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Η φωτογραφία μου
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, https://plus.google.com/communities/115462130054650919641?sqinv=VFJWaER0c2NCRl9ERzRjZWhxQmhzY09kVV84cjRn , ,https://plus.google.com/u/0/+AlexandrosGSfakianakis , https://www.youtube.com/channel/UCQH21WX8Qn5YSTKrlJ3OrmQ , https://www.youtube.com/channel/UCTREJHxB6yt4Gaqs4-mLzDA , https://twitter.com/g_orl?lang=el, https://www.instagram.com/alexandrossfakianakis/,

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Κυριακή, 21 Ιανουαρίου 2018

Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume

Abstract

Purpose

To study whether clinical outcome data from our patient cohort could give support to the new recommendation in the AHA/ASA guidelines for the management of aneurysmal subarachnoid hemorrhage that states "that microsurgical clipping may receive increased consideration in patients with ruptured middle cerebral artery (MCA) aneurysms and large (>50 mL) intraparenchymal hematomas", while clinical outcome data supporting this recommendation are sparse.

Methods

We reviewed the clinical and radiological data of 81 consecutive patients with MCA aneurysms and concomitant hematomas admitted between January 2006 and December 2015. The relation between (semi-automatically quantified) hematoma volume (< or > 50 ml), neurological condition on admission (poor: GCS < 8 or non-reactive pupils), treatment strategies (no treatment, coiling, or clipping with or without decompression and/or clot removal), and outcome (favorable: mRS score 0–3) was evaluated.

Results

Clinical outcome data were available for 76 patients. A significant difference in favorable outcome (17 vs 68%) was seen when comparing patients with poor and good neurological condition on admission (p < 0.01). Patients with hematomas > 50 ml had similar outcomes for coiling and clipping, all underwent decompression. Patients with hematomas < 50 ml did not show differences in favorable outcome when comparing coiling and clipping with (33 and 31%) or without decompression (90 and 88%).

Conclusion

Poor neurological condition on admission, and not large intraparenchymal hematoma volume, was associated with poor clinical outcome. Therefore, even in patients with large hematomas, the neurological condition on admission and the aneurysm configuration seem to be equally important factors to determine the most appropriate treatment strategy.



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Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy

Abstract

Purpose

To compare and to combine iterative metal artifact reduction (MAR) and virtual monoenergetic extrapolations (VMEs) from dual-energy computed tomography (DECT) for reducing metal artifacts from intracranial clips and coils.

Methods

Fourteen clips and six coils were scanned in a phantom model with DECT at 100 and 150SnkVp. Four datasets were reconstructed: non-corrected images (filtered-back projection), iterative MAR, VME from DECT at 120 keV, and combined iterative MAR + VME images. Artifact severity scores and visibility of simulated, contrast-filled, adjacent vessels were assessed qualitatively and quantitatively by two independent, blinded readers.

Results

Iterative MAR, VME, and combined iterative MAR + VME resulted in a significant reduction of qualitative (p < 0.001) and quantitative clip artifacts (p < 0.005) and improved the visibility of adjacent vessels (p < 0.05) compared to non-corrected images, with lowest artifact scores found in combined iterative MAR + VME images. Titanium clips demonstrated less artifacts than Phynox clips (p < 0.05), and artifact scores increased with clip size. Coil artifacts increased with coil size but were reducible when applying iterative MAR + VME compared to non-corrected images. However, no technique improved the severe artifacts from large, densely packed coils.

Conclusions

Combining iterative MAR with VME allows for an improved metal artifact reduction from clips and smaller, loosely packed coils. Limited value was found for large and densely packed coils.



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How to Perform a Systematic Review and Meta-analysis of Diagnostic Imaging Studies

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Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Paul Cronin, Aine Marie Kelly, Duaa Altaee, Bradley Foerster, Myria Petrou, Ben A. Dwamena
A systematic review is a comprehensive search, critical evaluation, and synthesis of all the relevant studies on a specific (clinical) topic that can be applied to the evaluation of diagnostic and screening imaging studies. It can be a qualitative or a quantitative (meta-analysis) review of available literature. A meta-analysis uses statistical methods to combine and summarize the results of several studies. In this review, a 12-step approach to performing a systematic review (and meta-analysis) is outlined under the four domains: (1) Problem Formulation and Data Acquisition, (2) Quality Appraisal of Eligible Studies, (3) Statistical Analysis of Quantitative Data, and (4) Clinical Interpretation of the Evidence. This review is specifically geared toward the performance of a systematic review and meta-analysis of diagnostic test accuracy (imaging) studies.



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Best Practices From the APDR

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Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Daryl T. Goldman, Gail L. Peters, Aaron M. Fischman, George G. Vatakencherry, Peter R. Bream, Jonathan G. Martin, Janice M. Newsome, Zachary L. Bercu, Michael A. Schacht, Karen S. Johnson, James M. Milburn, Seng Ong, Vivek Kalia, Eric England, Darel E. Heitkamp




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Virtual Computed Tomography Colonography

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Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Hannes Seuss, Rolf Janka, Matthias Hammon, Alexander Cavallaro, Michael Uder, Peter Dankerl
Rationale and ObjectivesTo evaluate two- and three-dimensional (2D and 3D) image quality of sub-milliSievert (mSv) computed tomography (CT) colonography utilizing a third-generation dual source CT scanner featuring a tin filter.MethodsWe retrospectively evaluated 26 consecutive patients who underwent third-generation dual source CT colonography, nine with the standard-dose clinical-scan protocol (SDP) and 17 with a low-dose protocol (LDP) featuring a tin filter. Radiation dose was evaluated by volume computed tomography dose index (CTDIvol), dose length product (DLP), effective dose (E), and size-specific dose estimate. Objective image quality was evaluated utilizing signal-to-noise ratio (SNR) derived from standardized placed regions of interest on the transverse 2D images and the ratio of SNR/CTDIvol (normalized SNR). Two radiologists in consensus assessed subjective image quality of the virtual 3D images.ResultsThere were no significant differences in subjective image quality (P = .661). All examinations were rated "excellent" or "good" for diagnostic confidence. The mean total for DLP/E was 143.4 ± 29.8 mGy/3.00 ± 0.40 mSv in the SDP and therefore significantly higher than in the LDP with 36.9 ± 8.7 mGy/0.75 ± 0.16 mSv (P < .001). The SNR was 8.9 ± 2.1 in the SDP and 4.9 ± 0.8 in the LDP.ConclusionsThird-generation dual source CT featuring a tin filter enables consistent sub-mSv colonography without substantially impairing image quality.



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Coregistration of Preoperative MRI with Ex Vivo Mesorectal Pathology Specimens to Spatially Map Post-treatment Changes in Rectal Cancer Onto In Vivo Imaging

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Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Jacob Antunes, Satish Viswanath, Justin T. Brady, Benjamin Crawshaw, Pablo Ros, Scott Steele, Conor P. Delaney, Raj Paspulati, Joseph Willis, Anant Madabhushi
Rationale and ObjectivesThe objective of this study was to develop and quantitatively evaluate a radiology-pathology fusion method for spatially mapping tissue regions corresponding to different chemoradiation therapy-related effects from surgically excised whole-mount rectal cancer histopathology onto preoperative magnetic resonance imaging (MRI).Materials and MethodsThis study included six subjects with rectal cancer treated with chemoradiation therapy who were then imaged with a 3-T T2-weighted MRI sequence, before undergoing mesorectal excision surgery. Excised rectal specimens were sectioned, stained, and digitized as two-dimensional (2D) whole-mount slides. Annotations of residual disease, ulceration, fibrosis, muscularis propria, mucosa, fat, inflammation, and pools of mucin were made by an expert pathologist on digitized slide images. An expert radiologist and pathologist jointly established corresponding 2D sections between MRI and pathology images, as well as identified a total of 10 corresponding landmarks per case (based on visually similar structures) on both modalities (five for driving registration and five for evaluating alignment). We spatially fused the in vivo MRI and ex vivo pathology images using landmark-based registration. This allowed us to spatially map detailed annotations from 2D pathology slides onto corresponding 2D MRI sections.ResultsQuantitative assessment of coregistered pathology and MRI sections revealed excellent structural alignment, with an overall deviation of 1.50 ± 0.63 mm across five expert-selected anatomic landmarks (in-plane misalignment of two to three pixels at 0.67- to 1.00-mm spatial resolution). Moreover, the T2-weighted intensity distributions were distinctly different when comparing fibrotic tissue to perirectal fat (as expected), but showed a marked overlap when comparing fibrotic tissue and residual rectal cancer.ConclusionsOur fusion methodology enabled successful and accurate localization of post-treatment effects on in vivo MRI.



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Study of an Oxygen Supply and Oxygen Saturation Monitoring System for Radiation Therapy Associated with the Active Breathing Coordinator.

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Study of an Oxygen Supply and Oxygen Saturation Monitoring System for Radiation Therapy Associated with the Active Breathing Coordinator.

