Παρασκευή, 19 Ιανουαρίου 2018

Photon vs. proton radiochemotherapy: Effects on brain tissue volume and perfusion

To compare the structural and hemodynamic changes of healthy brain tissue in the cerebral hemisphere contralateral to the tumor following photon and proton radiochemotherapy.

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Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis

To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin.

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Palliative radiotherapy for locally advanced non-metastatic head and neck cancer: A systematic review

Objectives: The objective of this systematic review was to identify and appraise the existing evidence of role of palliative radiotherapy for locally advanced non-metastatic head and neck cancer. Methods: A systematic search of the literature was conducted using Medline, Embase and Cochrane databases and relevant references were included. Results: Literature search revealed a wide variation in dose fractionation regimens. Reported outcomes showed high efficacy and low rate of significant side effects, except in studies utilising higher doses of radiotherapy where higher grade toxicities were seen.

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Optimization of combined proton–photon treatments

Proton treatment slots are a limited resource. Therefore, we consider combined proton–photon treatments in which most fractions are delivered with photons and only a few with protons. We demonstrate how both modalities can be combined to optimally capitalize on the proton's ability to reduce normal tissue dose.

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Does biopsy needle traversing through central portion of lesion increase the risk of hemoptysis during percutaneous transthoracic needle biopsy?

Abstract

Purpose

To evaluate whether traversal through the central part of a pulmonary lesion by a biopsy needle, and other factors, increases the risk of hemoptysis in patients undergoing CT-guided percutaneous transthoracic needle biopsy (PTNB).

Materials and methods

From July 2012 to November 2016, 227 patients undergoing 233 procedures were recruited as our study population. Patients were classified according to the occurrence of hemoptysis. Radiological assessments were performed by reviewing multiplanar reconstructed CT images. Other factors complicating PTNB-related hemoptysis were classified into (1) patient-related variables: age, gender, presence of emphysema; (2) lesion-related variables: size, location, distance to pleura, characteristics, presence of and degree of enhancement, histopathology of biopsy results; and (3) procedure-related variables: lesion depth, patient's body position.

Results

Twenty-two cases (9.4%) experienced hemoptysis. Univariate analysis revealed that subsolid lesions (p = 0.031) and lesion depth > 1 cm (p = 0.049) were risk factors. Traversal through the central part of the lesion by the biopsy needle was not a risk factor.

Conclusion

Traversal through the central part of the lesion by the biopsy needle is not a risk factor of PTNB-related hemoptysis, but subsolid lesions and lesion depth > 1 cm increase the risk of hemoptysis.



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2016 New Horizons Lecture: Beyond Imaging-Radiology of Tomorrow.

2016 New Horizons Lecture: Beyond Imaging-Radiology of Tomorrow.

Radiology. 2018 Jan 18;:171503

Authors: Hricak H

Abstract
This article is based on the New Horizons lecture delivered at the 2016 Radiological Society of North America Annual Meeting. It addresses looming changes for radiology, many of which stem from the disruptive effects of the Fourth Industrial Revolution. This is an emerging era of unprecedented rapid innovation marked by the integration of diverse disciplines and technologies, including data science, machine learning, and artificial intelligence-technologies that narrow the gap between man and machine. Technologic advances and the convergence of life sciences, physical sciences, and bioengineering are creating extraordinary opportunities in diagnostic radiology, image-guided therapy, targeted radionuclide therapy, and radiology informatics, including radiologic image analysis. This article uses the example of oncology to make the case that, if members in the field of radiology continue to be innovative and continuously reinvent themselves, radiology can play an ever-increasing role in both precision medicine and value-driven health care. © RSNA, 2018.

PMID: 29346031 [PubMed - as supplied by publisher]



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Sliding to predict: vision-based beating heart motion estimation by modeling temporal interactions

Abstract

Purpose

Technical advancements have been part of modern medical solutions as they promote better surgical alternatives that serve to the benefit of patients. Particularly with cardiovascular surgeries, robotic surgical systems enable surgeons to perform delicate procedures on a beating heart, avoiding the complications of cardiac arrest. This advantage comes with the price of having to deal with a dynamic target which presents technical challenges for the surgical system. In this work, we propose a solution for cardiac motion estimation.

Methods

Our estimation approach uses a variational framework that guarantees preservation of the complex anatomy of the heart. An advantage of our approach is that it takes into account different disturbances, such as specular reflections and occlusion events. This is achieved by performing a preprocessing step that eliminates the specular highlights and a predicting step, based on a conditional restricted Boltzmann machine, that recovers missing information caused by partial occlusions.

Results

We carried out exhaustive experimentations on two datasets, one from a phantom and the other from an in vivo procedure. The results show that our visual approach reaches an average minima in the order of magnitude of \(10^{-7}\) while preserving the heart's anatomical structure and providing stable values for the Jacobian determinant ranging from 0.917 to 1.015. We also show that our specular elimination approach reaches an accuracy of 99% compared to a ground truth. In terms of prediction, our approach compared favorably against two well-known predictors, NARX and EKF, giving the lowest average RMSE of 0.071.

Conclusion

Our approach avoids the risks of using mechanical stabilizers and can also be effective for acquiring the motion of organs other than the heart, such as the lung or other deformable objects.



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Postsurgical Outcomes and Surgical Completeness of Robotic Thyroid Surgery: A Single Surgeon's Experience on 700 Cases.

Postsurgical Outcomes and Surgical Completeness of Robotic Thyroid Surgery: A Single Surgeon's Experience on 700 Cases.

J Laparoendosc Adv Surg Tech A. 2018 Jan 18;:

Authors: Kim EB, Cho JW, Lee YM, Sung TY, Yoon JH, Chung KW, Hong SJ

Abstract
BACKGROUND: Advanced technology and understanding of robotic surgical system have rendered robotic thyroid surgery more expanding. The aim of this study was to identify the periodic changes in postsurgical outcomes of robotic thyroid surgery performed by a single surgeon.
METHODS: We conducted a retrospective review of 700 robotic thyroid surgery cases using gasless trans-axillary approach.
RESULTS: All patients underwent successful operations without conversion to open surgery, and were mostly younger than 45 years, female, less-extended thyroid surgery and lymph node dissection, and thyroid cancer. The median follow-up period was 67 months (12-99 months). Regarding technical outcomes, the operation time declined steeply after 100 consecutive cases, and reached 120.0-132.7 minutes for thyroid lobectomy and 162.9-174.1 minutes for total thyroidectomy (TT). The most common complication was transient hypoparathyroidism (43.7%), whose incidence decreased steeply to a range of 9.1% to 25.0% after 300 consecutive cases. Regarding surgical completeness for thyroid cancer, an average of seven lymph nodes was retrieved through central compartment node dissection without fluctuation over time. The proportion of the patients with serum stimulated thyroglobulin levels <10 ng/mL at the time of radioactive iodine remnant ablation after TT and <1 ng/mL 6-12 months after the first remnant ablation ranged between 86.4%-100% and 66.7%-100%, respectively, without significant fluctuation.
CONCLUSION: For properly selected patients, robotic thyroid surgery is useful surgical option with reliable technical outcome and surgical completeness and cosmetic benefit.

PMID: 29346027 [PubMed - as supplied by publisher]



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Comparison of Gene Expression Profiling and Chromosome 3 Analysis by Fluorescent in situ Hybridization and Multiplex Ligation Probe Amplification in Fine-Needle Aspiration Biopsy Specimens of Uveal Melanoma.

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Comparison of Gene Expression Profiling and Chromosome 3 Analysis by Fluorescent in situ Hybridization and Multiplex Ligation Probe Amplification in Fine-Needle Aspiration Biopsy Specimens of Uveal Melanoma.

