nutritional status of medical patients at admission to the adult intensive care unit (ICU) and to identify factors which prevent attainment of daily feeding goals in them. Methods: This was a 1 year prospective, observational study on 200 medical adult ICU patients. The study was carried out based on daily documentation. The primary outcome was the nutritional status of medical Patients at admission to the adult ICU. The tests for statistical analysis used were independent t test, Chi-square test, Fisher's exact test and multivariate logistic regression analysis. Results: Out of the 200 patients in our study, 45%, 48.5% and 9% of patients had mild, moderate and severe malnutrition, respectively, corresponding to subjective global assessment (SGA) rating A,B and C, respectively. The most common reasons for non-attainment of daily feeding goals were delayed feed procurement (17.57%), and feeds being held for procedures (16.36%). The overall mean length of ICU stay was 8.63 ± 7.26 days, and the ICU mortality rate was 47.5% (95/200). Patients with SGA rating B and C at admission had higher risk of mortality in the ICU, with an adjusted odds ratio of 3.54 (95% confidence interval [CI]- 1.71–7.33, P = 0.001) and 11.11 (95% CI-2.26–54.66, P = 0.003), respectively. Conclusion: Malnutrition is commonly present at admission among medical ICU patients, and is associated with higher ICU mortality.

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Undiagnosed intraoperative methaemoglobinaemia

Swapnil Verma, AK Sathpathy, U Srinivas, Sanath Reddy

Indian Journal of Anaesthesia 2018 62(1):72-74

Methaemoglobinaemia is a rare but potentially dangerous haemoglobinopathy that is often underdiagnosed. It is one of the causes for unexplained cyanosis with dark-coloured blood, especially in the absence of cardiac or pulmonary pathology. Not uncommonly so, it is an incidental perioperative finding in cases of dark-coloured blood not improving with oxygen in apparently acyanotic patients. The present case report is of a child with deaf-mutism posted for cochlear implant surgery who presented with 'chocolate-coloured blood' in the surgical field, despite blood gas analysis showing a normal partial pressure of oxygen.

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Maternal and anaesthesia-related risk factors and incidence of spinal anaesthesia-induced hypotension in elective caesarean section: A multinomial logistic regression

Atousa Fakherpour, Haleh Ghaem, Zeinabsadat Fattahi, Samaneh Zaree

Indian Journal of Anaesthesia 2018 62(1):36-46

Background and Aims: Although spinal anaesthesia (SA) is nowadays the preferred anaesthesia technique for caesarean section (CS), it is associated with considerable haemodynamic effects, such as maternal hypotension. This study aimed to evaluate a wide range of variables (related to parturient and anaesthesia techniques) associated with the incidence of different degrees of SA-induced hypotension during elective CS. Methods: This prospective study was conducted on 511 mother–infant pairs, in which the mother underwent elective CS under SA. The data were collected through preset proforma containing three parts related to the parturient, anaesthetic techniques and a table for recording maternal blood pressure. It was hypothesized that some maternal (such as age) and anaesthesia-related risk factors (such as block height) were associated with occurance of SA-induced hypotension during elective CS. Results: The incidence of mild, moderate and severe hypotension was 20%, 35% and 40%, respectively. Eventually, ten risk factors were found to be associated with hypotension, including age >35 years, body mass index ≥25 kg/m2, 11–20 kg weight gain, gravidity ≥4, history of hypotension, baseline systolic blood pressure (SBP) <120 mmHg and baseline heart rate >100 beats/min in maternal modelling, fluid preloading ≥1000 ml, adding sufentanil to bupivacaine and sensory block height >T4in anaesthesia-related modelling (P < 0.05). Conclusion: Age, body mass index, weight gain, gravidity, history of hypotension, baseline SBP and heart rate, fluid preloading, adding sufentanil to bupivacaine and sensory block hieght were the main risk factors identified in the study for SA-induced hypotension during CS.

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Subcutaneous emphysema - An unexpected cause for respiratory distress during vitreoretinal surgery under peribulbar block

Renu Sinha, Kanil Ranjith Kumar, Velmurugan Selvam, Apala R Chowdhury

Indian Journal of Anaesthesia 2018 62(1):79-80



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Admission Vitamin D status does not predict outcome of critically ill patients on mechanical ventilation: An observational pilot study

Sonu Yadav, Poonam Joshi, Ujjwal Dahiya, Dalim Kumar Baidya, Ravinder Goswami, Randeep Guleria, Ramakrishnan Lakshmy

Indian Journal of Anaesthesia 2018 62(1):47-52

Background and Aims: Effect of serum 25-hydroxy vitamin D (25[OH] D) levels on the recovery of critically ill mechanically ventilated patients is unclear. Hence, this study assessed 25(OH)D levels of critically ill patients on mechanical ventilation at the time of admission to the Intensive Care Unit (ICU) and its relationship with clinical outcome. Methods: In this prospective observational pilot study, forty adult patients receiving mechanical ventilation in the ICU were included. Serum 25(OH)D was assessed within 24 h of admission. Primary outcome was 30-day mortality and secondary outcomes were days on mechanical ventilation, ICU-length of stay (ICU-LOS), days to reach spontaneous breathing trial (SBT), requirement of advanced care modality and complications. Results: Seventy-five percent patients had low serum 25(OH)D (65% deficient and 10% insufficient). Between patients with low and normal vitamin D , there was no significant difference in 30-day mortality (10% vs. 16.7%; P = 0.81), days on mechanical ventilation (16.2 ± 8.9 vs. 19.9 ± 8.4; P = 0.23), ICU-length of stay (18.7 ± 8.5 vs. 23.3 ± 11.4; P = 0.28), days to reach SBT (11.5 (0–20) vs. 21 (8–30); P = 0.78), complications developed during ICU stay (P = 0.60) and need for advanced care modalities (P = 0.72). Conclusion: Low Vitamin D level at admission did not affect 30-day mortality of critically ill patients on mechanical ventilation.

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Keloid formation on neck after jugular central venous catheter placement: An unsightly unusual complication in a young female

Satyashiva Munjal, Jitendra Kumar, Pallav Kumar, VS Mehta

Indian Journal of Anaesthesia 2018 62(1):82-84



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Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial

Karthikeyan Kallidaikurichi Srinivasan, Anne-Marie Leo, Gabriella Iohom, Frank Loughnane, Peter J Lee

Indian Journal of Anaesthesia 2018 62(1):53-60

Background and Aims: Routine use of pre-procedural ultrasound guided midline approach has not shown to improve success rate in administering subarachnoid block. The study hypothesis was that the routine use of pre-procedural (not real time) ultrasound-guided paramedian spinals at L5-S1 interspace could reduce the number of passes (i.e., withdrawal and redirection of spinal needle without exiting the skin) required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach. Methods: After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either Group C where conventional midline approach with palpated landmarks was used or Group P where pre-procedural ultrasound was used to perform subarachnoid block by paramedian approach at L5-S1 interspace (real time ultrasound guidance was not used). Results: There was no difference in primary outcome (difference in number of passes) between the two groups. Similarly there was no difference in the number of attempts (i.e., the number of times the spinal needle was withdrawn from the skin and reinserted). The first pass success rates (1 attempt and 1 pass) was significantly greater in Group C compared to Group P [43% vs. 22%, P = 0.02]. Conclusion: Routine use of paramedian spinal anaesthesia at L5-S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful dural puncture.

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