Sci Rep. 2018 Jan 19;8(1):1254

Authors: Gong G, Guo Y, Sun X, Wang X, Yin Y, Feng DD

Abstract
In this study, we designed an oxygen supply and oxygen saturation monitoring (OSOSM) system. This OSOSM system can provide a continuous supply of oxygen and monitor the peripheral capillary oxygen saturation (SpO2) of patients who accept radiotherapy and use an active breathing coordinator (ABC). A clinical test with 27 volunteers was conducted. The volunteers were divided into two groups based on the tendency of SpO2 decline in breath-holding without the OSOSM system: group A (12 cases) showed a decline in SpO2 of less than 2%, whereas the decline in SpO2 in group B (15 cases) was greater than 2% and reached up to 6% in some cases. The SpO2 of most volunteers declined during rest. The breath-holding time of group A without the OSOSM system was significantly longer than that of group B (p < 0.05) and was extended with the OSOSM system by 26.6% and 27.85% in groups A and B, respectively. The SpO2 recovery time was reduced by 36.1%, and the total rest time was reduced by 27.6% for all volunteers using the OSOSM system. In summary, SpO2 declines during breath-holding and rest time cannot be ignored while applying an ABC. This OSOSM system offers a simple and effective way to monitor SpO2 variation and overcome SpO2 decline, thereby lengthening breath-holding time and shortening rest time.

PMID: 29352224 [PubMed - in process]



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New alkylresorcinol metabolites in spot urine as biomarkers of whole grain wheat and rye intake in a Swedish middle-aged population.

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New alkylresorcinol metabolites in spot urine as biomarkers of whole grain wheat and rye intake in a Swedish middle-aged population.

Eur J Clin Nutr. 2018 Jan 19;:

Authors: Landberg R, Wierzbicka R, Shi L, Nybacka S, Kamal-Eldin A, Hedblad B, Lindroos AK, Winkvist A, Forslund HB

Abstract
BACKGROUND/OBJECTIVES: Studies on the health effects of whole grains typically use self-reported intakes which are prone to large measurement errors. Dietary biomarkers that can provide an objective measure of intake are needed. New alkylresorcinol (AR) metabolites (3,5-dihydroxycinnamic acid (DHCA), 2-(3,5-dihydroxybenzamido)acetic acid (DHBA-glycine) and 5-(3,5-dihydroxyphenyl) pentanoic acid (DHPPTA)) in 24 h urine samples have been suggested as biomarkers for whole grain (WG) wheat and rye intake but remain to be evaluated in spot urine samples.
SUBJECTS/METHODS: The reproducibility of the new AR metabolites (DHCA, DHBA-glycine and DHPPTA) was investigated in 4 repeated samples over a period of 2 wk in spot urine from 40 Swedish men and women enroled in the SCAPIS-study, after adjustment of creatinine. Metabolite concentrations were correlated with total whole grain intake estimated during the same period.
RESULTS: The medium-term reproducibility determined for DHCA, DHPPTA and DHBA-glycine varied from moderate to excellent (intra-class correlation coefficient = 0.35-0.67). Moreover, DHCA and DHBA-glycine were independently associated with self-reported total WG intake (β = 0.18, P = 0.08 and β = 0.18, P = 0.02, respectively) and all metabolites except for DHPPA were higher among women.
CONCLUSIONS: This study supports the idea of using AR metabolites in one or several spot urine samples as biomarkers of whole grain intake. These findings need to be confirmed in different populations.

PMID: 29352219 [PubMed - as supplied by publisher]



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Pediatricians′ attitudes in management of acute otitis media and ear pain in Turkey

Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey.

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Whole exome sequencing identifies a pathogenic mutation in WFS1 in two large Chinese families with autosomal dominant all-frequency hearing loss and prenatal counseling

To identify the pathogenic mutation and provide prenatal counseling and diagnosis in two large Chinese families with autosomal dominant all-frequency hearing loss.

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Translation and validation of the Listen Inventory for Education Revised into Dutch

In Belgium the majority of children with CI's are being educated in mainstream schools. In mainstream schools difficult listening situations occur (e.g. due to background noise) which may result in educational risks for children with CI's. A tool that identifies potential listening difficulties, the English Listen inventory for Education Revised (LIFE-R), was translated and validated into Dutch for elementary and secondary schools (LIFE-NL, LIFE2-NL respectively).

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Analysis of risk factors associated with unilateral hearing loss in children who initially passed newborn hearing screening

To analyze 2007 Joint Committee on Infant Hearing (JCIH) risk factors in children with confirmed unilateral hearing loss (UHL) who initially passed newborn hearing screening.

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Challenges and outcomes of cholesteatoma management in children with Down syndrome

The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging.

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GJB2 mutations causing autosomal recessive non-syndromic hearing loss (ARNSHL) in two Iranian populations: Report of two novel variants

Hereditary hearing loss (HL) is a noticeable concern in medicine all over the world. On average, 1 in 166 babies born are diagnosed with HL in Iran, which makes it a major public health issue. Autosomal recessive non-syndromic HL (ARNSHL) is the most prevalent form of HL. Although over 60 genes have been identified for ARNSHL, GJB2 mutations are the most prevalent causes of ARNSHL in many populations. Previous studies have estimated the average frequency of GJB2 mutations to be between 16 and 18% in Iran, but would vary among different ethnic groups.

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Bony cochlear nerve canal stenosis in pediatric unilateral sensorineural hearing loss

This study was performed to evaluate the frequency of bony cochlear nerve canal (BCNC) stenosis and its clinical significance in pediatric patients with unilateral sensorineural hearing loss (SNHL) of unknown etiology.

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Geographic health disparities in the Los Angeles pediatric esophageal foreign body population

To assess geographical sociodemographic differences in the pediatric esophageal foreign body population of Los Angeles.

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Pattern of allergic rhinitis among children in Ekiti, Nigeria

Allergic rhinitis is a chronic and recurrent nasal condition. It is often neglected in children with late presentation. This study aimed at determining the prevalence, sociodemographic features, comorbid illnesses, complications and quality of life in children with allergic rhinitis in the study institution.

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Hospital cost analysis of children with preseptal cellulitis

Hospitalization of the children with preseptal cellulitis creates a burden on healthcare costs. This study aimed to analyze the hospital costs for preseptal cellulitis and determine the factors contributing.

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Respiratory events after adenotonsillectomy requiring escalated admission status in children with obstructive sleep apnea

To characterize postoperative respiratory complications following adenotonsillectomy (AT) in children with obstructive sleep apnea (OSA) and to identify variables associated with pediatric intensive care unit (PICU) admission.

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Neurotransmitters and Receptors Changes in Medial Nucleus of the Trapezoid Body (MNTB) of Early-Developmental Rats with Single-Side Deafness.

Neurotransmitters and Receptors Changes in Medial Nucleus of the Trapezoid Body (MNTB) of Early-Developmental Rats with Single-Side Deafness.

Med Sci Monit. 2018 Jan 20;24:397-404

Authors: Dai J, Liu J, Zhou M, Wang W, Xu ZD, Wang N

Abstract
BACKGROUND Congenital single-side deafness (SSD) affects sound localization even after cochlear implantation (CI) in some conditions. The medial nucleus of the trapezoid body (MNTB) plays an important role in binaural benefit and sound localization, but little is known about intrinsic molecular changes in MNTB with SSD. We aimed to observe changes in MNTB in early-developmental SSD rats, including the key neurotransmitters (GABA, Gly, Glu) and major receptors (GABAa-R/GABAb-R for GABA, Gly-R for Gly, and AMPA/NMDA for Glu). MATERIAL AND METHODS The model of early-developmental SSD was acquired by right cochlear ablation at P12 and confirmed by ABR. High-performance liquid chromatography fluorescence detection (HPLC-FLD) was performed to measure the levels of neurotransmitters in MNTB. The relative expression of neurotransmitter receptors was tested by quantitative real-time PCR analysis. RESULTS (1) The right MNTB of experimental rats had an increase in GABA, Gly, and Glu at 4 weeks after right cochlear ablation (P<0.05). (2) At 2 weeks, the left MNTB of experimental rats showed increases in GABAa-R, GABAb-R, Gly-R, and AMPA, while the right MNTB showed lower expression of NMDA (P<0.05). The higher receptors in left MNTB decreased to a level at which we found no difference at 1 week for GABAa-R and GABAb-R (P>0.05), and was even reversed for Gly-R and AMPA (P<0.05). (3) Gly level was significantly increased at 2 weeks bilaterally and continued to 4 weeks in the left MNTB (P<0.05). CONCLUSIONS Early-developmental SSD can lead to asymmetric distribution of neurotransmitters and receptors in MNTB, which can be the fundamental cause of defective sound localization after cochlear implantation.

PMID: 29352772 [PubMed - in process]



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Consolidative Radiotherapy to Residual Masses After Chemotherapy Is Associated With Improved Outcome in Diffuse Large B-Cell Lymphoma. A Retrospective, Population-Based Study.

Consolidative Radiotherapy to Residual Masses After Chemotherapy Is Associated With Improved Outcome in Diffuse Large B-Cell Lymphoma. A Retrospective, Population-Based Study.