Ocul Oncol Pathol. 2017 Dec;4(1):16-20

Authors: Klufas MA, Richter E, Itty S, Moreno C, McCannel CA, McCannel TA

Abstract
Purpose: The aim of this paper was to assess the concordance between results of DecisionDx-UM specific gene expression profiling (GEP) and fluorescence in situ hybridization (FISH) for chromosome 3 analysis, and between DecisionDx-UM GEP and multiplex ligation probe amplification (MLPA) in uveal melanoma undergoing intraoperative fine-needle aspiration biopsy (FNAB) for metastatic prognostication during brachytherapy.
Methods: We retrospectively reviewed consecutive patients diagnosed with posterior uveal melanoma who underwent intraoperative FNAB prior to placement of an iodine-125 radioactive plaque between 2012 and 2014. Two cohorts of patients were identified: Cohort 1 - tumors in which both GEP and FISH results were obtained, and Cohort 2 - tumors in which both GEP and MLPA results were obtained.
Results: Forty-four patients were identified for Cohort 1. FISH and GEP results were discordant in 7 tumors (15.9%). Forty-three patients were identified for Cohort 2. MLPA and GEP were discordant in 7 tumors (16.3%).
Conclusions: Discordance between GEP and chromosome 3 status by FISH and MLPA occurred in our series at a rate of 15.9 and 16.3%, respectively. Caution must be advised when counseling a patient with a good-prognosis GEP "Class 1" result that the uveal tumor may actually harbor monosomy 3, which is associated with a poor prognosis for metastasis in nearly 20% of the patients.

PMID: 29344493 [PubMed]



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Determining patient selection tool and response predictor for outpatient 30 mCi radioiodine ablation dose in non-metastatic differentiated thyroid carcinoma: a Japanese perspective.

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Determining patient selection tool and response predictor for outpatient 30 mCi radioiodine ablation dose in non-metastatic differentiated thyroid carcinoma: a Japanese perspective.

Endocr J. 2018 Jan 16;:

Authors: Higuchi T, Achmad A, Binh DD, Bhattarai A, Tsushima Y

Abstract
The lack of isolation ward throughout Japan has long been limiting the 131I radioactive iodine (RAI) ablation for differentiated thyroid cancer (DTC) cases. The 30 mCi RAI ablation was only recently permitted for outpatient basis. However, no patient selection tool nor response predictor has been proposed. This study evaluated factors to find response predictor and determinant for the suitable patients. The retrospective study reviewed 47 eligible non-metastatic papillary DTC patients whose had first 30 mCi RAI ablation after total thyroidectomy. Age, gender, clinical stage, risk category, and pre-ablation serum thyroglobulin (Tg) level were among covariates analyzed to determine the patient selection factors; while the thyroid bed uptake on initial whole body scan (WBS) was later also included in determining RAI ablation response. Thirteen (28%) patients had a low risk (T1-2) while 23 (49%) and 11 (23%) had an intermediate (T3) or high risk (T4), respectively. Twenty-five patients were responders, and 22 were non-responders. All factors were similar between responders and non-responders except pre-ablation serum Tg level (p < 0.001). In multivariate analysis, pre-ablation serum Tg level was the only significant factor for both patient selection (odd ratio (OR) = 1.52, 95% confidence interval (CI) = 1.13-2.06) and response predictor (OR = 1.48; 95% CI = 1.12-1.95). With the cut-off of 5.4 ng/mL, pre-ablation serum Tg level predicts RAI ablation response with 92% specificity and 73% sensitivity. Pre-ablation serum Tg level may help patient selection and predict the response to outpatient 30 mCi RAI ablation among post total thyroidectomy non-metastatic DTC patients.

PMID: 29343651 [PubMed - as supplied by publisher]



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General Anesthesia Inhibits the Activity of the "Glymphatic System".

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General Anesthesia Inhibits the Activity of the "Glymphatic System".

Theranostics. 2018;8(3):710-722

Authors: Gakuba C, Gaberel T, Goursaud S, Bourges J, Di Palma C, Quenault A, de Lizarrondo SM, Vivien D, Gauberti M

Abstract
INTRODUCTION: According to the "glymphatic system" hypothesis, brain waste clearance is mediated by a continuous replacement of the interstitial milieu by a bulk flow of cerebrospinal fluid (CSF). Previous reports suggested that this cerebral CSF circulation is only active during general anesthesia or sleep, an effect mediated by the dilatation of the extracellular space. Given the controversies regarding the plausibility of this phenomenon and the limitations of currently available methods to image the glymphatic system, we developed original whole-brain in vivo imaging methods to investigate the effects of general anesthesia on the brain CSF circulation. METHODS: We used magnetic resonance imaging (MRI) and near-infrared fluorescence imaging (NIRF) after injection of a paramagnetic contrast agent or a fluorescent dye in the cisterna magna, in order to investigate the impact of general anesthesia (isoflurane, ketamine or ketamine/xylazine) on the intracranial CSF circulation in mice. RESULTS:In vivo imaging allowed us to image CSF flow in awake and anesthetized mice and confirmed the existence of a brain-wide CSF circulation. Contrary to what was initially thought, we demonstrated that the parenchymal CSF circulation is mainly active during wakefulness and significantly impaired during general anesthesia. This effect was especially significant when high doses of anesthetic agent were used (3% isoflurane). These results were consistent across the different anesthesia regimens and imaging modalities. Moreover, we failed to detect a significant change in the brain extracellular water volume using diffusion weighted imaging in awake and anesthetized mice. CONCLUSION: The parenchymal diffusion of small molecular weight compounds from the CSF is active during wakefulness. General anesthesia has a negative impact on the intracranial CSF circulation, especially when using a high dose of anesthetic agent.

PMID: 29344300 [PubMed - in process]



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A Comparative Study of Shift Work Effects and Injuries among Nurses Working in Rotating Night and Day Shifts in a Tertiary Care Hospital of North India.

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A Comparative Study of Shift Work Effects and Injuries among Nurses Working in Rotating Night and Day Shifts in a Tertiary Care Hospital of North India.

Iran J Nurs Midwifery Res. 2018 Jan-Feb;23(1):51-56

Authors: Verma A, Kishore J, Gusain S

Abstract
Background: Shift work can have an impact on the physical and psychological well-being of the healthcare worker, affecting patients as well as their own safety at the workplace. This study was conducted to compare the health outcomes and injuries, along with associated risk factors between the nurses working in rotating night shift (RNS) as compared to day shift (DS) only.
Materials and Methods: It was a cross-sectional study conducted from June to November 2016 in a tertiary care hospital of Delhi. It involved 275 nurses working in RNS and 275 nurses from DS of various departments, selected through simple random sampling. Standard Shift Work Index Questionnaire (SSI) was used as the study instrument, with selected variables (according to objectives of the study). Data were analyzed using descriptive statistics, Chi-square, t-test, and multivariate regression.
Results: Female nurses had more sleep disturbance, fatigue, and poor psychological health. Working on a contractual basis, RNS, and living outside the hospital campus were associated with higher odds of having needle stick injury (NSI). The nurses working in RNSs were found to have significantly lower mean scores in job satisfaction (p = 0.04), sleep (p < 0.001), and psychological well-being (p = 0.047) as compared to DS workers.
Conclusions: Health outcomes among nurses working in RNSs call for the interventions, focused on various factors which can be modified to provide supportive and safer working environment.

PMID: 29344047 [PubMed]



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Ethical Issues in Social Media Research for Public Health.

Ethical Issues in Social Media Research for Public Health.

Am J Public Health. 2018 Jan 18;:e1-e6

Authors: Hunter RF, Gough A, O'Kane N, McKeown G, Fitzpatrick A, Walker T, McKinley M, Lee M, Kee F

Abstract
Social media (SM) offer huge potential for public health research, serving as a vehicle for surveillance, delivery of health interventions, recruitment to trials, collection of data, and dissemination. However, the networked nature of the data means they are riddled with ethical challenges, and no clear consensus has emerged as to the ethical handling of such data. This article outlines the key ethical concerns for public health researchers using SM and discusses how these concerns might best be addressed. Key issues discussed include privacy; anonymity and confidentiality; authenticity; the rapidly changing SM environment; informed consent; recruitment, voluntary participation, and sampling; minimizing harm; and data security and management. Despite the obvious need, producing a set of prescriptive guidelines for researchers using SM is difficult because the field is evolving quickly. What is clear, however, is that the ethical issues connected to SM-related public health research are also growing. Most importantly, public health researchers must work within the ethical principles set out by the Declaration of Helsinki that protect individual users first and foremost. (Am J Public Health. Published online ahead of print January 18, 2018: e1-e6. doi:10.2105/AJPH.2017.304249).

