Clinical Target Volume Definition in Preoperative Radiotherapy of Rectal Carcinoma: a Systematic Review

Abstract

Purpose of Review

Preoperative radiotherapy (RT) or chemoradiation represents a standard option in neoadjuvant treatment of rectal cancer (RC). The aim of this analysis is to present a systematic review of clinical target volume (CTV) definition in preoperative RT of RC.

A systematic review of published literature was performed. Studies providing clear indications for CTV definition in preoperative RT of RC were eligible. Only studies published as full text were considered. The search was restricted to English, German, and French languages. The CTV delineation, based on the different guidelines, was drawn on selected slices of a CT scan and the CTV definition based on different guidelines was reported in a table to facilitate the comparison.

Recent Findings

A total of six publications containing indications for CTV delineation fulfilled the selection criteria and were included in our review. The studies showed a large variability in available indications between CTV contouring guidelines of RC, partly arising from differences in methods used to propose the single guidelines: expert opinion, systematic review, computer-generated consensus, and 3D modeling of recurrence sites.

Summary

In our systematic analysis, the available indications for CTV definition in preoperative RT of RC were reviewed. A large variation in target volume delineation was observed.

http://ift.tt/2szEbew

Clinical Impact of Non-Congenital Zika Virus Infection in Infants and Children

Abstract

Purpose of Review

While the Zika virus (ZIKV) has been noted for its distinct neurotropism and identified as a significant cause for a congenital infection syndrome, there has been increased recognition of the importance to better understand the clinical impact of non-congenital ZIKV infection in infants and children. This article reviews reports of perinatal and breast milk transmission of ZIKV and summarizes current clinical outcome data of pediatric non-congenital ZIKV infection.

Recent Findings

Perinatal transmission and presence of infective ZIKV particles in breast milk have been reported. Most symptomatic non-congenital ZIKV infection in infants and children is mild and self-limited, but long-term follow-up studies are lacking.

Summary

The mechanism and impact of perinatal and breast milk transmission is unclear. The current WHO infant feeding guidelines in areas of ZIKV transmission support breastfeeding. Unless any scientific data raise concern regarding transmission via breastfeeding, the current guidelines should continue to be followed. Prospective population-based cohort studies to investigate maternal, perinatal, infant, and child outcomes are needed.

http://ift.tt/2trklC9

The Use of Statins and Risk of Community-Acquired Pneumonia

Abstract

Purpose of the Review

Community-acquired pneumonia (CAP) is still associated with a large burden and causes significant morbidity and mortality. Besides universal vaccination and antibiotic treatment, statins as adjunctive therapy may also have a beneficial role in the prevention and treatment of CAP. Our goal from this review is to discuss the epidemiology of CAP, and role of statins as adjunctive therapy in the development of CAP.

Recent Findings

Statins are lipid-lowering medications characterized by their ability to control hypercholesterolemia in addition to other pleiotropic effects that could explain their role in the pathogenesis of CAP. While most observational studies have shown that statins reduce risk of pneumonia in the general population, patients with diabetes, and recently in patients with myocardial infarction, no randomized controlled trial (RCT) to date has been conducted to assess the efficacy of statins to prevent development of CAP.

Summary

Given the paucity of robust randomized evidence to assess statin use and the development of CAP, and considering conflicting results of the observational studies, we are not in favor of initiation of statins for either the prevention or treatment of CAP.

http://ift.tt/2sRT0vY

Distinct proteome pathology of circulating microparticles in systemic lupus erythematosus

Abstract

Background

The pathogenesis of systemic lupus erythematosus (SLE) is poorly understood but has been linked to defective clearance of subcellular particulate material from the circulation. This study investigates the origin, formation, and specificity of circulating microparticles (MPs) in patients with SLE based on comprehensive MP proteome profiling using patients with systemic sclerosis (SSc) and healthy donors (HC) as controls.

Methods

We purified MPs from platelet-poor plasma using differential centrifugation of samples from SLE (n = 45), SSc (n = 38), and two sets of HC (n = 35, n = 25). MP proteins were identified and quantitated after trypsin digestion by liquid chromatography-tandem mass spectrometry. The abundance of specific proteins was compared between the groups using univariate statistics and false discovery rate correction for multiple comparisons. Specific proteins and protein ratios were explored for diagnostic and disease activity information using receiver-operating characteristic curves and by analysis of correlations of protein abundance with disease activity scores.

Results

We identify and quantitate more than 1000 MP proteins and show that a subpopulation of SLE-MPs (which we propose to call luposomes) are highly specific for SLE, i.e. not found in MP preparations from HC or patients with another autoimmune, systemic disease, SSc. In SLE-MPs platelet proteins and mitochondrial proteins are significantly diminished, cytoskeletal proteins deranged, and glycolytic enzymes and apoptotic proteins significantly increased.

Conclusions

Normal MPs are efficiently removed in SLE, but aberrant MPs, derived from non-lymphoid leukocytes, are less efficiently removed and abundantly produced leading to an altered MP proteome in SLE. The data suggest that an abnormal generation of MPs may partake in the pathology of SLE and that new diagnostic, monitoring, and treatment strategies targeting these processes may be advantageous.

http://ift.tt/2rBzvn2

Coagulation abnormalities in children with Celiac disease

Abstract

We prospectively analyzed the coagulation abnormalities in 111 children with Celiac disease at diagnosis and its association with histology grade on duodenal biopsy; 27% had deranged prothrombin time. There was an increasing proportion of coagulopathy with progression of Marsh Grade on duodenal histology.

http://ift.tt/2tr8W5r

Components of Metabolic syndrome at 22 years of age–Findings from Pune low birth weight study

Abstract

Objective

To study the early markers of Metabolic syndrome in a cohort of low birth weight (LBW) children followed up since birth, at the age of 22 years.

Design

Prospective cohort study.

Setting

Tertiary-care hospital

Participants

Neonates weighing less than 2000 g discharged from a neonatal special care unit were followed up prospectively; 153 cases and 77 controls were assessed at 22 years of age.

Methods

Fasting, 30 minute and 120 minute glucose and insulin after a bolus of 75g of glucose was determined. Insulin resistance was calculated. A lipid profile was also done. Anthropometric measurements were taken and abdominal fat was determined by magnetic resonance imaging.