Clin Lymphoma Myeloma Leuk. 2017 Dec 24;:

Authors: Fluge Ø, Mannsåker B, Torp A, Mjaaland I, Helgeland L, Klos J, Mella O, Berentsen S, Meyer P

Abstract
BACKGROUND: The role of consolidative radiotherapy (RT) in advanced diffuse large B-cell lymphoma (DLBCL) is not established.
PATIENTS AND METHODS: In a population-based retrospective analysis of patients with DLBCL in Western Norway during 2003 to 2008, 170 consecutive patients admitted to Haukeland University Hospital (HUS) and 94 to Stavanger University Hospital (SUS) were included. The mean age was 64 years (range, 17-95 years), 147 patients (56%) were male, 80 patients (30%) had stage I/II, 126 patients (48%) stage III/IV, and 57 patients (22%) had primary extranodal disease.
RESULTS: There were no differences between hospitals in patient characteristics, use of rituximab, number of chemotherapy courses or cumulative doses, or in distribution of response categories after chemotherapy. The use of RT was significantly different: 17 patients (23%) received RT at SUS and 92 patients (65%) at HUS (P < .001). For 219 patients with International Prognostic Index (IPI) score of 0 to 3, 5-year cancer-specific survival (CSS) was 67% at SUS and 81% at HUS (P = .012). For 73 patients with complete response after chemotherapy there were no differences in survival between patients with and without RT. For 138 patients with any residual mass after chemotherapy, there were highly significant differences in favor of receiving RT (n = 81) versus no RT (n = 57): 5-year CSS 89% versus 69% (P < .001), and 5-year overall survival 82% versus 59% (P = .005). The effect of RT on residual mass was evident in most subgroups, mainly in low to intermediate risk, but not in high-risk (IPI 4-5) patients.
CONCLUSION: With the limitations of a retrospective study, these data suggest that consolidative RT might improve survival in DLBCL patients with a residual mass after chemotherapy, also in advanced disease.

PMID: 29352718 [PubMed - as supplied by publisher]



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WHO is in and WHO is out of the mouth, salivary glands, and jaws sections of the 4th edition of the WHO classification of head and neck tumours.

WHO is in and WHO is out of the mouth, salivary glands, and jaws sections of the 4th edition of the WHO classification of head and neck tumours.

Br J Oral Maxillofac Surg. 2018 Jan 15;:

Authors: Kennedy RA

Abstract
This review of changes to the 4th edition of the WHO classification of head and neck tumours focuses on their impact on the surgical care of diseases that affect the salivary glands, jaws, and oral cavity. Updates to the chapter on the salivary glands include the addition of secretory carcinoma and sclerosing polycystic adenosis. The odontogenic cysts are back, and the odontogenic keratocyst is listed among them, as it has now lost its brief and confusing designation as a neoplasm. The newly-defined sclerosing odontogenic carcinoma and primordial odontogenic tumour have been added. Oropharyngeal tumours have been separated from those of the oral cavity, which reflects the importance of HPV in carcinoma of the tonsils. The problems of grading oral epithelial dysplasia persist.

PMID: 29352614 [PubMed - as supplied by publisher]



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Induction of mitophagy in the HEI-OC1 auditory cell line and activation of the Atg12/LC3 pathway in the organ of Corti.

Induction of mitophagy in the HEI-OC1 auditory cell line and activation of the Atg12/LC3 pathway in the organ of Corti.

Hear Res. 2018 Jan 11;:

Authors: Setz C, Benischke AS, Pinho Ferreira Bento AC, Brand Y, Levano S, Paech F, Leitmeyer K, Bodmer D

Abstract
Autophagy is a highly evolutionary conserved quality control defense mechanism within cells, which has also been implicated in cell death processes. In the mammalian inner ear, autophagy has been shown to play a role during early morphogenesis as well as in adult cochlear hair cells exposed to ototoxic insults. Mitophagy, a selective autophagic cell process targeting mitochondria, hasn't been studied in the inner ear so far. On this work, we searched for molecular indicators of mitophagy within House Ear Institute-Organ of Corti-1 (HEI-OC1) cells as well as in the organ of Corti (OC). We first tested for the expression of Pink1/Park2 mRNA in 5-day-old C57BL/6 mice's cochleae using RT-PCR. We focused on the induction of mitophagy in HEI-OC1 cells as well as in the OC and investigated a possible mitophagic potential of the aminoglycoside agent gentamicin. The induction of mitophagy in HEI-OC1 cells was detected by objectivizing the translocation of fluorescence-tagged LC3 to mitochondria using confocal microscopy after a 6-h incubation with a well-described mitochondrial uncoupler and mitophagy-inducing agent: carbonyl cyanide m-chlorophenyl hydrazone (CCCP). Incubation with gentamicin generated no mitochondrial translocation of LC3. Protein levels of COXIV, Atg5/12 and LC3 were evaluated by an immunoblot analysis after a 24-h CCCP treatment as well as gentamicin. We demonstrated mitophagy after CCCP exposure in HEI-OC1 cells by showing a downregulation of COXIV. A downregulation of COXIV could also be visualized in the OC after CCCP. A significant oxygen consumption rate (OCR) changed in cells treated with CCCP as well as significant morphological changes of mitochondria by electron microscopy (EM) strengthen this assumption. Gentamicin exposure generated no impact on OCR or mitochondrial morphological changes by EM. Finally, we demonstrated changes in the expression of Atg12 and LC3 proteins in both the OC and HEI-OC1 cells after CCCP exposure but not after gentamicin. Our data indicate that gentamicin had no impact in the activation of mitophagy-neither in the HEI-OC1 cell line nor in the OC. Therefore, we speculate that mitophagic-independent mechanisms may underly aminoglycoside ototoxicity.

PMID: 29352609 [PubMed - as supplied by publisher]



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A Significant Treatable Cause of Hearing Loss in Our Time.

A Significant Treatable Cause of Hearing Loss in Our Time.

Otolaryngol Clin North Am. 2018 Jan 15;:

Authors: Chandrasekhar SS

PMID: 29352571 [PubMed - as supplied by publisher]



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p53-independent Noxa induction by cisplatin is regulated by ATF3/ATF4 in head and neck squamous cell carcinoma cells.

Related Articles

p53-independent Noxa induction by cisplatin is regulated by ATF3/ATF4 in head and neck squamous cell carcinoma cells.

Mol Oncol. 2018 Jan 19;:

Authors: Sharma K, Vu TT, Cook W, Naseri M, Zhan K, Nakajima W, Harada H

Abstract
The platinum-based DNA damaging agent cisplatin is used as a standard therapy for locally advanced head and neck squamous cell carcinoma (HNSCC). However, the mechanisms underpinning the cytotoxic effects of this compound are not entirely elucidated. Cisplatin produces anticancer effects primarily via activation of the DNA damage response, followed by inducing BCL-2 family-dependent mitochondrial apoptosis. We have previously demonstrated that cisplatin induces the expression of pro-apoptotic BCL-2 family protein, Noxa, that can bind to the pro-survival BCL-2 family protein, MCL-1, to inactivate its function and induce cell death. Here, we show that the up-regulation of Noxa is critical for cisplatin-induced apoptosis in p53-null HNSCC cells. This induction is regulated at the transcriptional level. With a series of Noxa promoter-luciferase reporter assays, we find that the CRE (cAMP response element) in the promoter is critical for the Noxa induction by cisplatin treatment. Among the CREB/ATF transcription factors, ATF3 and ATF4 are induced by cisplatin, and down-regulation of ATF3 or ATF4 reduced cisplatin-induced Noxa. ATF3 and ATF4 bind to and cooperatively activate the Noxa promoter. Furthermore, ERK1 is involved in cisplatin-induced ATF4 and Noxa induction. In conclusion, ATF3 and ATF4 are important regulators that induce Noxa by cisplatin treatment in a p53-independent manner.

PMID: 29352505 [PubMed - as supplied by publisher]



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Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck.

Related Articles

Analysis and Comparison of the 8th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System in Cutaneous and Oral Squamous Cell Cancer of the Head and Neck.

Ann Surg Oncol. 2018 Jan 19;:

Authors: Moeckelmann N, Ebrahimi A, Dirven R, Liu J, Low TH, Gupta R, Ashford B, Ch'ng S, Palme CE, Clark JR

Abstract
BACKGROUND: The American Joint Committee on Cancer (AJCC) uses the same nodal staging system for cutaneous and mucosal squamous cell carcinoma of the head and neck in its 8th edition (AJCC 8) despite differences in the etiology, risk factors, and clinical behavior of the two diseases. This study aims to evaluate the performance of the AJCC 8 nodal staging system by direct comparison of cutaneous (cSCC) versus oral squamous cell carcinoma (oSCC) patients.
METHODS: Patients with metastatic cSCC (N = 382) and oSCC (N = 325) were identified from a prospective database (years 1987-2016). Multivariable analysis was performed using Cox proportional hazards competing risk model. To assess staging system performance, an explained variation measure (proportion of variation explained, PVE) as well as a discrimination measure (Harrell's concordance index, C-index) were used.
RESULTS: Inclusion of extranodal extension (ENE) in AJCC 8 increased the proportion of patients in N3b category (48.7% in cSCC, 40.3% in oSCC). AJCC 8 stratified poorly with regards to risk of death from cSCC and oSCC and showed limited monotonicity of the nodal categories. Estimates of model performance revealed modest predictive capacity for overall survival (OS) and disease-specific survival (DSS) in oSCC (Harrell's C of 0.66 in both) and weak predictive capacity in cSCC (Harrell's C of 0.58 and 0.61, respectively).
CONCLUSIONS: The AJCC 8 nodal staging system performs poorly in terms of stratifying survival by N category, especially in cSCC. The data indicate that cSCC merits an independent nodal staging system from that for mucosal SCC.