PMID: 29346005 [PubMed - as supplied by publisher]



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Mimesis and clinical pictures: thinking with Plato and Broekman through the production and meaning of images of disease.

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Mimesis and clinical pictures: thinking with Plato and Broekman through the production and meaning of images of disease.

Med Health Care Philos. 2018 Jan 17;:

Authors: Oele M

Abstract
This paper contends, following Plato and Broekman, that (1) seeing images as images is crucial to theorizing medicine and that (2) considering clinical pictures as images of images is a much-needed epistemic complement to the domineering view that sees clinical pictures as mirrors of disease. This does not only offer epistemic, but also ethical benefits to individual patients, especially in those cases where patients suffer from chronic, debilitating, and terminal illnesses and where medicine provides no, or limited, answers in terms of treatment, intervention, and meaning. By creating room for a theory of clinical pictures that rightfully emphasizes its pictorial nature, patients and doctors alike may be encouraged to consider under what authorship, and with which epistemic tools, alternative, supplemental images may be produced to get at the existential reality of disease and suffering. Ultimately, this paper argues that the epistemic tools provided by aesthetics may offer such glimpses into the reality of disease and suffering, and I conclude by discussing a few artistic renditions of breast cancer to illustrate my point.

PMID: 29344910 [PubMed - as supplied by publisher]



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Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise (TRIANGLE): Study Protocol for a Randomised Controlled Trial.

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Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise (TRIANGLE): Study Protocol for a Randomised Controlled Trial.

Eur Eat Disord Rev. 2017 Nov;25(6):512-523

Authors: Cardi V, Ambwani S, Robinson E, Albano G, MacDonald P, Aya V, Rowlands K, Todd G, Schmidt U, Landau S, Arcelus J, Beecham J, Treasure J

Abstract
TRIANGLE is a multicentre trial investigating whether the addition of a novel intervention for patients and carers (ECHOMANTRA) to treatment as usual (TAU) improves outcomes for people with anorexia nervosa (AN). ECHOMANTRA is based on the cognitive interpersonal model of AN and includes assessments, workbooks, videos, online groups and joint Skype sessions for patients and carers. People receiving intensive hospital treatment (N = 380) will be randomised to TAU or TAU plus ECHOMANTRA. Participants will be assessed over an 18-month period following randomisation. The primary outcome is patient psychological well-being at 12 months postrandomisation. Secondary outcomes include (i) patient's weight, eating disorder symptoms, motivation to change, quality of life and number of days in hospital at 12 months postrandomisation and (ii) carer's psychological well-being, burden and skills at 12 months (some outcomes will be assessed at 18 months postrandomisation). The results from this trial will establish the effectiveness of ECHOMANTRA.
TRIAL REGISTRATION: ISRCTN registry ISRCTN14644379, 08/12/2016. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

PMID: 28944595 [PubMed - indexed for MEDLINE]



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Reply to the letter to the editor 'Specific QOL scales that reflect toxicity-induced impairment are needed in RCTs'.

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Reply to the letter to the editor 'Specific QOL scales that reflect toxicity-induced impairment are needed in RCTs'.

Ann Oncol. 2017 08 01;28(8):2033-2034

Authors: Schuurhuizen CSEW, Braamse AMJ, Konings IRHM, Sprangers MAG, Ket JCF, Dekker J, Verheul HMW

PMID: 28838215 [PubMed - indexed for MEDLINE]



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Uniform FDG-PET guided GRAdient Dose prEscription to reduce late Radiation Toxicity (UPGRADE-RT): study protocol for a randomized clinical trial with dose reduction to the elective neck in head and neck squamous cell carcinoma.

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Uniform FDG-PET guided GRAdient Dose prEscription to reduce late Radiation Toxicity (UPGRADE-RT): study protocol for a randomized clinical trial with dose reduction to the elective neck in head and neck squamous cell carcinoma.

BMC Cancer. 2017 Mar 21;17(1):208

Authors: van den Bosch S, Dijkema T, Kunze-Busch MC, Terhaard CH, Raaijmakers CP, Doornaert PA, Hoebers FJ, Vergeer MR, Kreike B, Wijers OB, Oyen WJ, Kaanders JH

Abstract
BACKGROUND: In definitive radiation therapy for head and neck cancer, clinically uninvolved cervical lymph nodes are irradiated with a so-called 'elective dose' in order to achieve control of clinically occult metastases. As a consequence of high-resolution diagnostic imaging, occult tumor volume has significantly decreased in the last decades. Since the elective dose is dependent on occult tumor volume, the currently used elective dose may be higher than necessary. Because bilateral irradiation of the neck contributes to dysphagia, xerostomia and hypothyroidism in a dose dependent way, dose de-escalation to these regions can open a window of opportunity to reduce toxicity and improve quality of life after treatment.
METHODS: UPGRADE-RT is a multicenter, phase III, single-blinded, randomized controlled trial. Patients to be treated with definitive radiation therapy for a newly diagnosed stage T2-4 N0-2 M0 squamous cell carcinoma of the oropharynx, hypopharynx or larynx are eligible. Exclusion criteria are recurrent disease, oncologic surgery to the head and neck area, concomitant chemotherapy or epidermal growth factor receptor inhibitors. In total, 300 patients will be randomized in a 2:1 ratio to a treatment arm with or without de-escalation of the elective radiation dose and introduction of an intermediate dose-level for selected lymph nodes. Radiation therapy planning FDG-PET/CT-scans will be acquired to guide risk assessment of borderline-sized cervical nodes that can be treated with the intermediate dose level. Treatment will be given with intensity-modulated radiation therapy or volumetric arc therapy with simultaneous-integrated boost using an accelerated fractionation schedule, 33 fractions in 5 weeks. The primary endpoint is 'normalcy of diet' at 1 year after treatment (toxicity). The secondary endpoint is the actuarial rate of recurrence in electively irradiated lymph nodes at 2 years after treatment (safety).
DISCUSSION: The objective of the UPGRADE-RT trial is to investigate whether de-escalation of elective radiation dose and the introduction of an intermediate dose-level for borderline sized lymph nodes in the treatment of head and neck cancer will result in less radiation sequelae and improved quality of life after treatment without compromising the recurrence rate in the electively treated neck.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02442375 .

PMID: 28327089 [PubMed - indexed for MEDLINE]



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Insomnia, Sleep Quality, and Quality of Life in Mild to Moderate Parkinson's Disease.

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Insomnia, Sleep Quality, and Quality of Life in Mild to Moderate Parkinson's Disease.

Ann Am Thorac Soc. 2017 Mar;14(3):412-419

Authors: Shafazand S, Wallace DM, Arheart KL, Vargas S, Luca CC, Moore H, Katzen H, Levin B, Singer C

Abstract
RATIONALE: Sleep disorders are prevalent in Parkinson's disease but underreported in clinical settings. The contribution of sleep disorders to health-related quality of life (HRQOL) for patients with this degenerative neurological disease are not well known.
OBJECTIVES: To evaluate the impact of insomnia symptoms, obstructive sleep apnea (OSA), and poor sleep quality on HRQOL in a cohort of patients with idiopathic Parkinson's disease.
METHODS: We enrolled a convenience sample of 66 adults seen in the University of Miami Movement Disorders Clinic between July 2011 and June 2013. Participants completed validated questionnaires to determine insomnia symptoms, OSA risk, depression, anxiety, and HRQOL. All patients underwent unattended polysomnography to confirm OSA. Results were compared for those with and without insomnia symptoms. Principal component and regression analyses were performed to evaluate determinants of HRQOL.
MEASUREMENTS AND MAIN RESULTS: Participants were predominately Hispanic males with mild to moderate Parkinson's disease. Insomnia symptoms were reported for 46% of the study subjects. OSA (apnea-hypopnea index, ≥5) was noted in 47%, with a mean apnea-hypopnea index of 8.3 ± 11.0. Fairly bad to very bad sleep quality was reported by 21% of the participants. Insomnia (r = 0.71; P < 0.001), daytime sleepiness (r = 0.36; P = 0.003), depression symptoms (r =  0.44; P < 0.001), and anxiety symptoms (r = 0.33; P = 0.006) were significant correlates of poor sleep quality. OSA, severity of Parkinson's disease, and dopaminergic therapy were not. In the principal component analysis, sleep quality was a significant component of the "psychological factor" that in turn was a significant determinant of overall HRQOL.
CONCLUSIONS: Insomnia symptoms, OSA, and subsequent poor sleep quality are prevalent in Parkinson's disease. In this single-center, exploratory study, we found that insomnia and poor sleep quality, but not OSA, play important roles in determining overall quality of life for patients with this disease. Clinical trial registered with www.clinicaltrials.gov (NCT02034357).