Main outcome

Prevalence of the five components of Metabolic Syndrome as described by the International Diabetic Federation (IDF).

Results

65.1% of the cohort was born small for gestational age. All three components of Metabolic syndrome were present in only three cases and none of the controls. However, two components were present in 25 (16.4%) cases and 5 (6%) controls (P=0.039). Cases in the lowest quartile of birthweight who became big at 22 years had significantly higher fasting insulin (P=0.001), Homeostatic Model Assessment–Insulin Resistance (Homa-IR) (P=0.001) and higher systolic blood pressure. Sum of skinfold thickness at 4 sites correlated significantly with fasting insulin and HOMA-IR, and was a stronger correlate compared to BMI, waist circumference and MRI fat. There was no difference in the biochemical parameters between appropriate for gestational age and small for gestational age infants.

Conclusion

Prevelence of three or more components of Metabolic syndrome was low in LBW children at 22 years, but of two components was high. Those 'Small at birth and big at 22 years' had high insulin resistance.

http://ift.tt/2sS58gq

Dengue: Differently conceptualized

http://ift.tt/2tryz68

Consensus statement of the Indian Academy of Pediatrics on evaluation and management of Attention Deficit Hyperactivity Disorder

Abstract

Justification

Attention-Deficit/Hyperactivity Disorder (ADHD) is highly prevalent in children worldwide. Management of ADHD requires a systematic, multidisciplinary approach and therefore evidence-based, standardized national guidelines are essential.

Process

A meeting for formulation of national consensus guidelines on neurodevelopmental disorders was organized by Indian Academy of Pediatrics in Mumbai, on 18^th and 19^th December, 2015. The invited experts included Pediatricians, Developmental Pediatricians, Pediatric Neurologists, Psychiatrists, Remedial Educators and Clinical Psychologists. The participants framed guidelines after extensive discussions.

Objective

To provide consensus guidelines on evaluation and management of ADHD in children in India.

Recommendations

ADHD is a chronic condition and thus education of patients, families, and teachers regarding the diagnosis is an integral part of management. Involvement of patient the and the family in the management program is extremely vital. Management of ADHD centers on the achievement of target outcomes, which are chosen in collaboration with the child, parents, and school personnel. Coexisting conditions must be treated concurrently with ADHD. Modalities of management of ADHD include behavioral interventions, medications, and educational interventions. These modalities can be implemented individually or in combination.

http://ift.tt/2sRBoQX

Right atrial diverticulosis and early-onset arrhythmia: Rare cause of incessant neonatal arrhythmia

Abstract

Background

Atrial flutter not responding to medications could be secondary to structural malformations of heart.

Case characteristics

A 5-year-old child with resistant arrhythmia, with onset in neonatal period.

Outcome

Multiple right atrial diverticuli were detected on CT angiography and cardiac catheterization. Patient reverted to sinus rhythm following surgical excision of diverticuli.

Message

In cases of intractable supraventricular tachycardia, structural anomalies of atrium should be suspected.

http://ift.tt/2trjLVc

Kyphoscolitic type of Ehlers-Danlos syndrome with prenatal stroke

Abstract

Background

The kyphoscoliotic type of Ehlers-Danlos syndrome (EDS type VIA) is an autosomal recessive disorder characterized by connective tissue dysplasia.

Case characteristics

We report two children with perinatal stroke; accompanied by neonatal joint hypermobility, hypotonia; and early development of kyphoscoliosis.

Outcome

Molecular analysis revealed a PLOD1 gene mutation. Our definitive diagnosis was a EDS VIA.

Message

Prenatal brain stroke is a rare clinical feature of EDSVIA.

http://ift.tt/2tr8VhT

Correspondence

http://ift.tt/2sRyD22

Clinical and molecular characterization of children with neonatal diabetes mellitus at a tertiary care center in northern India

Abstract

Objective

To study the genetic mutations and clinical profile in children with neonatal diabetes mellitus

Methods

Genetic evaluation, clinical management and follow-up of infants with neonatal diabetes

Results

Eleven infants were studied of which eight had permanent neonatal diabetes. Median age at presentation was 8 weeks and mean (SD) birth weight was 2.4 (0.5) kg. Pathogenic genetic mutations were identified in 7 (63.6%) children; 3 infants with mutations in KCNJ11 gene and 1 in ABCC8 were switched to oral sulfonylureas; 2 infants had mutations in INS and 1 in ZFP57.

Conclusion

Neonatal diabetes mellitus is a heterogeneous disorder. Identification of genetic cause guides clinical management.

http://ift.tt/2tqZcbx

Family-centered care to complement care of sick newborns: A randomized controlled trial

Abstract

Objective

To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.

Design

Randomized controlled trial

Setting

Tertiary referral nursery (October 2010 to March 2012).

Participants

295 neonates randomized at the time of hospitalization in neonatal intensive care unit.

Intervention

Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.

Outcome measure

Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.

Results

Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].

Conclusions

There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

http://ift.tt/2sRyBaq

Infantile tumoral calcinosis

http://ift.tt/2trmsG8

Editorial

http://ift.tt/2sRYI11

An Indian family with tyrosine hydroxylase deficiency

Abstract

Background

Tyrosine Hydroxylase deficiency is a rare neurotransmitter disorder.

Case Characteristics

An Indian family with the disorder.

Observation

Phenotypic variation, elevated serum prolactin, genetic confirmation, and partial treatment-responsiveness.

Messages

Tyrosine Hydroxylase deficiency is a treatable inborn error of metabolism and serum prolactin assists in diagnosis.

http://ift.tt/2trjK3A

Randomized controlled trial evaluating probiotics in children with severe acute malnutrition

Summary

This randomized, double-blind, placebo-controlled trial was conducted involving 400 children hospitalized with severe acute malnutrition (SAM). Patients received one daily dose of a blend of Bifidobacterium animalis subsp lactis and Lactobacillus rhamnosus (10 billion colony-forming units, 50:50) or placebo during hospitalization followed by an 8- to 12-week outpatient treatment period, depending on patients' recovery rate. The primary outcome was number of days with diarrhea during hospitalization. Secondary outcomes included other diarrhea outcomes, pneumonia, weight gain, and recovery. There was no difference in number of days with diarrhea between the probiotic (n=200) and placebo (n=200) groups during inpatient treatment (adjusted difference +0.2 days, 95% confidence interval -0.8 to 1.2, P=0.69); however, during outpatient treatment, probiotics reduced days with diarrhea (adjusted difference -2.2 days 95% confidence interval -3.5 to -0.3, P=0.025). Twenty-six patients died in the probiotic versus 20 in the placebo group (P=0.38). The authors concluded that these probiotics had no effect on diarrhea in children with SAM during hospitalization, but reduced the number of days with diarrhea in outpatient treatment by 26%.

http://ift.tt/2sRUmXO

Theme : Pediatric gastroenterology

http://ift.tt/2trjDoG

News in brief

http://ift.tt/2sRUJRQ

Ethical off-label drug-use: Need for a rethink?