PMID: 29352431 [PubMed - as supplied by publisher]



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Abnormal Speech Motor Control in Individuals with 16p11.2 Deletions.

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Abnormal Speech Motor Control in Individuals with 16p11.2 Deletions.

Sci Rep. 2018 Jan 19;8(1):1274

Authors: Demopoulos C, Kothare H, Mizuiri D, Henderson-Sabes J, Fregeau B, Tjernagel J, Houde JF, Sherr EH, Nagarajan SS

Abstract
Speech and motor deficits are highly prevalent (>70%) in individuals with the 600 kb BP4-BP5 16p11.2 deletion; however, the mechanisms that drive these deficits are unclear, limiting our ability to target interventions and advance treatment. This study examined fundamental aspects of speech motor control in participants with the 16p11.2 deletion. To assess capacity for control of voice, we examined how accurately and quickly subjects changed the pitch of their voice within a trial to correct for a transient perturbation of the pitch of their auditory feedback. When compared to controls, 16p11.2 deletion carriers show an over-exaggerated pitch compensation response to unpredictable mid-vocalization pitch perturbations. We also examined sensorimotor adaptation of speech by assessing how subjects learned to adapt their sustained productions of formants (speech spectral peak frequencies important for vowel identity), in response to consistent changes in their auditory feedback during vowel production. Deletion carriers show reduced sensorimotor adaptation to sustained vowel identity changes in auditory feedback. These results together suggest that 16p11.2 deletion carriers have fundamental impairments in the basic mechanisms of speech motor control and these impairments may partially explain the deficits in speech and language in these individuals.

PMID: 29352208 [PubMed - in process]



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Persistent pain following common outpatient surgeries in children: A multicenter study in Italy.

Persistent pain following common outpatient surgeries in children: A multicenter study in Italy.

Paediatr Anaesth. 2018 Jan 20;:

Authors: Mossetti V, Boretsky K, Astuto M, Locatelli BG, Zurakowski D, Lio R, Nicoletti R, Sonzogni V, Maffioletti M, Vicchio N, Ivani G

Abstract
INTRODUCTION: The prevalence of persistent postsurgical pain in children is over 20% after major surgeries; however, data are scarce on the prevalence, character, and risk factors among children undergoing common ambulatory surgeries. The primary aim of this study was to evaluate the prevalence of persistent pain following pediatric ambulatory surgery at 1, 3, and 6 months. Secondary aims were to identify risk factors and characterize the pain and consequences of persistent postsurgical pain.
METHODS: ASA I-II, ages 1 month to 16 years old, undergoing elective hypospadias repair, herniorraphy, orchiopexy, and orthopedic surgery were enrolled in a prospective, longitudinal, observational study at 3 pediatric centers in Italy. All patients received general plus regional anesthesia. Postoperative pain was evaluated using age appropriate pain scales at 1 and 3 hours. At 1, 3, and 6 months, pain scores were obtained and Parent's Postoperative Pain Measures (<8 yo) and Child Activity Limitations Interview (>8 yo) surveys were administered.
RESULTS: About 350 patients completed the study. The prevalence of pain at 1, 3, and 6 months was 24% (84/350), 6.0% (21/350), and 4.0% (14/350), respectively. Inguinal herniorraphy patients experienced significantly higher pain at all 3-time points; 35.6%, 14.9%, and 9.2%. There was no significant association between mean pain scores >4 in PACU and persistent pain. Pain persisting at 6 months had neuropathic characteristics and frequently interfered with daily activities and sleep.
CONCLUSION: Our data support the presence of persistent pain in pediatric patients after common surgeries. Most patients who developed persistent pain at 6 months had pain at 1 month. We recommend questioning at follow-up visit about persistent pain and functional impairment with follow-up until resolution.

PMID: 29352738 [PubMed - as supplied by publisher]



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Developmental plasticity of GABAergic neurotransmission to brainstem motoneurons.

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Developmental plasticity of GABAergic neurotransmission to brainstem motoneurons.

J Physiol. 2018 Jan 20;:

Authors: Wollman LB, Levine RB, Fregosi RF

Abstract
Nicotinic acetylcholine receptor (nAChR) signalling regulates neuronal differentiation and synaptogenesis. Here we test the hypothesis that developmental nicotine exposure (DNE) disrupts the development of GABAergic synaptic transmission to hypoglossal motoneurons (XIIMNs). GABAergic spontaneous and miniature inhibitory postsynaptic currents (sIPSC/mIPSC) were recorded from XIIMNs in brainstem slices from control and DNE rat pups of either sex, 1-5 days old, at baseline and following acute stimulation of nAChRs with nicotine. At baseline, sIPSCs were less frequent and smaller in DNE cells (consistent with decreased action potential mediated GABA release), and mIPSCs were more frequent (consistent with increased vesicular GABA release from presynaptic terminals). Acute nicotine challenge increased sIPSC frequency in both groups, though the increase was greater in DNE cells. Acute nicotine challenge did not change the frequency of mIPSCs in either group, though mIPSC amplitude increased significantly in DNE cells, but not control cells. Stimulation of postsynaptic GABAA receptors with muscimol caused a significantly greater chloride current in DNE cells than in control cells. The increased quantal release of GABA, coupled with the rise in the strength of postsynaptic inhibition may be homeostatic adjustments to the decreased action-potential mediated input from GABAergic interneurons. However, this will exaggerate synaptic inhibition under conditions where the release of GABA (e.g. hypoxia) or ACh (sleep-wake transitions) is increased. These findings reveal a mechanism that may explain why DNE is associated with deficits in the ability to respond appropriately to chemosensory stimuli or to changes in neuromodulation secondary to changes in central nervous system state. This article is protected by copyright. All rights reserved.

PMID: 29352468 [PubMed - as supplied by publisher]



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Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches.

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Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches.

Sports Med. 2018 Jan 20;:

Authors: Bonnar D, Bartel K, Kakoschke N, Lang C

Abstract
BACKGROUND: Athletes experience various situations and conditions that can interfere with their sleep, which is crucial for optimal psychological and physiological recovery as well as subsequent performance. Conventional sleep screening and intervention approaches may not be efficacious for athletes given their lifestyle, the demands of training and travel associated with interstate/international competition.
OBJECTIVES: The present systematic review aimed to summarize and evaluate sleep intervention studies targeting subsequent performance and recovery in competitive athletes. Based on the findings, a secondary aim was to outline a possible sleep intervention for athletes, including recommendations for content, mode of delivery and evaluation.
METHODS: A systematic review was conducted based on the PRISMA guidelines in May 2016 with an update completed in September 2017. Ten studies met our inclusion criteria comprising a total of 218 participants in the age range of 18-24 years with athletes from various sports (e.g., swimming, soccer, basketball, tennis). A modified version of the quality assessment scale developed by Abernethy and Bleakley was used to evaluate the quality of the studies.
RESULTS: The included studies implemented several sleep interventions, including sleep extension and napping, sleep hygiene, and post-exercise recovery strategies. Evidence suggests that sleep extension had the most beneficial effects on subsequent performance. Consistent with previous research, these results suggest that sleep plays an important role in some, but not all, aspects of athletes' performance and recovery.
CONCLUSION: Future researchers should aim to conduct sleep interventions among different athlete populations, compare results, and further establish guidelines and intervention tools for athletes to address their specific sleep demands and disturbances.

PMID: 29352373 [PubMed - as supplied by publisher]



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Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia.

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Quality of life in obstructive sleep apnea is related to female gender and comorbid insomnia.

Sleep Breath. 2018 Jan 19;:

Authors: Tasbakan MS, Gunduz C, Pirildar S, Basoglu OK

Abstract
PURPOSE: Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients.
METHODS: World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital.
RESULTS: Out of 197 patients (age 50.4 ± 12.1 years, AHI 38.5 ± 28.4/h), 139 (70.6%) were men and 79.2% had moderate-to-severe OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL.
CONCLUSIONS: Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.

PMID: 29352360 [PubMed - as supplied by publisher]



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Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction.

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Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction.

J Am Heart Assoc. 2018 Jan 19;7(2):

Authors: Xie J, Sert Kuniyoshi FH, Covassin N, Singh P, Gami AS, Chahal CAA, Somers VK

Abstract
BACKGROUND: Excessive daytime sleepiness (EDS), a common symptom among patients with sleep-disordered breathing, is closely associated with the development of cardiovascular diseases, but its long-term prognostic value is not completely understood. The aim of this study was to investigate whether EDS would be an independent prognostic factor after myocardial infarction.
METHODS AND RESULTS: We prospectively recruited 112 post-myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and EDS was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with EDS had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ2=5.27, P=0.022) and reinfarction (29.0% versus 5.5%, χ2=13.51, P=0.0002) compared with those without EDS. In the Cox proportional hazards model, patients with EDS had 2.15 times (95% confidence interval, 1.08-4.18; P=0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea-hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04-4.26, P=0.039). Furthermore, among participants with moderate to severe sleep-disordered breathing, the presence of EDS was associated with higher risk of major adverse cardiac events than those without EDS, after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22-7.76, P=0.019).
CONCLUSIONS: EDS may be an independent prognostic factor of adverse outcome in post-myocardial infarction patients with moderate to severe sleep-disordered breathing. Evaluation of EDS may shed new light on risk stratification and identify treatment responders for this patient population.