PMID: 28231027 [PubMed - indexed for MEDLINE]



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Perspective on pre- and post-natal agro-food exposure to persistent organic pollutants and their effects on quality of life.

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Perspective on pre- and post-natal agro-food exposure to persistent organic pollutants and their effects on quality of life.

Environ Int. 2017 Mar;100:79-101

Authors: Fernández-Cruz T, Martínez-Carballo E, Simal-Gándara J

Abstract
BACKGROUND: Adipose tissue constitutes a continual source of internal exposure to organic pollutants (OPs). When fats mobilize during pregnancy and breastfeeding, OPs could affect foetal and neonatal development, respectively.
SCOPE AND APPROACH: The main aim of this review is to deal with pre- and post-natal external exposure to organic pollutants and their effects on health, proposing prevention measures to reduce their risk. The goal is the development of a biomonitoring framework program to estimate their impact on human health, and prevent exposure by recommending some changes in personal lifestyle habits.
KEY FINDINGS AND CONCLUSIONS: It has been shown that new studies should be developed taking into account their cumulative effect and the factors affecting their body burden. In conclusion, several programs should continuously be developed by different health agencies to have a better understanding of the effect of these substances and to develop a unified public policy.

PMID: 28089279 [PubMed - indexed for MEDLINE]



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Accelerating Scientific Advancement for Pediatric Rare Lung Disease Research. Report from a National Institutes of Health-NHLBI Workshop, September 3 and 4, 2015.

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Accelerating Scientific Advancement for Pediatric Rare Lung Disease Research. Report from a National Institutes of Health-NHLBI Workshop, September 3 and 4, 2015.

Ann Am Thorac Soc. 2016 Dec;13(12):385-393

Authors: Young LR, Trapnell BC, Mandl KD, Swarr DT, Wambach JA, Blaisdell CJ

Abstract
Pediatric rare lung disease (PRLD) is a term that refers to a heterogeneous group of rare disorders in children. In recent years, this field has experienced significant progress marked by scientific discoveries, multicenter and interdisciplinary collaborations, and efforts of patient advocates. Although genetic mechanisms underlie many PRLDs, pathogenesis remains uncertain for many of these disorders. Furthermore, epidemiology and natural history are insufficiently defined, and therapies are limited. To develop strategies to accelerate scientific advancement for PRLD research, the NHLBI of the National Institutes of Health convened a strategic planning workshop on September 3 and 4, 2015. The workshop brought together a group of scientific experts, intramural and extramural investigators, and advocacy groups with the following objectives: (1) to discuss the current state of PRLD research; (2) to identify scientific gaps and barriers to increasing research and improving outcomes for PRLDs; (3) to identify technologies, tools, and reagents that could be leveraged to accelerate advancement of research in this field; and (4) to develop priorities for research aimed at improving patient outcomes and quality of life. This report summarizes the workshop discussion and provides specific recommendations to guide future research in PRLD.

PMID: 27925785 [PubMed - indexed for MEDLINE]



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Half-century of Dental Public Health research: bibliometric analysis of world scientific trends.

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Half-century of Dental Public Health research: bibliometric analysis of world scientific trends.

Community Dent Oral Epidemiol. 2016 Dec;44(6):557-563

Authors: Celeste RK, Broadbent JM, Moyses SJ

Abstract
OBJECTIVES: To describe the characteristics of Dental Public Health (DPH) scientific publications within core DPH journals over time and to compare DPH journals with DPH content from other journal types.
METHODS: The Scopus database was used to identify DPH-relevant articles published from 1965 to 2014 in three core DPH journals (DPHJs) and from 2005 to 2014 in Dental Journals (DJs), Public Health (PHJs) and General Journals (GJs). To identify DPH-relevant articles, a search strategy with words about oral health and public health was applied to each group of journals. Research themes were created by grouping similar keywords to report changes in the focus of articles over time. The most productive journals, countries, institutions and authors were also estimated for each set of journals.
RESULTS: In 2005-2014, 60 297 articles were identified, of which 2.7% in DPHJs, 10.4% from PHJs, 38.2% from GJs and 48.7% from DJs. DPH-relevant articles published in the core DPHJs, DJs and PHJs tended to share a strong emphasis on dental caries, healthcare/services research on children and adolescents. Over time, the focus in the DPHJs has increased towards health behaviour/promotion/education, quality of life and socioeconomic factors. In the last decade, those themes were more frequent in DPH journals than in the other groups.
CONCLUSIONS: DPH research published in DPHJs had some unique features and greater focus on the themes of quality of life, socioeconomic factors and health behaviour/education/promotion than other groups of journals.

PMID: 27500895 [PubMed - indexed for MEDLINE]



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Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study.

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Psychometric assessment of the short-form Child Perceptions Questionnaire: an international collaborative study.

Community Dent Oral Epidemiol. 2016 Dec;44(6):549-556

Authors: Thomson WM, Foster Page LA, Robinson PG, Do LG, Traebert J, Mohamed AR, Turton BJ, McGrath C, Bekes K, Hirsch C, Del Carmen Aguilar-Diaz F, Marshman Z, Benson PE, Baker SR

Abstract
OBJECTIVE: To examine the factor structure and other psychometric characteristics of the most commonly used child oral-health-related quality-of-life (OHRQoL) measure (the 16-item short-form CPQ11-14 ) in a large number of children (N = 5804) from different settings and who had a range of caries experience and associated impacts.
METHODS: Secondary data analyses used subnational epidemiological samples of 11- to 14-year-olds in Australia (N = 372), New Zealand (three samples: 352, 202, 429), Brunei (423), Cambodia (244), Hong Kong (542), Malaysia (439), Thailand (220, 325), England (88, 374), Germany (1055), Mexico (335) and Brazil (404). Confirmatory factor analysis (CFA) was used to examine the factor structure of the CPQ11-14 across the combined sample and within four regions (Australia/NZ, Asia, UK/Europe and Latin America). Item impact and internal reliability analysis were also conducted.
RESULTS: Caries experience varied, with mean DMFT scores ranging from 0.5 in the Malaysian sample to 3.4 in one New Zealand sample. Even more variation was noted in the proportion reporting only fair or poor oral health; this was highest in the Cambodian and Mexican samples and lowest in the German sample and one New Zealand sample. One in 10 reported that their oral health had a marked impact on their life overall. The CFA across all samples revealed two factors with eigenvalues greater than 1. The first involved all items in the oral symptoms and functional limitations subscales; the second involved all emotional well-being and social well-being items. The first was designated the 'symptoms/function' subscale, and the second was designated the 'well-being' subscale. Cronbach's alpha scores were 0.72 and 0.84, respectively. The symptoms/function subscale contained more of the items with greater impact, with the item 'Food stuck in between your teeth' having greatest impact; in the well-being subscale, the 'Felt shy or embarrassed' item had the greatest impact. Repeating the analyses by world region gave similar findings.
CONCLUSION: The CPQ11-14 performed well cross-sectionally in the largest analysis of the scale in the literature to date, with robust and mostly consistent psychometric characteristics, albeit with two underlying factors (rather than the originally hypothesized four-factor structure). It appears to be a sound, robust measure which should be useful for research, practice and policy.

PMID: 27477903 [PubMed - indexed for MEDLINE]



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A resilience intervention involving mindfulness training for transplant patients and their caregivers.

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A resilience intervention involving mindfulness training for transplant patients and their caregivers.

Clin Transplant. 2016 Nov;30(11):1466-1472

Authors: Stonnington CM, Darby B, Santucci A, Mulligan P, Pathuis P, Cuc A, Hentz JG, Zhang N, Mulligan D, Sood A

Abstract
Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness-based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness-based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6-week mindfulness-based resilience training (MBRT) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty-one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health-related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant (P<.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality-of-life mental component (P=.006) and positive affect (P=.02) also improved at follow-up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well-being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.