Abstract

Off-label drug use is unavoidable, especially in children. Legal justice originates from ethical justice; therefore, ethical off-label drug use can be considered legal. We share our successful experiences with this issue in China, which may provide a reference to Indian healthcare professionals, to develop a common executable standard to be applied to evaluate the off-label drug use in clinical practice.

http://ift.tt/2trGSz4

Screening for hypoglycemia in exclusively breastfed high-risk neonates

Abstract

Objective

To determine incidence of hypoglycemia in exclusively breastfed, high-risk but healthy newborns, and risk factors for its development.

Methods

This observational study enrolled 407 exclusively breastfed high-risk (low birth weight newborns (1800-2499 g), late preterms, small-for-gestation, large-for-gestation and infant of diabetic mother), who did not require admission to neonatal intensive care unit and were kept in postnatal wards with mother. Hypoglycemia was defined as blood glucose ≤46 mg/dL (2.6 mmol/L). Blood glucose was monitored till 48 hours of life.

Results

27% of the screened newborns developed hypoglycemia in first 48 hours. 31 (7.6%) developed recurrent (>2) episodes, 28 (6.8%) had moderate (<37mg/dL) while 8 (1.9%) developed symptomatic hypoglycemia. With increase in birthweight, risk of hypoglycemia reduced significantly (P=0.003). Hypoglycemia was observed more frequently in first 2 hours as compared to next 48 hours (P=0.0001). Low birth-weight, preterm gestation and male gender was significantly associated with increased risk of hypoglycemia.

Conclusion

Healthy, high-risk exclusively breastfed newborns in postnatal wards need close monitoring for hypoglycemia in first 24 hrs of life.

http://ift.tt/2sRHlxn

Acquired methemoglobinemia–A sporadic Holi disaster

Abstract

Objective

To study clinical profile and outcome in patients with methemoglobinemia following exposure to toxic colors during Holi festival.

Methods

This retrospective study included 112 children (5 to 12 years) admitted with methemoglobinemia after playing Holi. Clinical and treatment details were reviewed.

Results

The common symptoms were giddiness, vomiting and headache. Treatment included thorough skin wash, intravenous fluid and methylene blue in 111 children. Age 7-9 and > 11 years, vomiting, giddiness, cyanosis, PaO2 < 80 mm Hg and oxygen saturation < 95% were associated with higher need for methylene blue. All children had a good outcome.

Conclusion

Timely diagnosis and management of acquired methemoglobinemia can save lives.

http://ift.tt/2trCYGr

Pneumococcal conjugate vaccine introduction in India’s Universal immunization program

http://ift.tt/2szuywg

HCC Locoregional Therapies: Yttrium-90 (Y-90) Selective Internal Radiation Therapy (SIRT)

http://ift.tt/2sRSfTC

Subcutaneous endoscopically assisted ligation of spermatic vessels (SEAL-SV) using an epidural-&-spinal needle: a novel technique to repair adolescent varicocele

Abstract

We describe a novel technique of subcutaneous endoscopically assisted ligation of spermatic vessels (SEAL-SV) using a modified epidural-&-spinal needle. This technique achieves very cosmetic and minimally invasive outcomes. We have successfully performed SEAL-SV for five consecutive boys and considered it a simple, safe, and effective procedure for adolescent varicoceles.

http://ift.tt/2sTPJMw

Knowledge, Awareness, and Prevention of Hepatitis B Virus Infection Among Korean American Parents

Abstract

Hepatitis B (HB) affects 240 million people around the world, and children and young adults make up a large proportion of the infected population. Approximately 1 million people die from HB each year. Despite the seriousness of HB and its complications, many are poorly linked to clinical care. A lack of health literacy may be a critical barrier hindering access to HB care for adults as well as children in these populations. We, therefore, performed a survey to assess the level of knowledge of HB among Korean American parents. The survey was conducted on 521 Korean American adults who attended community-based HB awareness campaigns held at various locations throughout the metropolitan New York area between January 2015 and November 2016. Of these, 296 parents, who had children between ages 1 and 30, were identified. All participants were asked a series of questions regarding various aspects of HB and were evaluated on the basis of their awareness on each subject. A separate questionnaire was also employed to obtain demographic characteristics of the participants. The study revealed a significant deficit of knowledge of HB in most aspects the survey evaluated. Although the majority of the participants knew that HB is a liver disease, and many of them had been screened for HB, they had a poor understanding of vaccination, screening, their own HB status, modes of HBV transmission, and the consequences and treatment of HB. The participants also had a low level of awareness of their own children's HB status. This study demonstrates a low level of knowledge of HB among Korean American parents electing to attend a hepatitis education program. In addition, many parents are not aware of their children's screening and immune (or non-immune) status. The lack of health literacy may contribute to poor health access in HB care, not only in adults but also in children. This suggests an urgent need for education on HB in Korean American parents as well as in young children.

http://ift.tt/2rTsb5H

Incidental finding of coarctation of the aorta in a Marfan patient: a case report

Abstract

Aneurysm of the ascending aorta with coarctation of the aorta is a rare find in the literature. We report a case of a huge ascending aorta aneurysm in a patient of Marfan's syndrome and associated coarctation of the aorta. The patient underwent staged procedure in the form of balloon dilatation for the coarctation of the aorta and a successful Bentall procedure for the aneurysm of the aorta with a brief period of deep hypothermic circulatory arrest (DHCA). Two-staged approach is the ideal management for such cases amenable for endovascular repair.

http://ift.tt/2tM0Pj9

Venous Thromboembolism Is an Independent Predictor of Mortality Among Patients with Gastric Cancer

Abstract

Background

Venous thromboembolism (VTE) is an independent predictor of death among patients with cancer. Patients with gastric cancer (GC) are at higher risk for VTE when compared to other solid tumors, and if one considers its prevalence, GC may be responsible for one of the highest incidences of cancer-associated thrombosis. The impact of VTE on mortality is not well defined among patients with GC.