PMID: 29352093 [PubMed - in process]



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Activity During Sleep Measured by a Sheet-Shaped Body Vibrometer and the Severity of Atopic Dermatitis in Adults: A Comparison With Wrist Actigraphy.

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Activity During Sleep Measured by a Sheet-Shaped Body Vibrometer and the Severity of Atopic Dermatitis in Adults: A Comparison With Wrist Actigraphy.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Kogure T, Ebata T

Abstract
STUDY OBJECTIVES: To use a sheet-shaped body vibrometer (SBV) for measuring sleep in adult patients with atopic dermatitis (AD) of various severities and to compare the results with those measured by wrist actigraphy (WA).
METHODS: Simultaneous measurements of activity during sleep by WA and the SBV were performed in 20 outpatients with AD for 5 to 10 days. The mean activity count per minute (ACT) and sleep efficiency (SE) were obtained using each device. The severity of AD was evaluated by the severity scoring of AD (SCORAD), serum thymus and activation-regulated chemokine (TARC) level, serum total immunoglobulin E level, and peripheral eosinophil count.
RESULTS: The ACT measured by WA was correlated with SCORAD (Spearman correlation coefficient [rs] = .64, P = .002) and TARC (rs = .60, P = .005). The ACT obtained by the SBV was significantly correlated with TARC (rs = .58, P = .008) and ACT obtained by WA (rs = .63, P = .003). SE obtained by WA resulted in lower values compared with SE obtained by the SBV (69.7 ± 9.4% versus 82.9 ± 9.3%, P< .001), although SE obtained by WA was highly correlated with SE obtained by the SBV (rs = .82, P< .001). Bland-Altman plots revealed that SE measured by WA always had lower values in all the patients.
CONCLUSIONS: Activity during sleep, presumably composed of scratching and other motions, is more vigorous in patients with severe adult AD. This was successfully demonstrated by the SBV and WA assessment. However, we consider that ACT measured by WA is more suited for the scratch evaluation and SE measured by the SBV is preferable for the sleep evaluation.

PMID: 29351828 [PubMed - as supplied by publisher]



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Nocturnal REM Sleep Without Atonia Is a Diagnostic Biomarker of Pediatric Narcolepsy.

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Nocturnal REM Sleep Without Atonia Is a Diagnostic Biomarker of Pediatric Narcolepsy.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Bin-Hasan S, Videnovic A, Maski K

Abstract
STUDY OBJECTIVES: Compare nocturnal REM sleep without atonia (nRWA) and REM sleep behavior disorder (RBD) between pediatric patients with and without narcolepsy and determine if the nRWA index is a valid diagnostic biomarker for narcolepsy.
METHODS: Retrospective cohort study of children ages 6 to 18 years who completed a nocturnal polysomnogram (PSG) and Multiple Sleep Latency Test (MSLT). Our study sample included 11 patients with narcolepsy type 1 (NT1), 6 with narcolepsy type 2 (NT2), 12 with idiopathic hypersomnia (IH), and 11 with subjective hypersomnia (sHS). We compared group nRWA indices (epochs of RWA/total stage R sleep epochs) from the nocturnal PSGs and analyzed nRWA index receiver operating curve (ROC) statistics for narcolepsy diagnosis.
RESULTS: The median nRWA index of patients with NT1 was 15 to 30 times higher compared to sHS and IH (Ps < .005) but similar to that of the NT2 group (P = .46). RBD was present in 25% of patients with narcolepsy (NT1 and NT2). In comparing those with and without narcolepsy, the nRWA index area under the curve was 0.87 (0.6), 95% confidence interval (CI) = 0.75 to 0.99, P< .001. The threshold of having ≥ 1% of stage R sleep epochs with nRWA yielded a sensitivity of 88.2%, 95% CI = 63.6-98.5 and specificity of 60.9%, 95% CI = 38.5 to 80.3 for diagnosis of narcolepsy. In contrast, a threshold of ≥ 8% yielded a specificity of 95.7%, 95% CI = 78.1 to 99.9 and sensitivity of 52.9%, 95% CI = 27.8 to 77.
CONCLUSIONS: The nRWA index is a very good diagnostic biomarker of pediatric narcolepsy. Depending on the clinical cutoffs utilized, this biomarker can identify more children/adolescents with narcolepsy using just the PSG or reduce false-positive diagnostic results.

PMID: 29351827 [PubMed - as supplied by publisher]



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Nonadherence to CPAP Associated With Increased 30-Day Hospital Readmissions.

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Nonadherence to CPAP Associated With Increased 30-Day Hospital Readmissions.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Truong KK, De Jardin R, Massoudi N, Hashemzadeh M, Jafari B

Abstract
STUDY OBJECTIVES: The primary objective of this study was to determine if nonadherence to continuous positive airway pressure (CPAP) is associated with increased 30-day all-cause, cardiovascular-cause, and pulmonary-cause hospital readmissions.
METHODS: Retrospective cohort study at a Veterans Affairs hospital of patients with obstructive sleep apnea (OSA) who were hospitalized from January 1, 2007 to December 31, 2015. Odds ratio of 30-day readmission was calculated for all-cause, cardiovascular-cause, and pulmonary-cause readmissions. Logistic regression model was used to evaluate odds of nonadherent versus adherent group while adjusting for age, sex, body mass index, living situation, race, comorbidities, and medication adherence.
RESULTS: Out of 2,077 records reviewed, 345 patients (183 adherent and 162 nonadherent) met our inclusion criteria. The adherent group had a total of 215 initial admissions, and the nonadherent group had a total of 268 index admissions. Thirty-day all-cause readmission rate was significantly higher in the nonadherent group, with an adjusted odds ratio (OR) of 3.52 (95% confidence interval [CI], 2.04-6.08, P< .001). Thirty-day cardiovascular-cause readmission rate was significantly higher in the nonadherent group, with an adjusted OR of 2.31 (95% CI, 1.11-4.78, P = .024). Difference in 30-day pulmonary-cause readmissions was not statistically significant, with an adjusted OR of 3.66 (95% CI, 0.41-32.76, P = .25).
CONCLUSIONS: Nonadherence to CPAP is associated with increased 30-day all-cause and cardiovascular-cause readmission in patients with OSA. Ensuring CPAP adherence is crucial in addressing general and cardiovascular-related healthcare utilization and morbidity in patients with OSA.

PMID: 29351826 [PubMed - as supplied by publisher]



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CPAP Adherence and Readmission: Marker of Health or Cost-Effective Tool?

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CPAP Adherence and Readmission: Marker of Health or Cost-Effective Tool?

J Clin Sleep Med. 2018 Jan 16;:

Authors: Donovan LM, Billings ME

PMID: 29351825 [PubMed - as supplied by publisher]



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Nurse Practitioners and Physician Assistants are Important to the Sleep Team.

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Nurse Practitioners and Physician Assistants are Important to the Sleep Team.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Rosen IM

PMID: 29351824 [PubMed - as supplied by publisher]



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Nurse Practitioners and Physician Assistants are Qualified to Perform Home Sleep Apnea Test Clinical Evaluations.

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Nurse Practitioners and Physician Assistants are Qualified to Perform Home Sleep Apnea Test Clinical Evaluations.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Colvin LJ, Cartwright A, Freedman N, Rogers AE, Vana KD

PMID: 29351823 [PubMed - as supplied by publisher]



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Influence of Obstructive Sleep Apnea in the Functional Aspects of Patients With Osteoarthritis.

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Influence of Obstructive Sleep Apnea in the Functional Aspects of Patients With Osteoarthritis.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Silva A, Mello MT, Serrão PR, Luz RP, Ruiz F, Bittencourt LR, Tufik S, Mattiello SM

Abstract
STUDY OBJECTIVES: It has been demonstrated in recent studies that obstructive sleep apnea (OSA) is the most prevalent sleep disorder in patients with osteoarthritis (OA), and thus the current study aimed to investigate the influence of OSA on knee extensor torque, pain, stiffness, and physical function in men with low-grade knee OA.
METHODS: The study included 60 male volunteers, aged 40 to 70 years, allocated into four groups: Group 1 (G1) Control (n = 15): without OA and without OSA; Group 2 (G2) (n = 15): with OA and without OSA; Group 3 (G3) (n = 15): without OA and with OSA; and Group 4 (G4) (n = 15) with OA and with OSA. All volunteers were examined using knee radiographs and polysomnography, responded to the Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire, and completed a test on an isokinetic dynamometer to evaluate peak isometric knee extensor torque, both concentric and eccentric (90°/s and 180°/s).
RESULTS: Regarding the data from the WOMAC questionnaire (for pain, stiffness, and physical function), it was observed that G4 showed higher values compared to G1 or G3. For the concentric isometric and isokinetic peak knee extensor torque, lower values were observed in G4 compared to G1 or G3.
CONCLUSIONS: Patients who have knee OA in the early grades, when associated with OSA, have higher changes of the peak extensor torque, pain, stiffness, and physical function, compared with patients who did not have OSA.
CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov, Identifier: NCT01422967, Title: Changes Of Sleep on the Sensoriomotor and Cytokine In Patients With Osteoarthritis, URL: http://ift.tt/2G1ecDa.

PMID: 29351822 [PubMed - as supplied by publisher]



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Reliability of the American Academy of Sleep Medicine Rules for Assessing Sleep Depth in Clinical Practice.