PMID: 27618687 [PubMed - indexed for MEDLINE]



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The Clinical Significance of Collateral Ventilation.

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The Clinical Significance of Collateral Ventilation.

Ann Am Thorac Soc. 2016 Dec;13(12):2251-2257

Authors: Terry PB, Traystman RJ

Abstract
Oxygen delivery and carbon dioxide removal being critical to cell survival, mammals have developed collateral vascular and ventilation systems to ensure tissue viability. Collateral ventilation, defined as ventilation of alveoli via pathways that bypass normal airways, is present in humans and many other species. The presence of collateral ventilation can be beneficial in certain disease states, whereas its relative absence can predispose to other diseases. These well defined anatomical pathways contribute little to ventilation in normal humans, but modulate ventilation perfusion imbalance in a variety of diseases, including obstructive diseases, such as asthma and emphysema. These pathways can be affected by pharmaceuticals and inhaled gas compositions. The middle lobe and lingula, constrained by their isolated, segmental anatomy, have reduced collateral ventilation, which predisposes them to disease. Recently, attempts to improve the quality of life of patients with emphysema, by performing nonsurgical lung volume reduction via use of endobronchial valves, have led to mixed results, because the role of collateral ventilation in the success or failure of the procedure was not initially appreciated. This review describes the anatomical pathways of collateral ventilation, their physiology and relationship to disease states, their modulatory effects on gas exchange, treatment considerations, and their effect on diagnostic procedures.

PMID: 27739872 [PubMed - indexed for MEDLINE]



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Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.

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Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.

Surg Endosc. 2017 May;31(5):2109-2121

Authors: Patel LY, Lapin B, Gitelis ME, Brown C, Linn JG, Haggerty S, Denham W, Butt Z, Barrera E, Joehl R, Carbray J, Hall T, Ujiki MB

Abstract
BACKGROUND: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools.
METHODS: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression.
RESULTS: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors.
CONCLUSIONS: Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.

PMID: 27585467 [PubMed - indexed for MEDLINE]



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Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias.

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Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias.

Surg Endosc. 2017 May;31(5):2096-2102

Authors: Rona KA, Reynolds J, Schwameis K, Zehetner J, Samakar K, Oh P, Vong D, Sandhu K, Katkhouda N, Bildzukewicz N, Lipham JC

Abstract
BACKGROUND: Magnetic sphincter augmentation (MSA) has demonstrated long-term safety and efficacy in the treatment of patients with gastroesophageal reflux (GERD), but its efficacy in patients with large hiatal hernias has yet to be proven. The aim of our study was to assess outcomes of MSA in patients with hiatal hernias ≥3 cm.
METHODS: We retrospectively reviewed all patients who underwent MSA at our institutions over a 6-year period. Information obtained consisted of patient demographics, symptoms of GERD, preoperative GERD Health-Related Quality-of-Life (HRQL) scores, perioperative details, and implantation of the MSA device. Primary endpoints included postoperative GERD-HRQL scores, proton-pump inhibitor (PPI) use, symptom change, and procedure-related complications. A large hiatal hernia was defined as a hernia measuring ≥3 cm by intraoperative measurement.
RESULTS: A total of 192 patients were reviewed. Median follow-up was 20 months (3-75 months). Mean GERD-HRQL scores in the overall population before and after MSA were 18.9 and 5.0, respectively (p < 0.001). In the majority of patients symptoms improved or resolved (N = 177, p < 0.001). Fifty-two patients (27.0 %) had a hiatal hernia ≥3 cm (range 3-7 cm). Their mean GERD-HRQL score decreased from 20.5 to 3.6 (p < 0.001) following MSA. When compared to patients with smaller hernias, patients with large hiatal hernias had decreased postoperative PPI requirement (9.6 vs. 26.6 %, p = 0.011) and lower mean postoperative GERD-HRQL scores (3.6 vs. 5.6, p = 0.027). The percent of patients requiring postoperative intervention for dysphagia was similar (13.5 vs. 17.9 %, p = 0.522), as was the incidence of symptom resolution or improvement (98.1 vs. 91.3 %, p = 0.118).
CONCLUSION: MSA in patients with large hiatal hernias demonstrates decreased postoperative PPI requirement and mean GERD-HRQL scores compared to patients with smaller hernias. The incidence of symptom resolution or improvement and the percentage of patients requiring intervention for dysphagia are similar. Short-term outcomes of MSA are encouraging in patients with gastroesophageal reflux disease and large hiatal hernias.

PMID: 27553803 [PubMed - indexed for MEDLINE]



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Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight.

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Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight.

Int J Obes (Lond). 2016 Aug;40(8):1268-77

Authors: Melasch J, Rullmann M, Hilbert A, Luthardt J, Becker GA, Patt M, Stumvoll M, Blüher M, Villringer A, Arelin K, Meyer PM, Bresch A, Sabri O, Hesse S, Pleger B

Abstract
BACKGROUND/OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress related to weight remain largely unknown.
PARTICIPANTS/METHODS: Here we combined positron emission tomography, using the serotonin transporter (5-HTT) radiotracer [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile, with functional connectivity magnetic resonance imaging, the Beck Depression Inventory (BDI-II) and the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) to investigate the role of central serotonin in the severity of depression (BDI-II), as well as in the loss of emotional well-being with body weight (IWQOL-Lite).
RESULTS: In a group of lean to morbidly obese individuals (n=28), we found sex differences in the 5-HTT availability-related connectivity of the hypothalamus. Males (n=11) presented a strengthened connectivity to the lateral orbitofrontal cortex, whereas in females (n=17) we found strengethened projections to the ventral striatum. Both regions are known as reward regions involved in mediating the emotional response to food. Their resting-state activity correlated positively to the body mass index (BMI) and IWQOL-Lite scores, suggesting that each region in both sexes also underpins a diminished sense of emotional well-being with body weight. Contrarily to males, we found that in females also the BDI-II positively correlated with the BMI and by trend with the activity in ventral striatum, suggesting that in females an increased body weight may convey to other mood dimensions than those weight-related ones included in the IWQOL-Lite.
CONCLUSIONS: This study suggests sex differences in serotonin-hypothalamic connections to brain regions of the reward circuitry underpinning a diminished sense of emotional well-being with an increasing body weight.

PMID: 27102051 [PubMed - indexed for MEDLINE]



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The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight.

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The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight.

Int J Obes (Lond). 2016 May;40(5):779-87

Authors: Melasch J, Rullmann M, Hilbert A, Luthardt J, Becker GA, Patt M, Villringer A, Arelin K, Meyer PM, Lobsien D, Ding YS, Müller K, Sabri O, Hesse S, Pleger B

Abstract
OBJECTIVES: The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered.
METHODS: In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite).
RESULTS: In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was.
CONCLUSIONS: This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.

PMID: 26620766 [PubMed - indexed for MEDLINE]



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Association of Surgeons in Training responds to GMC erasure case

The case of Hadiza Bawa-Garba highlights problems with the developing blame culture, the use of a junior doctor’s educational reflective practice in court, and senior supervision.1In November 2016,...
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Chronic hip pain

A 55 year old woman presented to her general practitioner with a six month history of pain over the lateral aspect of her left hip in the trochanteric region. She described the pain as “a niggling...
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Management of incidental adrenal tumours

What you need to knowAn adrenal incidentaloma is an adrenal lesion found incidentally in asymptomatic patients undergoing imaging scans not performed for suspected adrenal disease. Adrenal...
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Issue Information



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A Critical Review of the Consensus Statement from the European Atherosclerosis Society Consensus Panel 2017