Aim

The aim of this study is to measure the impact of VTE as independent predictor of GC mortality.

Methods

Chart review of patients with GC treated in the Department of Oncology at John Stroger Hospital between the years of 2010 and 2015. VTE events were objectively confirmed with imaging in all cases. Active GC was defined as biopsy-proven metastatic disease or on active chemotherapy. Along with cancer-specific data, we abstracted risk assessments tools, non-GC-specific, validated for VTE and mortality prediction cancer, including the Khorana score (KRS), platelet lymphocyte ratio (PLR), and neutrophil lymphocyte ratio (NLR). Continuous variables are expressed by the median as appropriate according to normality. Categorical variables are expressed as percentages. SPSS version 22 was used and chi-square, Mann-Whitney U, Kaplan-Meier curve, and Cox proportional hazard with forward modeling were applied.

Results

We included 112 patients in the analysis. The patients were predominantly men (66%), 58-year-old, with adenocarcinoma (84%) and advanced disease (59%). The median follow-up was 21.3 months (IQR 8.9–42.4). Cumulative incidence of VTE at 1 year was 9%. The median time from diagnosis to VTE occurrence was 59 days (IQR 36 to 258). Patients with VTE had worse OS when compared to the non-VTE group (medians 11.87 vs 29.97 months, p = 0.02). Patients stratified as high risk by the PLR had worse OS (medians 22.6 vs 42.77 months, p = 0.02). There was no statistical difference in OS among patients stratified as high risk by the KRS (medians 23.7 vs 42.5, p = 0.16) and NLR (medians 24.1 vs 42.7 months, p = 0.21). In multivariate analysis, the independent predictors of mortality were VTE (hazard ratio (HR), 2.9; 95% CI, 1.4 to 6.6; p < 0.01), adenocarcinoma (HR, 3.1; 95% CI, 1.1 to 9.0; p = 0.03), advanced disease (HR, 2.8; 95% CI, 1.4 to 5.8; p < 0.01), and PLR (HR, 2.2; 95% CI, 1.3 to 3.8; p < 0.01).

Conclusion

VTE is associated with worse survival among patients with GC along with adenocarcinoma, advanced disease, and PLR. Moreover, these findings were independent of other cancer- and treatment-specific variables. Although potentially predictive in other cancer types, NLR and KRS were not associated with worse survival in this cohort.

http://ift.tt/2rOIS7l

Synthesis and thermal properties of natural rubber grafted with poly(2-hydroxyethyl acrylate)

Abstract

A novel modified natural rubber with grafted poly(2-hydroxyethyl acrylate) (NR-g-PHEA) was synthesized by emulsion polymerization in latex stage. Cumene hydroperoxide and tetraethylene pentamine were used as redox initiators (1:1 M ratio). The influences of reaction temperature, reaction time, initiator concentration and monomer concentration on percent grafting and grafting efficiency were investigated. Transmission electron microscopy was used to observe the NR-g-PHEA particles, which exhibited core-shell morphology. Chemical structure of purified NR-g-PHEA was confirmed by Fourier transform infrared spectroscopy and proton nuclear magnetic resonance spectroscopy. The thermal properties were examined by thermogravimetric analysis and by differential scanning calorimetry. The modified NR had improved thermal stability, and the NR-g-PHEA also presented slightly higher glass transition temperature than virgin NR.

http://ift.tt/2rBevwG

Can music-based movement therapy improve motor dysfunction in patients with Parkinson’s disease? Systematic review and meta-analysis

Abstract

This study aimed to quantify whether there is association between music-based movement therapy and motor dysfunction in patients with Parkinson's disease, and, if so, whether music-based movement therapy can be used as first-line non-pharmacological treatment. To conduct a systematic review and meta-analysis of clinical trials that examined the effect of music-based movement therapy on patient-relevant and disease-specific outcomes. Comprehensive literature was searched of PubMed, EMbase, and the Cochrane Library from inception to November 2016. Randomized controlled trial of patients with Parkinson's disease was searched to identify trials comparing music-based movement therapy with no music care. A total of 8 studies (11 analyses, 241 subjects) were included; all of them had acceptable quality by PEDro scale score. Studies based on any type of Parkinson's disease patients were combined and subgroup analyzed. Compared with the control group, the SMD of Berg Balance Scale score was 0.85(0.46 to 1.25), −0.60 (−0.98 to −0.22) in Parkinson Disease Questionnaire-39 summary index, −0.90s (−1.56 to −0.23) in Time Up and Go text, and −0.43 (−1.11 to 0.25) in Unified Parkinson's Disease Rating Scale Motor Subscale 3 as instrument methods for motor function. Secondary outcomes included cognitive function and quality of life. There was positive evidence to support the use of music-based movement therapy on treatment of motor function; there was neutral evidence to support the use of music for the treatment of cognitive function quality of life.

http://ift.tt/2sO87FU

Determinants of change in polypharmacy status in Switzerland: the population-based CoLaus study

Abstract

Objectives

This study aimed to assess the prevalence, the change, and the determinants of change in polypharmacy in a population-based sample.

Methods

Baseline (2003–2006) and follow-up (2009–2012) data are from 4679 participants aged between 35 and 75 years (53.5% women, mean age 52.6 ± 10.6 years) from the population of Lausanne, Switzerland. Polypharmacy was defined by the regular use of ≥5 drugs. Four categories of change were defined: never (no polypharmacy at baseline and follow-up), initiating (no polypharmacy at baseline but at follow-up), maintaining, or quitting.

Results

Polypharmacy increased from 7.7% at baseline to 15.3% at follow-up. Cardiovascular drugs were the most prescribed medicines at baseline and follow-up. Gender, age, obesity, smoking, previously diagnosed hypertension, or diabetes or dyslipidemia were significantly and independently associated with initiating and maintaining polypharmacy.