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Reliability of the American Academy of Sleep Medicine Rules for Assessing Sleep Depth in Clinical Practice.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Younes M, Kuna ST, Pack AI, Walsh JK, Kushida CA, Staley B, Pien GW

Abstract
STUDY OBJECTIVES: The American Academy of Sleep Medicine has published manuals for scoring polysomnograms that recommend time spent in non-rapid eye movement sleep stages (stage N1, N2, and N3 sleep) be reported. Given the well-established large interrater variability in scoring stage N1 and N3 sleep, we determined the range of time in stage N1 and N3 sleep scored by a large number of technologists when compared to reasonably estimated true values.
METHODS: Polysomnograms of 70 females were scored by 10 highly trained sleep technologists, two each from five different academic sleep laboratories. Range and confidence interval (CI = difference between the 5th and 95th percentiles) of the 10 times spent in stage N1 and N3 sleep assigned in each polysomnogram were determined. Average values of times spent in stage N1 and N3 sleep generated by the 10 technologists in each polysomnogram were considered representative of the true values for the individual polysomnogram. Accuracy of different technologists in estimating delta wave duration was determined by comparing their scores to digitally determined durations.
RESULTS: The CI range of the ten N1 scores was 4 to 39 percent of total sleep time (% TST) in different polysomnograms (mean CI ± standard deviation = 11.1 ± 7.1 % TST). Corresponding range for N3 was 1 to 28 % TST (14.4 ± 6.1 % TST). For stage N1 and N3 sleep, very low or very high values were reported for virtually all polysomnograms by different technologists. Technologists varied widely in their assignment of stage N3 sleep, scoring that stage when the digitally determined time of delta waves ranged from 3 to 17 seconds.
CONCLUSIONS: Manual scoring of non-rapid eye movement sleep stages is highly unreliable among highly trained, experienced technologists. Measures of sleep continuity and depth that are reliable and clinically relevant should be a focus of clinical research.

PMID: 29351821 [PubMed - as supplied by publisher]



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Restless Legs Syndrome in Iranian People With Type 2 Diabetes Mellitus: The Role in Quality of Life and Quality of Sleep.

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Restless Legs Syndrome in Iranian People With Type 2 Diabetes Mellitus: The Role in Quality of Life and Quality of Sleep.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Modarresnia L, Golgiri F, Madani NH, Emami Z, Tanha K

Abstract
STUDY OBJECTIVES: To investigate the prevalence of restless legs syndrome (RLS) in patients with type 2 diabetes mellitus (T2DM) and explore its role in quality of life (QoL) and quality of sleep of these patients.
METHODS: This is a cross-sectional study performed on 210 Iranian people with T2DM. The diagnosis of RLS was established based on the essential diagnostic criteria for RLS recommended by the National Institutes of Health. Sleep quality and QoL were assessed in all participants using Pittsburgh Sleep Quality Index and EuroQol five-dimension questionnaire, respectively. Regression models were used for final analysis of data.
RESULTS: The prevalence of RLS was 19.5%; of whom 38.1% had poor quality of sleep. Male sex, being single, body mass index (BMI), and RLS were associated with poor quality of sleep. Patients with RLS were almost three times as likely as the patients without RLS to have poor sleep quality. Moreover, being female, BMI value, level of glycosylated hemoglobine (HbA1C), and RLS were associated with lower QoL. RLS lowers the score of QoL even more than BMI and HbA1C. In addition, the QoL and sleep quality of this population of patients with diabetes have not been affected by the severity of RLS as well as presence or absence of neuropathy.
CONCLUSIONS: RLS has an independent and significant role in sleep quality and QoL in the patients with diabetes. Neuropathy with RLS does not confer any additive burden on QoL and sleep quality of this population of patients with diabetes.

PMID: 29351820 [PubMed - as supplied by publisher]



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Patient-Reported Outcomes in Older Adults With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure Therapy.

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Patient-Reported Outcomes in Older Adults With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure Therapy.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Pallansch J, Li Y, Bena J, Wang L, Foldvary-Schaefer N

Abstract
STUDY OBJECTIVES: Although continuous positive airway pressure (CPAP) therapy is regarded as the gold standard treatment for obstructive sleep apnea (OSA) in adults, outcomes in older patients are limited. This study examines the effect of CPAP therapy in older adults with OSA (older than 60 years) compared to younger adults (age 18 to 60 years) to inform the current standard of practice.
METHODS: We performed a retrospective study with a convenience sample to compare responses to CPAP treatment in older versus younger adults with OSA using validated, patient-reported outcomes (PROs). A total of 532 patients were analyzed at baseline and at 3, 6, and 12 months after CPAP initiation. The effects of CPAP adherence and OSA severity on PRO scores were measured in each age group.
RESULTS: Patients older than 60 years had higher apnea-hypopnea indices but lower Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9) scores and higher Functional Outcomes of Sleep Questionnaire (FOSQ) scores at baseline compared to patients age 18 to 60 years. At 1 year after CPAP initiation, significant and comparable improvements in ESS, FSS, PHQ-9, and FOSQ scores were observed in patients older than 60 years relative to younger patients. When stratifying by OSA severity, change between age groups was significantly different only for PHQ-9 in patients with mild OSA, with greater improvements observed in younger patients.
CONCLUSIONS: This study adds to the limited data on treatment outcomes with CPAP therapy in older adults with OSA. Patients older than 60 years achieve improvement in sleepiness, fatigue, depressive symptoms, and quality of life analogous to that of younger adults.

PMID: 29351819 [PubMed - as supplied by publisher]



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Obstructive Sleep Apnea in Patients With Congenital Central Hypoventilation Syndrome Ventilated by Diaphragm Pacing Without Tracheostomy.

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Obstructive Sleep Apnea in Patients With Congenital Central Hypoventilation Syndrome Ventilated by Diaphragm Pacing Without Tracheostomy.

J Clin Sleep Med. 2018 Jan 16;:

Authors: Wang A, Kun S, Diep B, Davidson Ward SL, Keens TG, Perez IA

Abstract
STUDY OBJECTIVES: To determine presence of obstructive sleep apnea (OSA) in patients with congenital central hypoventilation syndrome (CCHS) ventilated by diaphragm pacing (DP) without tracheostomy, and to determine if OSA can be improved by DP setting changes.
METHODS: We reviewed polysomnography (PSG) results of 15 patients with CCHS from October 2001 to April 2014, age 15.4 ± 7.8 years, body mass index 22.0 ± 6.0 kg/m2, and 60% female.
RESULTS: Of the 22 PSG results obtained for the 15 patients with CCHS, 9 were performed with tracheostomy capped, and 13 were performed after patients underwent decannulation. OSA was present on 6 of 9 tests in patients with tracheostomy capped, including 3 patients with immediate, severe OSA necessitating that the studies be completed with tracheostomy uncapped. OSA was present on 2 of 13 tests in patients in whom decannulation had been performed. Hypoventilation was seen on only one test without OSA. On 2 of 5 tests showing OSA, OSA improved by decreasing DP amplitude settings; apnea-hypopnea index decreased from 11.1 ± 2.5 to 1.8 ± 2.5 events/h; PETCO2 decreased from 57.5 ± 3.5 to 38.5 ± 0.7 torr; SpO2 increased from 76.5 ± 0.7% to 93.0 ± 7.1%. OSA improved in one patient with slight increase in respiratory rate. Settings were manipulated in 4 tests showing OSA; no changes were attempted in the remaining study. One patient was placed on bilevel positive airway pressure with temporary suspension of DP. Age (P< .119), previous adenotonsillectomy (P< .211), and body mass index (P< .112) did not significantly contribute to OSA.
CONCLUSIONS: OSA occurs in patients with CCHS ventilated by DP. However, decreasing DP amplitude settings can lessen upper airway obstruction without compromising gas exchange.

PMID: 29351818 [PubMed - as supplied by publisher]



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The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature

Publication date: Available online 20 January 2018
Source:The Journal of Emergency Medicine
Author(s): Michael Gottlieb, Brit Long, Alex Koyfman
BackgroundToxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately.ObjectiveThis review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS.DiscussionThe most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid.ConclusionTSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.



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An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature

Publication date: Available online 20 January 2018
Source:The Journal of Emergency Medicine
Author(s): Lane C. Thaut, Andrew S. Murtha, Anthony E. Johnson, Jamie L. Roper
BackgroundThe management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices.Case ReportA 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department.Why Should an Emergency Physician Be Aware of This?Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients.



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Non-coding RNAs in the reprogramming of glucose metabolism in cancer

Proliferating cancer cells reprogram their metabolic circuitry to thrive in an environment deficient in nutrients and oxygen. Cancer cells exhibit a higher rate of glucose metabolism than normal somatic cells, which is achieved by switching from oxidative phosphorylation to aerobic glycolysis to meet the energy and metabolites demands of tumour progression. This phenomenon, which is known as the Warburg effect, has generated renewed interest in the process of glucose metabolism reprogramming in cancer cells.

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Targeting c-Myc: JQ1 as a promising option for c-Myc-amplified esophageal squamous cell carcinoma

c-Myc amplification-induced cell cycle dysregulation is a common cause for esophageal squamous cell carcinoma (ESCC), but no approved targeted drug is available so far. The bromodomain inhibitor JQ1, which targets c-Myc, exerts anti-tumor activity in multiple cancers. However, the role of JQ1 in ESCC remains unknown. In this study, we reported that JQ1 had potent anti-proliferative effects on ESCC cells in both time- and dose-dependent manners by inducing cell cycle arrest at G1 phase, cell apoptosis, and the mesenchymal-epithelial transition.