Background: The Consensus Statement from the European Atherosclerosis Society (EAS) Consensus Panel 2017 concludes on the basis of 3 different types of clinical studies that low-density lipoprotein (LDL) causes atherosclerotic cardiovascular disease (ASCVD). In Mendelian randomization studies, rare genetic mutations affecting LDL receptor function were found to cause higher or lower LDL-C levels, which are associated with correspondingly altered ASCVD risk. In prospective cohort studies and randomized controlled trials (RCTs) of statins, a remarkably consistent log-linear association was demonstrated between the absolute magnitude of LDL-C exposure and ASCVD risk. The EAS Statement proposes that any mechanism of lowering plasma LDL concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C. However, as we explain, we do not find this conclusion acceptable. Summary: Our review points out that different interpretations are possible for the results of Mendelian randomization studies. As for prospective cohort studies, many inconsistent reports on the association of LDL-C and ASCVD were disregarded when drafting the Statement, reports with and without genetic factors related to LDL receptor function should be analyzed separately, and the term ASCVD in the Statement is used inappropriately because myocardial infarction and cerebral infarction differ in their association with LDL-C. As for RCTs, clinical reports on statins published before and after the implementation of new regulations affecting clinical trials (2004/2005) should not both be included in meta-analyses because the evaluated efficacy of statins changed markedly, and the irreversible adverse effects of statins need to be evaluated more rigorously now that their mechanisms have been elucidated. Key Messages: Apart from the EAS hypothesis that LDL causes ASCVD, recent pharmacological/biochemical studies, as summarized in this review and elsewhere, have revealed that atherosclerosis is caused by statins taken to lower LDL-C, as well as by warfarin and some types of vegetable fats and oils, in the absence of significantly elevated LDL-C levels. Thus, the promotion of statin treatment by the Statement is rather risky and we do not feel that the conclusions are justified for the prevention of ASCVD.
Pharmacology 2018;101:184–218

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Stereoselective Inhibition of Renal Basolateral Human Organic Anion Transporter 3 by Lansoprazole Enantiomers

Lansoprazole, a proton pump inhibitor, potently inhibits human organic anion transporter, hOAT3 (SLC22A8). Lansoprazole has an asymmetric atom in its structure and is clinically administered as a racemic mixture of (R)-and (S)-enantiomers. However, little is known about the stereoselective inhibitory potencies of lansoprazole against hOAT3 and its homolog, hOAT1. In the present study, the stereoselective inhibitory effect of lansoprazole was evaluated using hOAT1-and hOAT3-expressing cultured cells. hOAT1 and hOAT3 transported [14C]p-aminohippurate and [3H]estrone-3-sulfate (ES) with Michaelis-Menten constants of 29.8 ± 4.0 and 30.1 ± 9.0 µmol/L respectively. Lansoprazole enantiomers inhibited hOAT1- and hOAT3-mediated transport of each substrate in a concentration-dependent manner. The IC50 value of (S)-lansoprazole against hOAT3-mediated transport of [3H]ES (0.61 ± 0.08 µmol/L) was significantly lower than that of (R)-lansoprazole (1.75 ± 0.31 µmol/L). In contrast, stereoselectivity was not demonstrated for the inhibition of hOAT1. Furthermore, (S)-lansoprazole inhibited hOAT3-mediated transport of pemetrexed and methotrexate (hOAT3 substrates) more strongly than the corresponding (R)-lansoprazole. This study is the first to demonstrate that the stereoselective inhibitory potency of (S)-lansoprazole against hOAT3 is greater than that of (R)-lansoprazole. The present findings provide novel information about the drug interactions associated with lansoprazole.
Pharmacology 2018;101:176–183

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The burden of non-melanoma skin cancers in Auckland, New Zealand

Abstract

Background/Objectives

As the New Zealand Cancer Registry does not require mandatory reporting of non-melanoma skin cancers (NMSC), basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), the clinical burden of these diseases is unknown.

Methods

A retrospective review of all patients with histopathology performed allowed us to estimate invasive BCC and SCC in the Auckland region in 2008 (population 1.44 million).

Results

During this period, a total of 21 236 NMSC were diagnosed among 13 996 patients, consisting of 5611 SCC lesions (26%) and 15 525 (74%) BCC. The Auckland incidence rates per 100 000 were 425 for SCC and 1177 for BCC. The overall rate of NMSC per 100 000 was 1906.5 (standardised to the census data of Australia 2001); 1385 for BCC and 522 for SCC. Using published data on incidence trends and population growth, we estimate that 29 000–33 000 NMSC would have been excised in Auckland in 2016, and 78 000–87 000 in New Zealand.

Conclusion

Auckland has the highest reported incidence of invasive NMSC in the world. We believe that high-risk cutaneous SCC and complex BCC should be recorded. Our study provides information for clinicians and health economists on the scale of the problem.



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Risikofaktoren

Risikofaktoren spielen eine wichtige Rolle in der Vorhersage und Prävention von psychischen Störungen. Klare und präzise Definitionen der Risikobegriffe sind Voraussetzung für die korrekte Interpretation und das Verständnis von Resultaten und damit auch für eine klare und präzise Kommunikation von Befunden über Risikofaktoren. Dies gilt sowohl in der Wissenschaft als auch in den Medien, gegenüber der Allgemeinbevölkerung wie auch den Patienten. Gleichwohl ist die Verwendung von unpräziser Sprache sogar im Bereich der Risikoforschung nicht selten und Begrifflichkeiten wie Risiko, Risikofaktoren und Ursachen werden inkonsistent gebraucht. Ziel dieses Artikels ist es, einen Überblick über zentrale Begriffe und Konzepte im Bereich der epidemiologischen Risikoforschung zu geben. Wir werden uns dafür vor allem auf die Definition von Kraemer et al. stützen.

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Conjunctival Dirofilariasis Causing Symptoms for 1 Day

No abstract available

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Multiple Eyelid Cysts (Apocrine and Eccrine Hidrocystomas, Trichilemmal Cyst, and Hybrid Cyst) in a Patient With a Prolactinoma

A 53-year-old man presented with smooth-domed, variegated cysts (polycystic disease) of all 4 eyelids, worse on the left side. Some of the cysts were clear, while others were creamy-white colored. In addition, multiple, very fine vesicopapules were noted along the eyelid margins. Histopathologic examination revealed a trichilemmal cyst, several pure apocrine hidrocystomas displaying multiple chambers, a hybrid cyst, and many small eccrine cysts of the deep dermis. The apocrine lesions, including the small ones at the eyelid margins, predominated. Smooth muscle actin sometimes positively stained outer myoepithelial cells in some of the apocrine cysts, which helped to distinguish them from eccrine cysts. Most noteworthy was the fact that the patient had been diagnosed with a prolactinoma 20 years earlier. There is only 1 previous report of multiple apocrine cysts and an antecedent prolactinoma in the dermatologic literature. This syndrome should be separated from that of Schöpf–Schulz–Passarge, which manifests multiple small eyelid apocrine cysts and other ectodermal dysplasias without any association with neoplasia, and from that of focal dermal hypoplasia (Goltz–Gorlin) syndrome with apocrine cysts but again without neoplasia. Accepted for publication December 20, 2017. Supported by the Heed Fellowship (to N.W.). The authors have no conflicts of interest to disclose. Address correspondence and reprint requests to Frederick A. Jakobiec, M.D., D.Sc., David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street Suite 208, Boston, MA 02114. E-mail: Fred_Jackobiec@meei.harvard.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Scientists identify potential target genes to halt progression of thyroid cancer

Thyroid cancer is a disease with good cure rates in most cases. In 5% of patients, however, the tumour becomes refractory to the available therapies and may spread all over the body, causing death. In a study conducted at the University of São Paulo's...

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Cancer gene screening more cost effective in the general population than high-risk groups

A study published in the Journal of the National Cancer Institute indicates that screening the general population for mutations in specific genes is a more cost effective way to detect people at risk and prevents more breast and ovarian cancers compared...

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More evidence of link between severe gum disease and cancer risk

Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by researchers at the Johns Hopkins Bloomberg...

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Two new breast cancer genes emerge from lynch syndrome gene study

Researchers at Columbia University Irving Medical Center and NewYork-Presbyterian have identified two new breast cancer genes. Having one of the genes--MSH6 and PMS2--approximately doubles a woman's risk of developing breast cancer by age 60. The study...

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Can mice really mirror humans when it comes to cancer?

A new Michigan State University study is helping to answer a pressing question among scientists of just how close mice are to people when it comes to researching cancer. The findings, now published in PLOS Genetics, reveal how mice can actually mimic...