Conclusion

In a population-based sample, prevalence of polypharmacy doubled over a 5.6-year period. The main determinants of initiating polypharmacy were age, overweight and obesity, smoking status, and previously diagnosed cardiovascular risk factors.

http://ift.tt/2tLZ1a0

Multi-step biocatalytic depolymerization of lignin

Abstract

Lignin is a biomass-derived aromatic polymer that has been identified as a potential renewable source of aromatic chemicals and other valuable compounds. The valorization of lignin, however, represents a great challenge due to its high inherent functionalization, what compromises the identification of chemical routes for its selective depolymerization. In this work, an in vitro biocatalytic depolymerization process is presented, that was applied to lignin samples obtained from beech wood through OrganoCat pretreatment, resulting in a mixture of lignin-derived aromatic monomers. The reported biocracking route comprises first a laccase-mediator system to specifically oxidize the Cα hydroxyl group in the β-O-4 structure of lignin. Subsequently, selective β-O-4 ether cleavage of the oxidized β-O-4 linkages is achieved with β-etherases and a glutathione lyase. The combined enzymatic approach yielded an oily fraction of low-molecular-mass aromatic compounds, comprising coniferylaldehyde and other guaiacyl and syringyl units, as well as some larger (soluble) fractions. Upon further optimization, the reported biocatalytic route may open a valuable approach for lignin processing and valorization under mild reaction conditions.

http://ift.tt/2sNSSN4

CCL11 (Eotaxin-1) Levels Predict Long-Term Functional Outcomes in Patients Following Ischemic Stroke

Abstract

Circulating levels of the pro-inflammatory cytokine C-C motif chemokine 11 (CCL11, also known as eotaxin-1) are increased in several animal models of neuroinflammation, including traumatic brain injury and Alzheimer's disease. Increased levels of CCL11 have also been linked to decreased neurogenesis in mice. We hypothesized that circulating CCL11 levels would increase following ischemic stroke in mice and humans, and that higher CCL11 levels would correlate with poor long-term recovery in patients. As predicted, circulating levels of CCL11 in both young and aged mice increased significantly 24 h after experimental stroke. However, ischemic stroke patients showed decreased CCL11 levels compared to controls 24 h after stroke. Interestingly, lower post-stroke CCL11 levels were predictive of increased stroke severity and independently predictive of poorer functional outcomes in patients 12 months after ischemic stroke. These results illustrate important differences in the peripheral inflammatory response to ischemic stroke between mice and human patients. In addition, it suggests CCL11 as a candidate biomarker for the prediction of acute and long-term functional outcomes in ischemic stroke patients.

http://ift.tt/2tqQ7iI

Personal Autonomy and Authenticity: Adolescents’ Discretionary Use of Methylphenidate

Abstract

Minors with attention-deficit-hyperactivity disorders (ADHD) are liable to use pharmacological treatment against their will and may find their authentic "I" modified. Thus, their use is widely criticized. In this study, the effect of ADHD drugs on adolescents' personal experience is examined. The goal is to understand how psychological changes that young people experience when they take these medications interrelate with their attitude toward being medicated. Methylphenidate is the most common pharmacological treatment for ADHD. We look into the change that Israeli adolescents undergo when they use it; their experience in controlling the change, and their assessment of the meaning of the change for their lives. Thirty-eight adolescents participated in semi-structured interviews. The findings, analyzed using grounded theory, show that methylphenidate affects the participants' demeanor, mood, and even preferences. The participants, aware of these effects, apply discretion in taking methylphenidate and thus influence their traits and their willingness to engage in various activities. When needing to prepare for a matriculation exam, for example, they take methylphenidate; when they need to be creative or sociable, they avoid it and enjoy what they consider the advantages of ADHD, such as creativity and spontaneity. As discretionary users, they shape their life stories in a way that makes them more meaningful and diverse, better tailored to their social surroundings, and more useful in maintaining personal autonomy in the course of pharmacological treatment of ADHD.

http://ift.tt/2sO4Y8Y

Physicochemical properties of liquid natural rubber bearing fluoro groups for hydrophobic surfaces

Abstract

The modification of liquid natural rubber (LNR) has attracted interests among chemists as it brings improvements to several of its properties and widens its application to various fields. LNR can be modified into fluorinated LNR (F-LNR) which is of interest to industries due to its remarkable properties, including low surface energies, high thermal stabilities, together with its significant hydrophobic characters. In this work, a new route to prepare fluorinated rubber was presented. Hydroxylated LNR (OH-LNR) was initially synthesized in good yield via oxidation in the presence of tungsten complex catalyst and acetic acid with hydrogen peroxide as an oxidant. The optimum hydroxyl content of 57.0% was obtained within 6 h reaction time at 90 °C. In the second step, the esterification of OH-LNR using pentadecafluorooctanoyl chloride (PDFOC) under mild conditions was conducted, leading to LNR bearing fluoro groups in the side chain of LNR (F-LNR). ATR-FTIR spectroscopy was used to elucidate the structure and determine any changes in the functional groups that may have been induced during the reaction. ¹H NMR spectroscopy was employed to reveal that a high fluorine content of 48.6% was obtained using 3:1 molar ratio of OH-LNR:PDFOC for 8 h at 50 °C. The microstructure of F-LNR was further analyzed using ¹⁹F NMR and ¹³C NMR spectroscopies, and the results confirmed the presence of fluorine in LNR. Thermogravimetric analyses also indicated that the modification improved thermal stability of the LNR. Contact angle measurements were also conducted to verify the hydrophobicity of the fluorinated rubber and the results obtained showed that F-LNR exhibited higher hydrophobicity than LNR.

http://ift.tt/2tqPkhQ

Genotoxicity in the Offspring of Rats Exposed to Contaminated and Acidified Experimentally Soils