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Peroxisome Proliferator-Activated Receptor γ and PGC-1α in Cancer: Dual Actions as Tumor Promoter and Suppressor

Peroxisome proliferator-activated receptor γ (PPARγ) is part of a nuclear receptor superfamily that regulates gene expression involved in cell differentiation, proliferation, immune/inflammation response, and lipid metabolism. PPARγ coactivator-1α (PGC-1α), initially identified as a PPARγ-interacting protein, is an important regulator of diverse metabolic pathways, such as oxidative metabolism and energy homeostasis. The role of PGC-1α in diabetes, neurodegeneration, and cardiovascular disease is particularly well known. PGC-1α is also now known to play important roles in cancer, independent of the role of PPARγ in cancer. Though many researchers have studied the expression and clinical implications of PPARγ and PGC-1α in cancer, there are still many controversies about the role of PPARγ and PGC-1α in cancer. This review examines and summarizes some recent data on the role and action mechanisms of PPARγ and PGC-1α in cancer, respectively, particularly the recent progress in understanding the role of PPARγ in several cancers since our review was published in 2012.

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Ingested Foreign Body Migration to the Liver: An Unusual Cause of Persistent Abdominal Pain in a 54-Year-Old Female

Abdominal pain is a common presentation in emergency medicine. We describe the case of a 54-year-old female who presented to the emergency department due to worsening abdominal pain. She had a history of right upper quadrant (RUQ) abdominal pain that had been ongoing for several months. The pain had been thought by the primary care team to be related to gastritis and she had been prescribed a proton pump inhibitor (PPI). Her abdominal pain increased in the three days prior to her presentation to the emergency department (ED). The computed tomography (CT) scan of the abdomen showed a foreign body (FB) in the liver which was successfully removed surgically. Pathology results showed that the FB was consistent with a small bone fragment. Ingestions of FB are common but seldom result in complications. When complications do arise, perforation of a hollow viscous is typically seen. Rarely, transmigration of the FB can occur.

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Application of Federal Kalman Filter with Neural Networks in the Velocity and Attitude Matching of Transfer Alignment

The centralized Kalman filter is always applied in the velocity and attitude matching of Transfer Alignment (TA). But the centralized Kalman has many disadvantages, such as large amount of calculation, poor real-time performance, and low reliability. In the paper, the federal Kalman filter (FKF) based on neural networks is used in the velocity and attitude matching of TA, the Kalman filter is adjusted by the neural networks in the two subfilters, the federal filter is used to fuse the information of the two subfilters, and the global suboptimal state estimation is obtained. The result of simulation shows that the federal Kalman filter based on neural networks is better in estimating the initial attitude misalignment angle of inertial navigation system (INS) when the system dynamic model and noise statistics characteristics of inertial navigation system are unclear, and the estimation error is smaller and the accuracy is higher.

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Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness

Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson’s disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.

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Higher Dimensional Charged Black Hole Solutions in Gravitational Theories

We present, without any assumption, a class of electric and magnetic flat horizon -dimension solutions for a specific class of , all of which behave asymptotically as Anti-de-Sitter spacetime. The most interesting property of these solutions is that the higher dimensions black holes, , always have constant electric and magnetic charges in contrast to what is known in the literature. For , we show that the magnetic field participates in the metric on equal foot as the electric field participates. Another interesting result is the fact that the Cauchy horizon is not identical with the event horizon. We use Komar formula to calculate the conserved quantities. We study the singularities and calculate the Hawking temperature and entropy and show that the first law of thermodynamics is always satisfied.

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Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25%) and severe (+4) mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation.

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Cerebral Venous Sinus Thrombosis in a Patient with Ulcerative Colitis Flare

Inflammatory bowel disease is characterized by a chronic inflammatory state and is therefore associated with abnormalities in coagulation and a hypercoagulable state. Cerebral venous sinus thrombosis is a rare complication of inflammatory bowel disease yet contributes significant morbidity and mortality to those affected. Early diagnosis is critical, as a delay in diagnosis portends a worse prognosis. This paper seeks to highlight the increased risk of venous sinus thrombosis in patients with inflammatory bowel disease. We start by discussing the case of a seventeen-year-old female who presented with ulcerative colitis flare and developed new-onset seizures, found to be caused by a large venous sinus thrombosis.

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Empirical Experience and Experimental Evaluation of Open5GCore over Hypervisor and Container

One of the most important technologies for future 5G networks is to utilize Network Function Virtualization (NFV) to virtualize the network components. NFV provides flexibility, short time to market, and low cost solution to build network services, which are important features of 5G networks. Although the idea of virtualization is just being applied to cellular networks, it has been used in the community of cloud computing. There are two main virtualization techniques, hypervisor and container. In this paper, we present our practical experience of virtualizing Open5GCore, a commercial product of SDN-enabled Evolved Packet Core (EPC), over hypervisor and container. In addition to describing how to virtualize Open5GCore, we also present the experimental performance evaluation of the systems. Finally, some important lessons learned are provided.

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Humification and Humic Acid Composition of Suspended Soil in Oligotrophous Environments in South Vietnam

Humification is considered to be a global process that is implemented in soils and organic sediments and also in natural water and air. The term “suspended soils” has become increasingly common in recent years. Suspended soils are defined as the part of the organic matter that has not undergone the full decomposition process and has not turned into the humus of terrestrial soils. Suspended soils were shown to contain higher total nitrogen, phosphorus, and potassium contents than the forest soil, but the moisture content in suspended soils was significantly lower. Our study of the structural composition of humic substances in suspended soils was conducted with an aim of evaluating the humification rates and structural composition of humic acids in the suspended soil in tropical forests of South Vietnam. Soil samples from three selected areas were investigated: the soil under phorophytes (mineral soil presented by samples of topsoil of the typical dry savanna landscape) and two soils from epiphytous formations. Samples were collected from savanna-type sparse communities, located on oligotrophous plains in Phú Quốc Island (South Vietnam) in 2015. General properties of the soil and the elemental composition of suspended soils were determined, and the humic substance chemical composition was evaluated using solid state 13C-NMR. Data obtained showed that the pH of the soils under phorophytes was higher than in the suspended soils; basal respiration did not tend to change indices between soils under phorophytes and suspended soils, but the suspended soil was less enriched by nitrogen than the soil under phorophytes. This can be related to the total amount of organic matter exposed to humification in various soils and to the presence of an essential portion of mineral particles in the soil under phorophytes. Data on elemental composition of the humic acids (HAs) indicated that one method of humification is implemented in all three soils that were investigated. The humic acids of the phorophyte soil showed the same content of aromatic fraction as the suspended soil. The most comparable soil type in terms of humic substance composition is Cambisols from humid forests of subboreal and subtropical zones. The humification process implemented in suspended soils showed the absence of mineral compounds or mineral fine earth, which indicated that humification in conditions of pure organic substrates can result in formation of deep humified organic matter, as shown by humic acids with an essential aromatic fraction content.

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A Simple and Scalable Method for the Preparation of Magnetite/Graphene Oxide Nanocomposites under Mild Conditions

Nanostructured composite dispersions containing magnetic nanoparticles (MNPs) and graphene oxide (GO) lamellae have been prepared by a simple and easily scalable room temperature procedure. We show that, owing to the enormous surface area and negative surface charge developed in aqueous GO suspensions, large amounts of positively charged MNPs can be electrostatically attached to the layered host. This procedure is superior to many previous synthesis pathways because it exploits the charge-regulated adhesion of naked MNPs to GO resulting in the formation of stable and uniform nanocomposite materials in a wide composition range without any preliminary functionalization steps or harsh conditions that may lead to chemical degradation of the graphene-based nanosheets.

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Breast Implant-Associated Anaplastic Large Cell Lymphoma: Case Report and Review of the Literature

We are reporting the case of a 58-year-old woman with history of bilateral silicone breast implants for cosmetic augmentation. At 2-year interval from receiving the breast implants, she presented with swelling of the right breast with associated chest wall mass, effusion around the implant, and axillary lymphadenopathy. Pathology confirmed breast implant-associated anaplastic large cell lymphoma (stage III, T4N2M0, using BIA-ALCL TNM staging and stage IIAE, using Ann-Arbor staging). The patient underwent bilateral capsulectomy and right partial mastectomy with excision of the right breast mass and received adjuvant CHOP chemotherapy and radiation to the right breast and regional nodes. Since completion of multimodality therapy, the patient has sustained remission on both clinical exam and PET/CT scan. We report this case and review of the literature on this rare form of lymphoma.