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Generalised screening for multiple cancer types

Researchers have developed a noninvasive blood test based on combined analysis of DNA and proteins that may allow earlier detection of eight common cancer types. In more than 1,000 patients, their method detected cancer with a sensitivity of 69 to 98%...

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Erythrocytes and Skeletal Muscle Unsaturated and Omega-6 Fatty Acids Are Positively Correlated after Caloric Restriction and Exercise

Background: Nutritional intervention studies with fatty acid (FA) supplements assess the efficacy of the intervention by measuring the changes in erythrocyte membrane lipid profiles reflected in tissue composition changes. The aim was to determine the effects of caloric restriction (CR) on erythrocytes lipid composition and to compare and correlate these changes with skeletal muscle acid profiles after CR. Methods: Erythrocytes were obtained from 11 healthy men before and after 4 weeks of 33% CR in post-exercise conditions; muscle biopsies were obtained from the same athletes after 4 weeks of 33% CR in post-exercise conditions. Samples were used for FA determination by chromatography. Results: CR significantly modified erythrocyte FAs composition. Skeletal muscle FA profile was significantly different from that for the erythrocytes. The erythrocyte FA profile was more saturated (52.1 ± 1.5% and 32.8 ± 0.9%, respectively) and less monounsaturated (21.0 ± 0.8% and 39.0 ± 2.0%, respectively) than the skeletal muscle FA profile and similarly polyunsaturated. Conclusions: CR modifies erythrocyte lipid composition, mainly omega-6 FAs. Erythrocyte monounsaturated, polyunsaturated and omega-6 FAs, but not the saturated and omega-3 FAs, were significantly positively correlated with skeletal muscle FAs. There is a discordance between saturated and omega-3 FAs from erythrocyte and from muscle, but monounsaturated, polyunsaturated and omega-6 fatty acids are positively correlated.
Ann Nutr Metab 2018;72:126–133

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Long-term changes in multimodal intensive tinnitus therapy

Abstract

Background

We present 5‑year follow-up data for tinnitus-specific and comorbid depressive symptoms as well as stress-related outcome variables of an intensive multimodal 7‑day tinnitus therapy.

Method

Tinnitus burden (Tinnitus Questionnaire), stress (Perceived Stress Questionnaire), and depressive symptomatology (General Depression Scale) were measured at the 5‑year follow-up after a multimodal intensive 7‑day intervention. In all, 94 patients participated in the study.

Results

All outcome variables showed significant improvement at the end of the 7‑day intensive treatment. These effects remained significant after 5 years.

Conclusion

The results of the present study support the effectiveness of the 7‑day multimodal intensive therapy for tinnitus. Posttreatment improvements were related to both tinnitus burden as well as stress and depressive symptoms and were maintained at the 5‑year follow-up.



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Semiprone position is superior to supine position for paediatric endotracheal intubation during massive regurgitation, a randomized crossover simulation trial

Endotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management. Gastric contents tend to block suction catheters, and few treatment alternatives exist. Bas...

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RT @CancerworldESO : “We must have the honesty to admit to patients that our current research models are not patient centred” @EORTC ’s Denis…

RT @CancerworldESO : “We must have the honesty to admit to patients that our current research models are not patient centred” @EORTC ’s Denis…

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More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

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More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

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More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

More on the new cancer screening blood test from @bbchealth - this test can spot cancers up to one year early.… https://t.co/9OkDWsiKhM

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://twitter.com/ecancer/status/954283315565072384
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A new blood test to for 8 types of cancer is "enormously exciting" . https://t.co/ApM1N3NUqa #news #cancer… https://t.co/TxJTokdSkO

A new blood test to for 8 types of cancer is "enormously exciting" . https://t.co/ApM1N3NUqa #news #cancer… https://t.co/TxJTokdSkO

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://twitter.com/ecancer/status/954283110379778048
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JCDD, Vol. 5, Pages 4: Imaging of PDE2- and PDE3-Mediated cGMP-to-cAMP Cross-Talk in Cardiomyocytes

JCDD, Vol. 5, Pages 4: Imaging of PDE2- and PDE3-Mediated cGMP-to-cAMP Cross-Talk in Cardiomyocytes

Journal of Cardiovascular Development and Disease doi: 10.3390/jcdd5010004

Authors: Nikoleta Pavlaki Viacheslav Nikolaev

Cyclic nucleotides 3′,5′-cyclic adenosine monophosphate (cAMP) and 3′,5′-cyclic guanosine monophosphate (cGMP) are important second messengers that regulate cardiovascular function and disease by acting in discrete subcellular microdomains. Signaling compartmentation at these locations is often regulated by phosphodiesterases (PDEs). Some PDEs are also involved in the cross-talk between the two second messengers. The purpose of this review is to summarize and highlight recent findings about the role of PDE2 and PDE3 in cardiomyocyte cyclic nucleotide compartmentation and visualization of this process using live cell imaging techniques.



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How can nurses flu vaccination rates be boosted?

Why are influenza vaccination rates among health care workers, particularly nurses, so low? What can be done about it? Because of the threat influenza poses to vulnerable patients, should the influenza vaccination be the required default position for all health care workers? Where do the requirements of the Health and Safety Act fit? This article considers these issues.

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Að færa út veginn: Um samrýmanleika heimspeki Derrida og kínverskrar heimspekiorðræðu (Broadening the Way: On Commensurability between Derrida's Philosophy and Chinese Philosophical Narratives)



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Bookreview: Nevo et al. 2002: Evolution of wild emmer and wheat improvement



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Chemosensors, Vol. 6, Pages 5: Raman and Surface-Enhanced Raman Scattering for Biofilm Characterization

Chemosensors, Vol. 6, Pages 5: Raman and Surface-Enhanced Raman Scattering for Biofilm Characterization

Chemosensors doi: 10.3390/chemosensors6010005

Authors: Seda Keleştemur Ertug Avci Mustafa Çulha

Biofilms are a communal way of living for microorganisms in which microorganism cells are surrounded by extracellular polymeric substances (EPS). Most microorganisms can live in biofilm form. Since microorganisms are everywhere, understanding biofilm structure and composition is crucial for making the world a better place to live, not only for humans but also for other living creatures. Raman spectroscopy is a nondestructive technique and provides fingerprint information about an analyte of interest. Surface-enhanced Raman spectroscopy is a form of this technique and provides enhanced scattering of the analyte that is in close vicinity of a nanostructured noble metal surface such as silver or gold. In this review, the applications of both techniques and their combination with other biofilm analysis techniques for characterization of composition and structure of biofilms are discussed.



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A new blood test to for 8 types of cancer is "enormously exciting" - meet CancerSEEK: https://t.co/HGChZHslbr …… https://t.co/GhNNwU3HA0

A new blood test to for 8 types of cancer is "enormously exciting" - meet CancerSEEK: https://t.co/HGChZHslbr …… https://t.co/GhNNwU3HA0

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More on #CancerSEEK from @bbchealth - the test that can spot cancers up to one year early. #cancer #healthcarehttps://t.co/fUNmZPKTZf

More on #CancerSEEK from @bbchealth - the test that can spot cancers up to one year early. #cancer #healthcare https://t.co/fUNmZPKTZf

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IJERPH, Vol. 15, Pages 157: Diabetic Retinopathy Screening: A Systematic Review on Patients’ Non-Attendance

IJERPH, Vol. 15, Pages 157: Diabetic Retinopathy Screening: A Systematic Review on Patients’ Non-Attendance

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010157

Authors: Rahima Kashim Paul Newton Omorogieva Ojo

Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on ‘patients’ non-attendance at retinal screening’, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5–13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not.