Abstract

The aim of this study was to evaluate the genotoxic and mutagenic potential of contaminated soil diluted in acidic solutions and not acidic, in the offspring of rats exposed during pregnancy and neonatal periods. To this end, a comet assay and micronucleus test were performed. Soil samples were solubilized in the following three solvents: distilled water (control group), acid solvent at pH 5.2, and acid solvent at pH 3.6. Soil and solvent were mixed in a rate of 1:2 in g/mL, and hydrofluoric acid was used in the acid solvents. In the comet assay, the tail length, percentage of DNA within the tail and tail moment was analyzed in the whole blood of the pups that were studied. The number of micronuclei found in the bone marrow cells was counted in the micronucleus test. In all parameters evaluated in the comet assay, the group exposed to the lowest pH value when associated with contaminated soil (p < 0.05) had the most damage. However, the micronucleus test showed differences between all exposed groups and the control group (p < 0.05). These results reaffirm the health risks related to the exposure to soil contaminants.

http://ift.tt/2tLAvpu

The 50 Most Cited Articles in Facial Plastic Surgery

Abstract

Bibliometric analysis is a common method to determine the most influential articles in medical specialties, as it is an objective measure of peer recognition of scientific work. This study is the first bibliometric analysis of the literature in facial plastic surgery, to determine the most cited papers in the field. Bibliometric analysis was performed using the Science Citation Index from the Institute for Scientific Information, accessed through the Web of Science™. Filter terms relevant to the field of facial plastic surgery were used to identify the 50 most cited journal articles between 1900 and 2016. The median number of citations was 150 (range 116–1091). The articles spanned a wide range of topics in the field, with the most common topics being free flap reconstruction (n = 10), nasal surgery (n = 9), and rhytidectomy (n = 6). The majority of these articles (n = 29) presented findings supported by level IV or V evidence. This analysis provides an overview of the most cited articles in facial plastic surgery, many of which introduced some of the most fundamental principles and techniques in the field. These landmark articles represent important educational points that should be reviewed by all clinicians and trainees in this field.

Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Management of Tuberous Breast Deformities: Review of Long-term Outcomes and Patient Satisfaction with BREAST-Q

Abstract

Background

The treatment of a tuberous breast deformity has changed over the years, with a large variety of procedures described. However, maintaining a long-lasting breast contour is an ongoing challenge. The aim of this study was to evaluate the long-term results of tuberous breast corrections, focusing on the incidence of secondary procedures and patient satisfaction.

Materials and Methods

Forty-six patients who underwent correction of a tuberous breast deformity from 2000 through 2013 were considered. Age, degree of deformity, asymmetry, BMI, pregnancy, first surgical technique used, complications and further surgical procedures were evaluated. Statistical analysis was conducted to identify predicting factors for multiple procedures. Patient satisfaction was evaluated with BREAST-Q.

Results

Eighty-eight breasts were treated: 57 breasts underwent implant-based corrections, whereas 31 breasts underwent autologous procedures. A multi-step procedure was initially planned in 7 breasts only, and 41 breasts underwent secondary procedures: 33 out of 53 breasts (62.3%) were re-operated in the implant-based group, whereas 8 out of 28 breasts (28.6%) were re-operated in the autologous group. Statistical analysis showed a correlation between the number of procedures and young age (P = 0.0253) and between the number of procedures and the primary surgical technique (P = 0.0132). The BREAST-Q evaluation suggested that patient satisfaction was comparable.

Conclusions

The question of time is one of the main issues in breast surgery. The management of tuberous breast deformities requires a customized strategy considering all parameters to improve the longevity of the result in the long term.

Level of evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

http://ift.tt/2rAdqp6

Rectus Abdominis Fat Transfer (RAFT) in Lipoabdominoplasty: A New Technique to Achieve Fitness Body Contour in Patients that Require Tummy Tuck

Abstract

Objective

To describe a new technique to achieve a fit-look in lipoabdominoplasty patients through liposculpture and rectus abdominis fat transfer (RAFT).

Methods

Patients with a body mass index under 26 and of both genders scheduled for abdominoplasty or body lift were selected for this procedure. Fat was transferred directly to the rectus abdominis muscle after flap elevation during lipoabdominoplasty.

Results

A total of 26 patients were operated on with this technique. No complications attributable to the fat grafting were noticed. All patients had a high satisfaction level with the procedure. Demonstrative cases are shown.

Discussion

The RAFT technique is a useful and effective technique to improve results in standard lipoabdominoplasty. Its main limitation is the adequate selection of the patient. The RAFT technique can be incorporated easily to common day practice.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

http://ift.tt/2sTyUkE

Re-designing the pathway to surgery: better care and added value

Abstract

The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.

http://ift.tt/2syoFQd

Comparison of the Behavior of Male Rhesus Macaques in Individual and Group Keeping Conditions: Aggressivity and Anxiety

Individual variability in measures of aggressivity and anxiety in male Rhesus macaques (Macaca mulatta) was studied. The observations addressed 69 males reared in family groups and kept during the study in individual cages and then in outdoor corrals in groups consisting only of males. Measures of observer-directed aggression and anxiety noted in individual conditions were found not to be reliable predictors of measures of aggressivity and anxiety in social group conditions. Categories of males were identified with different reactions to the change in conditions. Transfer of males from individual conditions to corrals had therapeutic effects on their mental status. In corral conditions, pathological forms of self-directed behavior disappeared from the repertoires of most males. Thus, these observations show that keeping conditions can have powerful influences on the behavioral phenotype of adult male Rhesus macaques, which has to be considered when performing studies requiring analysis of aggressivity and anxiety in monkeys.

http://ift.tt/2sR4m3w

Age-Related Changes in Morphometric Parameters of Hippocampal Neurons in Humans

Age-related changes in the hippocampus (HPO) lead to derangements of all types of memory and changes in emotional reactions. The aim of the present work was to study morphometric measures of neurons in the human HPO during aging. Specimens were obtained at autopsy of 43 people of both genders, aged 21–92 years, divided into four age groups. Specimens were stained with cresyl violet to detect neurons. Neurons were counted per unit area in the pes hippocampi in sections of intrinsic hippocampal fields CA1 and CA3 and the dentate gyrus, with measurement of neuron body profile field areas. Aging was found to be associated with heterochronous loss of nerve cells in the human HPO, this process occurring at different intensities in the midpart and the pes. The extent of age-related death of nerve cells in the human HPO increases in the direction dentate gyrus ⟶ field CA3 ⟶ field CA1. Most parts of the HPO showed compensatory increases in neuron profile field areas from 36 to 74 years, followed by a decrease in subjects more than 75 years old.