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Effectiveness of Bilateral Superficial Cervical Plexus Block as Part of Postoperative Analgesia for Patients Undergoing Thyroidectomy in Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia

Introduction. The pain after thyroid surgery is considered of moderate intensity and short duration. Most trials showed significant reduction in pain intensity and severity of pain in patients for whom bilateral superficial cervical plexus block (BSCPB) was done. Objective. To assess the postoperative analgesic effect of BSCPB for thyroid surgery. Methods. Sixty six euthyroid patients were recruited and assigned to two groups (33 patients each). Group 1 BSCPB and Group 2 standard analgesia. The unpaired Student’s t-test and Mann–Whitney test were used for comparison. Statistical significance was stated at value 

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Three Case Reports of Rhupus Syndrome: An Overlap Syndrome of Rheumatoid Arthritis and Systemic Lupus Erythematosus

We present the clinical and serological characteristics of three patients with rhupus. The 3 patients with rhupus presented ACR criteria for SLE as well as for RA, ANA positive with a titer of 1/100 in all patients, and positive anti-DNA in 2 of the 3 patients, with the predominance of symmetrical polyarthritis. We found anti-CCP positivity and rheumatoid factor positivity and high titers in all patients, positive anti- anti-SSA in one patient, and positive anti- anti-Sm in one patient. Renal and liver function tests were normal in all patients. The 3 patients achieved clinical remission with DMARD treatment.

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Hydrogen Sulfide Abrogates Hemoglobin-Lipid Interaction in Atherosclerotic Lesion

The infiltration of red blood cells into atheromatous plaques is implicated in atherogenesis. Inside the lesion, hemoglobin (Hb) is oxidized to ferri- and ferrylHb which exhibit prooxidant and proinflammatory activities. Cystathione gamma-lyase- (CSE-) derived H2S has been suggested to possess various antiatherogenic actions. Expression of CSE was upregulated predominantly in macrophages, foam cells, and myofibroblasts of human atherosclerotic lesions derived from carotid artery specimens of patients. A similar pattern was observed in aortic lesions of apolipoprotein E-deficient mice on high-fat diet. We identified several triggers for inducing CSE expression in macrophages and vascular smooth muscle cells including heme, ferrylHb, plaque lipids, oxidized low-density lipoprotein, tumor necrosis factor-α, and interleukin-1β. In the interplay between hemoglobin and atheroma lipids, H2S significantly mitigated oxidation of Hb preventing the formation of ferrylHb derivatives, therefore providing a novel function as a heme-redox-intermediate-scavenging antioxidant. By inhibiting Hb-lipid interactions, sulfide lowered oxidized Hb-mediated induction of adhesion molecules in endothelium and disruption of endothelial integrity. Exogenous H2S inhibited heme and Hb-mediated lipid oxidation of human atheroma-derived lipid and human complicated lesion. Our study suggests that the CSE/H2S system represents an atheroprotective pathway for removing or limiting the formation of oxidized Hb and lipid derivatives in the atherosclerotic plaque.

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Early Implanon Discontinuation and Associated Factors among Implanon User Women in Debre Tabor Town, Public Health Facilities, Northwest Ethiopia, 2016

Background. Implanon discontinuation closely related to higher rates of overall fertility rate, unwanted pregnancies, and induced abortion. This might have social and economic consequences. In Ethiopia the magnitude of early Implanon discontinuation and contributing factors is not well studied. Objective. To assess early Implanon discontinuation and associated factors among Implanon user women in Debre Tabor town, 2016. Methods. A facility based cross-sectional study was conducted from May 1 to August 2016 through face-to-face interview. A total of 449 Implanon user women were selected by systematic random sampling technique. Epi Info version 7 and SPSS version 20 were used for data entry and analysis, respectively. Factors associated with early Implanon discontinuation were analyzed using binary and multivariable logistic regression model. Variables with p value of

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Parameter Identification of an Activated Sludge Wastewater Treatment Process Based on Particle Swarm Optimization Method

The current paper is entirely devoted to show the applicability of Particle Swarm Optimization (PSO) algorithm as a parameter identification method for a representative model of an Activated Sludge Wastewater Treatment Process (ASWWTP) with alternating phases. The model of identification is composed of two linear submodels: one for the aerobic phase and the other for the anoxic phase. In order to prove the efficiency of the proposed method, its performance is compared with another classical method called Simplex Search Algorithm (SSA) as well as with the experimental data.

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Modern Diagnostic Techniques for the Assessment of Ocular Blood Flow in Myopia: Current State of Knowledge

Myopia is the most common refractive error and the subject of interest of various studies assessing ocular blood flow. Increasing refractive error and axial elongation of the eye result in the stretching and thinning of the scleral, choroid, and retinal tissues and the decrease in retinal vessel diameter, disturbing ocular blood flow. Local and systemic factors known to change ocular blood flow include glaucoma, medications and fluctuations in intraocular pressure, and metabolic parameters. Techniques and tools assessing ocular blood flow include, among others, laser Doppler flowmetry (LDF), retinal function imager (RFI), laser speckle contrast imaging (LSCI), magnetic resonance imaging (MRI), optical coherence tomography angiography (OCTA), pulsatile ocular blood flowmeter (POBF), fundus pulsation amplitude (FPA), colour Doppler imaging (CDI), and Doppler optical coherence tomography (DOCT). Many researchers consistently reported lower blood flow parameters in myopic eyes regardless of the used diagnostic method. It is unclear whether this is a primary change that causes secondary thinning of ocular tissues or quite the opposite; that is, the mechanical stretching of the eye wall reduces its thickness and causes a secondary lower demand of tissues for oxygen. This paper presents a review of studies assessing ocular blood flow in myopes.

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Shiftwork-Mediated Disruptions of Circadian Rhythms and Sleep Homeostasis Cause Serious Health Problems

Shiftwork became common during the last few decades with the growing demands of human life. Despite the social inactivity and irregularity in habits, working in continuous irregular shifts causes serious health issues including sleep disorders, psychiatric disorders, cancer, and metabolic disorders. These health problems arise due to the disruption in circadian clock system, which is associated with alterations in genetic expressions. Alteration in clock controlling genes further affects genes linked with disorders including major depression disorder, bipolar disorder, phase delay and phase advance sleep syndromes, breast cancer, and colon cancer. A diverse research work is needed focusing on broad spectrum changes caused by jet lag in brain and neuronal system. This review is an attempt to motivate the researchers to conduct advanced studies in this area to identify the risk factors and mechanisms. Its goal is extended to make the shift workers aware about the risks associated with shiftwork.

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Basophils from allergic patients are neither hyper-responsive to activation signals nor hypo-responsive to inhibition signals

Basophils from allergic patients are neither hyper-responsive to IgE-induced activation nor hypo-responsive to IgG- and/or lactobacilli-induced inhibition. Mechanisms that control basophil activation can therefore be used as therapeutic tools in allergic diseases.

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Umbilical cord blood transplantation without in vivo T-cell depletion for children with MHC class II deficiency



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Human dendritic cell subset 4 (DC4) correlate to a subset of CD14dim/-CD16++ monocytes



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Simple laryngeal suspension procedure by suturing the digastric muscle to the periosteum of the mandible in neck dissection for tongue cancer

In this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed.

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IJERPH, Vol. 15, Pages 167: Influence of Muscle Mass and Outdoor Environmental Factors on Appetite and Satiety Feeling in Young Japanese Women

IJERPH, Vol. 15, Pages 167: Influence of Muscle Mass and Outdoor Environmental Factors on Appetite and Satiety Feeling in Young Japanese Women

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15010167

Authors: Masahiro Okada

Research on the influence of relationships among satiety, muscle mass, and outdoor environmental factors is sparse. In this work the relationships among satiety feeling, body composition, and outdoor environmental factors on eating in healthy young Japanese women are investigated. Fifty three (53) women were examined over an approximately 2-year period. All participants ate the same lunch; feelings of satiety and body composition were measured before and immediately after lunch. Satiety was assessed using a visual analog scale. Outdoor environmental factors were recorded at the time of measurement. Results showed that satiety before lunch decreased with increased muscle mass and decreased humidity (p &lt; 0.05). The Δ satiety increased on eating with increased outdoor temperature (p &lt; 0.05). The Δ satiety with high outdoor temperature was significantly greater than with low outdoor temperature (p = 0.005). Decreased muscle mass more influenced Δ satiety with respect to outdoor temperature than increased muscle mass (p = 0.007). The results suggest that increased muscle mass and decreased humidity increase hunger (unlike satiety) before eating. The findings also show that outdoor temperature clearly influences the magnitude of satiety on eating. Increasing muscle mass may be useful for satiety control at various outdoor temperatures in young women.



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Dysmenorrhea among University Health Science Students, Northern Ethiopia: Impact and Associated Factors

Background. It is estimated that more than half of all women in adolescence age suffer from dysmenorrhea and it often interferes with their daily physical and emotional aspects. It is the leading cause of short-term school absenteeism and is associated with a negative impact on academic and daily activities. Objectives. To investigate impacts of dysmenorrhea, factors associated with it, and its self-management strategies used by health science students. Methods. A cross-sectional institution based study was conducted among 246 Mekelle University health science students selected by stratified random sampling technique. Data were collected using self-administered semistructured questionnaire. Data were analyzed using SPSS 16. Results. The prevalence of dysmenorrhea was 71.8%. Participants who had long menstrual cycle interval, long menses flows, and positive family history and who were alcohol users were more likely to had dysmenorrhea. Participants reported that 28.6% feel depressed, 16.2% are absent from class, and 22.9% had poor personal relationship due to dysmenorrhea and 78.2% of them practiced self-medication. Conclusion. Dysmenorrhea is common among Mekelle University health science students and it is major problem representing the cause of feeling depressed, poor personal relationship, and class absenteeism. Majority of the study participants used self-medication to treat dysmenorrhea.

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