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IJMS, Vol. 19, Pages 300: Changes in the Expression of AQP4 and AQP9 in the Hippocampus Following Eclampsia-Like Seizure

IJMS, Vol. 19, Pages 300: Changes in the Expression of AQP4 and AQP9 in the Hippocampus Following Eclampsia-Like Seizure

International Journal of Molecular Sciences doi: 10.3390/ijms19010300

Authors: Xinjia Han Qian Huang Lei Liu Xiaoyan Sha Bihui Hu Huishu Liu

Eclampsia is a hypertensive disorder of pregnancy that is defined by the new onset of grand mal seizures on the basis of pre-eclampsia. Until now, the mechanisms underlying eclampsia were poorly understood. Brain edema is considered a leading cause of eclamptic seizures; aquaporins (AQP4 and AQP9), the glial water channel proteins mainly expressed in the nervous system, play an important role in brain edema. We studied AQP4 and AQP9 expression in the hippocampus of pre-eclamptic and eclamptic rats in order to explore the molecular mechanisms involved in brain edema. Using our previous animal models, we found several neuronal deaths in the hippocampal CA1 and CA3 regions after pre-eclampsia and that eclampsia induced more neuronal deaths in both areas by Nissl staining. In the current study, RT-PCR and Western blotting data showed significant upregulation of AQP4 and AQP9 mRNA and protein levels after eclamptic seizures in comparison to pre-eclampsia and at the same time AQP4 and AQP9 immunoreactivity also increased after eclampsia. These findings showed that eclamptic seizures induced cell death and that upregulation of AQP4 and AQP9 may play an important role in this pathophysiological process.



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IJMS, Vol. 19, Pages 298: Cyclin B3 Deficiency Impairs Germline Stem Cell Maintenance and Its Overexpression Delays Cystoblast Differentiation in Drosophila Ovary

IJMS, Vol. 19, Pages 298: Cyclin B3 Deficiency Impairs Germline Stem Cell Maintenance and Its Overexpression Delays Cystoblast Differentiation in Drosophila Ovary

International Journal of Molecular Sciences doi: 10.3390/ijms19010298

Authors: Dongsheng Chen Lijuan Zhou Fuling Sun Mingzhong Sun Xiaoqian Tao

It is well known that cyclin B3 (cycB3) plays a key role in the control of cell cycle progression. However, whether cycB3 is involved in stem cell fate determination remains unknown. The Drosophila ovary provides an exclusive model for studying the intrinsic and extrinsic factors that modulate the fate of germline stem cells (GSCs). Here, using this model, we show that Drosophila cycB3 plays a new role in controlling the fate of germline stem cells (GSC). Results from cycB3 genetic analyses demonstrate that cycB3 is intrinsically required for GSC maintenance. Results from green fluorescent protein (GFP)-transgene reporter assays show that cycB3 is not involved in Dad-mediated regulation of Bmp signaling, or required for dpp-induced bam transcriptional silencing. Double mutants of bam and cycB3 phenocopied bam single mutants, suggesting that cycB3 functions in a bam-dependent manner in GSCs. Deficiency of cycB3 fails to cause apoptosis in GSCs or influence cystoblast (CB) differentiation into oocytes. Furthermore, overexpression of cycB3 dramatically increases the CB number in Drosophila ovaries, suggesting that an excess of cycB3 function delays CB differentiation. Given that the cycB3 gene is evolutionarily conserved, from insects to humans, cycB3 may also be involved in controlling the fate of GSCs in humans.



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Cancers, Vol. 10, Pages 23: mTOR Cross-Talk in Cancer and Potential for Combination Therapy

Cancers, Vol. 10, Pages 23: mTOR Cross-Talk in Cancer and Potential for Combination Therapy

Cancers doi: 10.3390/cancers10010023

Authors: Fabiana Conciatori Ludovica Ciuffreda Chiara Bazzichetto Italia Falcone Sara Pilotto Emilio Bria Francesco Cognetti Michele Milella

The mammalian Target of Rapamycin (mTOR) pathway plays an essential role in sensing and integrating a variety of exogenous cues to regulate cellular growth and metabolism, in both physiological and pathological conditions. mTOR functions through two functionally and structurally distinct multi-component complexes, mTORC1 and mTORC2, which interact with each other and with several elements of other signaling pathways. In the past few years, many new insights into mTOR function and regulation have been gained and extensive genetic and pharmacological studies in mice have enhanced our understanding of how mTOR dysfunction contributes to several diseases, including cancer. Single-agent mTOR targeting, mostly using rapalogs, has so far met limited clinical success; however, due to the extensive cross-talk between mTOR and other pathways, combined approaches are the most promising avenues to improve clinical efficacy of available therapeutics and overcome drug resistance. This review provides a brief and up-to-date narrative on the regulation of mTOR function, the relative contributions of mTORC1 and mTORC2 complexes to cancer development and progression, and prospects for mTOR inhibition as a therapeutic strategy.



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Proanthocyanidins and the risk of prostate cancer in Italy

Abstract

Proanthocyanidins are polymers of monomeric unit flavan-3-ols with antioxidant, anti-inflammatory and free radical scavenging activities. We investigated the association between proanthocyanidin intake and prostate cancer risk through data that were collected between 1991 and 2002 in an Italian case–control study, including a total of 1,294 incident, histologically confirmed cases of prostate cancer and 1,451 controls admitted to hospital for acute, non-neoplastic, and non-hormone-related diseases. We estimated odds ratios (ORs) and their 95% confidence intervals (CIs) using multiple logistic regression models, and computed energy-adjusted proanthocyanidin intakes using the residual method. The ORs for the highest versus the lowest tertile were 0.80 (95% CI 0.83–1.00) for energy-adjusted monomers and dimers combined, 0.72 (95% CI 0.59–0.87) for polymers with ≥ 3 mers, and 0.72 (95% CI 0.59–0.88) for total proanthocyanidins. The inverse relation was stronger among cases with a Gleason score ≥ 7, with the ORs of 0.56 (95% CI 0.40–0.78) for monomers and dimers, 0.62 (95% CI 0.40–0.78) for polymers with ≥ 3 mers, and 0.57 (95% CI 0.42–0.77) for total proanthocyanidins. These risk estimates were consistent across strata of age, education, body mass index, and family history of prostate cancer. Our data indicate an inverse association between proanthocyanidins and prostate cancer risk.



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A neutralizing antibody that blocks delivery of the enzymatic cargo of Clostridium difficile toxin TcdB into host cells [Microbiology]

Clostridium difficile infection is the leading cause of hospital-acquired diarrhea and is mediated by the actions of two toxins, TcdA and TcdB. The toxins perturb host cell function through a multistep process of receptor binding, endocytosis, low pH–induced pore formation, and the translocation and delivery of an N-terminal glucosyltransferase domain that inactivates host GTPases. Infection studies with isogenic strains having defined toxin deletions have established TcdB as an important target for therapeutic development. Monoclonal antibodies that neutralize TcdB function have been shown to protect against C. difficile infection in animal models and reduce recurrence in humans. Here, we report the mechanism of TcdB neutralization by PA41, a humanized monoclonal antibody capable of neutralizing TcdB from a diverse array of C. difficile strains. Through a combination of structural, biochemical, and cell functional studies, involving X-ray crystallography and EM, we show that PA41 recognizes a single, highly conserved epitope on the TcdB glucosyltransferase domain and blocks productive translocation and delivery of the enzymatic cargo into the host cell. Our study reveals a unique mechanism of C. difficile toxin neutralization by a monoclonal antibody, which involves targeting a process that is conserved across the large clostridial glucosylating toxins. The PA41 antibody described here provides a valuable tool for dissecting the mechanism of toxin pore formation and translocation across the endosomal membrane.

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Elevated sodium chloride drives type I interferon signaling in macrophages and increases antiviral resistance [Cell Biology]

Type I IFN production and signaling in macrophages play critical roles in innate immune responses. High salt (i.e. high concentrations of NaCl) has been proposed to be an important environmental factor that influences immune responses in multiple ways. However, it remains unknown whether high salt regulates type I IFN production and signaling in macrophages. Here, we demonstrated that high salt promoted IFNβ production and its signaling in both human and mouse macrophages, and consequentially primed macrophages for strengthened immune sensing and signaling when challenged with viruses or viral nucleic acid analogues. Using both pharmacological inhibitors and RNA interference we showed that these effects of high salt on IFNβ signaling were mediated by the p38 MAPK/ATF2/AP1 signaling pathway. Consistently, high salt increased resistance to vesicle stomatitis virus (VSV) infection in vitro. In vivo data indicated that a high-salt diet protected mice from lethal VSV infection. Taken together, these results identify high salt as a crucial regulator of type I IFN production and signaling, shedding important new light on the regulation of innate immune responses.

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