http://ift.tt/2tqH55q

Cytoarchitectonics and Neuronal Organization of the Basolateral Nucleus of the Amygdaloid Body of the Brain in Rats Preferring and Not Preferring Alcohol

Analysis of the cytoarchitectonics of the basolateral (BL) nucleus of the amygdaloid body (AB) was performed using cresyl violet-stained frontal paraffin sections of the brains of 10 alcohol-preferring (AP) and 10 alcohol non-preferring (NAP) rats (with equal numbers of males and females in each group). Large and small neurons were found in the BL nucleus. Most large neurons in AP rats were chromoneutral or moderately chromophilic, while those in NAP rats were moderately chromophobic. Studies using the Golgi method showed that long-axon densely branched pyramid-shaped neurons were equivalents of large neurons, while short-axon neurons corresponded to small neurons. Assessment of the ratio of large to small neurons showed that the proportion of the latter in AP rats was 12.3 ± 0.6%, while that in NAP rats was significantly greater, at 19.70 ± 0.23%. These results explain previously reported data showing that the greater specific area of the BL nucleus of the AB in NAP rats was due to the presence of larger numbers of interneurons than present in AP rats.

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Dynamic Properties of Human Tympanic Membrane After Exposure to Blast Waves

Abstract

Blast overpressure causes dynamic damage to middle ear components, and tympanic membrane (TM) rupture is the most frequent middle ear injury. However, it is unclear how the blast waves change mechanical properties of the TM and affect sound transmission through the ear. This paper reports the current study on dynamic properties of the TM after exposure to blast waves by using acoustic loading and laser Doppler vibrometry (LDV). The TM specimens were prepared from human temporal bones following exposures to blast overpressure. Vibration of the TM specimen induced by acoustic loading was measured by LDV over a frequency range of 200–8000 Hz. An inverse-problem solving method with finite element modeling was used to determine the complex modulus of the TM specimen. The post-blast storage modulus ranged from 23.1 to 26.9 MPa, and loss modulus ranged from 0.09 to 3.78 MPa as frequency increased from 200 to 8000 Hz. Compared to the complex modulus of normal TM reported in the literature, the post-blast storage and loss modulus decreased significantly across the frequency range. The scanning electron microscopy (SEM) images of the post-blast TM samples showed microstructural changes of the tissue, which explained the alteration of mechanical properties of the TM samples.

http://ift.tt/2snHhnt

Engineering poly(lactic- co -glycolic acid) (PLGA) micro- and nano-carriers for Controlled Delivery of 17β-Estradiol

Abstract

With menopause, circulating levels of 17β-estradiol (E2) markedly decrease. E2-based hormone therapy is prescribed to alleviate symptoms associated with menopause. E2 is also recognized for its beneficial effects in the central nervous system (CNS), such as enhanced cognitive function following abrupt hormonal loss associated with ovariectomy. For women with an intact uterus, an opposing progestogen component is required to decrease the risk of developing endometrial hyperplasia. While adding an opposing progestogen attenuates these detrimental effects on the uterus, it can attenuate the beneficial effects of E2 in the CNS. Poly(lactic-co-glycolic acid) (PLGA) micro- and nano- carriers (MNCs) have been heavily investigated for their ability to enhance the therapeutic activity of hydrophobic agents following exogenous administration, including E2. Multiple PLGA MNC formulation parameters, such as composition, molecular weight, and type of solvent used, can be altered to systematically manipulate the pharmacokinetic and pharmacodynamic profiles of encapsulated agents. Thus, there is an opportunity to enhance the therapeutic activity of E2 in the CNS through controlled delivery from PLGA MNCs. The aim of this review is to consider the fate of exogenously administered E2 and discuss how PLGA MNCs and route of administration can be used as strategies for controlled E2 delivery.

http://ift.tt/2sTyGKe

Enhancement and Intensity Inhomogeneity Correction of Diffusion-Weighted MR Images of Neonatal and Infantile Brain Using Dynamic Stochastic Resonance

Abstract

Imaging of infantile/neonatal brain mandates tailored radio frequency coils (RF coils) to achieve a homogeneous field over a small region of interest (ROI). Most centers, however, perform pediatric imaging using adult RF coils only as procurement of tailored pediatric coils might prove quite expensive. This practice may not scientifically justified, whereas the image post-processing techniques reduces the deleterious effects of magnetic field inhomogeneity due to a small ROI being scanned in a large RF coil. Further, the eccentric placement of ROI within the RF coil perpetuates the field inhomogeneity within the scanned region. Hence, the structures closer to the coil appear brighter than those farther away giving rise to a 'shading artefact'. The effect even more accentuates in weak signal sequences like diffusion-weighted imaging (DWI). The proposed method significantly removes shading artefact of real DWI and synthetic T1 and T2 weighted magnetic resonance images. Dynamic stochastic resonance (DSR) intelligently uses the coefficient of discrete cosine transform of an image for brightness normalization and image enhancement simultaneously. The quality of the output image depends on the bistability parameters associated with the dynamic equation. Particle swarm optimization (PSO) tunes these bistability parameters for the entropy minimization of different group of tissues individually. The proposed algorithm outperforms the post processing based homomorphic filtering, local entropy minimization with spline model and multiplicative intrinsic component optimization methods. The proposed PSO based DSR approach may be helpful in accurate diagnosis.

http://ift.tt/2sxvP7f

Automatic auditory disambiguation of visual awareness

Abstract

Multisensory integration can play a critical role in producing unified and reliable perceptual experience. When sensory information in one modality is degraded or ambiguous, information from other senses can crossmodally resolve perceptual ambiguities. Prior research suggests that auditory information can disambiguate the contents of visual awareness by facilitating perception of intermodally consistent stimuli. However, it is unclear whether these effects are truly due to crossmodal facilitation or are mediated by voluntary selective attention to audiovisually congruent stimuli. Here, we demonstrate that sounds can bias competition in binocular rivalry toward audiovisually congruent percepts, even when participants have no recognition of the congruency. When speech sounds were presented in synchrony with speech-like deformations of rivalling ellipses, ellipses with crossmodally congruent deformations were perceptually dominant over those with incongruent deformations. This effect was observed in participants who could not identify the crossmodal congruency in an open-ended interview (Experiment 1) or detect it in a simple 2AFC task (Experiment 2), suggesting that the effect was not due to voluntary selective attention or response bias. These results suggest that sound can automatically disambiguate the contents of visual awareness by facilitating perception of audiovisually congruent stimuli.

http://ift.tt/2sNbiO4

The Impact of Music-Based Rational-Emotive and Cognitive-Behavioral Education on Positive and Negative Emotions: A Preliminary Investigation in Ecological Conditions

Abstract

Although there is an extensive literature showing that both rational-emotive and cognitive-behavioral interventions (REBT/CBT) and music can alter various emotional responses, little is known about their ability to impact on both positive and negative emotions simultaneously. Thus, the present study aimed to investigate whether classical music combined with REBT/CBT psycho-education on emotions can alter people's levels of positive and negative emotions. A number of 459 participants (62.7% females; m age = 36.67, SD = 11.754) were recruited for this study from the public attending to a classical music concert. The classical music pieces were selected by a group of experts in order to be conceptualized in relationship with components of the REBT/CBT's ABC model of emotions (e.g., catastrophyzing, acceptance/meditation) and this conceptualization was also delivered during the concert (i.e., before each corresponding musical part). Emotions were assessed before and after the entire performance for all participants. Results indicated a significant change in emotions between the two assessments (F(11,397) = 59.99, p < .001, partial η² = .62), revealing significant increases for all the positive emotions and decreases for all the negative emotions that have been evaluated. This is one of the first experimental studies conducted on large-scale in fully ecological settings to confirm that music-based rational-emotive and cognitive-behavioral education might change the intensity of people's positive and negative emotions simultaneously. These findings are discussed in line with the existing models of music and emotions.

http://ift.tt/2rSn9Gx

Effect of Adherence on Pharmacokinetic/Pharmacodynamic Relationships of Oral Targeted Anticancer Drugs

Abstract

The emergence of oral targeted anticancer agents transformed several cancers into chronic conditions with a need for long-term oral treatment. Although cancer is a life-threatening condition, oncology medication adherence—the extent to which a patient follows the drug regimen that is intended by the prescriber—can be suboptimal in the long term, as in any other chronic disease. Poor adherence can impact negatively on clinical outcomes, notably because most of these drugs are given as a standard non-individualized dosage despite marked inter-individual variabilities that can lead to toxic or inefficacious drug concentrations. This has been especially studied with the prototypal drug imatinib. In the context of therapeutic drug monitoring (TDM), increasingly advocated for oral anticancer treatment optimization, unreported suboptimal adherence affecting drug intake history may lead to significant bias in the concentration interpretation and inappropriate dosage adjustments. In the same way, suboptimal adherence may also bias the results of pharmacokinetic modeling studies, which will affect in turn Bayesian TDM interpretation that relies on such population models. Detailed knowledge of the influence of adherence on plasma concentrations in pharmacokinetic studies or in routine TDM programs is however presently missing in the oncology field. Studies on this topic are therefore eagerly awaited to better pilot the treatment of cancer with the new targeted agents and to find their optimal dosage regimen. Hence, the development and assessment of effective medication adherence programs are warranted for these treatments.

http://ift.tt/2sn9QBC

Therapeutic Potential of Baicalein in Alzheimer’s Disease and Parkinson’s Disease

Abstract

Alzheimer's disease and Parkinson's disease are the two most common, progressive central neurodegenerative diseases affecting the population over the age of 60 years. Apart from treatments that temporarily improve symptoms, there is no medicine currently available to inhibit or reverse the progression of Alzheimer's disease and Parkinson's disease. In traditional Chinese medicine, the root of Scutellaria baicalensis Georgi is a classic compatible component in the decoction of herbal medicine used for treating central nervous system diseases. Modern pharmacokinetic studies have confirmed that baicalein (5,6,7-trihydroxyflavone) is a major bioactive flavone constituent root of S. baicalensis Georgi. Studies showed that baicalein possesses a range of key pharmacological properties, such as reducing oxidative stress, anti-inflammatory properties, inhibiting aggregation of disease-specific amyloid proteins, inhibiting excitotoxicity, stimulating neurogenesis and differentiation action, and anti-apoptosis effects. Based on these properties, baicalein shows therapeutic potential for Alzheimer's disease and Parkinson's disease. In this review, we summarize the pharmacological protective actions of baicalein that make it suitable for the treatment of Alzheimer's disease and Parkinson's disease, and discuss the potential mechanisms underlying the effects.

http://ift.tt/2rNTp2l

Novel vitamin B 12 -producing Enterococcus spp. and preliminary in vitro evaluation of probiotic potentials

Abstract

Vitamin B₁₂ is an essential nutrient required for crucial metabolic processes in humans. Vitamin B₁₂-producing lactic acid bacteria (LAB) have been attracting increased attentions currently because of the generally recognized as safe (GRAS) status. Most of recent studies focused on Lactobacillus, and little is known about B₁₂-producing Enterococcus. In the present study, five Enterococcus strains isolated from infant feces were identified as vitamin B₁₂ producers. Among them, Enterococcus faecium LZ86 had the highest B₁₂ production (499.8 ± 83.7 μg/L), and the B₁₂ compound from LZ86 was identified as the biological active adenosylcobalamin, using reversed phase high-performance liquid (RP-HPLC) chromatogram. We examined basic probiotic and safety properties of E. faecium LZ86 and found that it was able to survive harsh environmental conditions (hot temperature, cold temperature, ethanol and osmotic stresses), tolerate gastric acid (pH 2.0, 3 h) and bile salts (0.3%), and adhere to Caco-2 cells. We also showed that E. faecium LZ86 is devoid of transferable antibiotic resistance and potential virulence factors. Together, here we report a B₁₂-producing E. faecium strain LZ86 firstly, which has desirable probiotic properties and may serve as a good candidate for vitamin B₁₂ fortification in food industry.

http://ift.tt/2sT79J9

Fasciola hepatica —a “Diver” in the Biliary Tree

Abstract

Fasciola hepatica is an endemic trematode that affects millions of people worldwide. The human being can be an accidental host through consumption of contaminated food or water. The authors present a case of hepatic fascioliasis in a 69-year-old Portuguese woman who recently traveled from Egypt, Brazil, and India.

http://ift.tt/2sn2KwM

Microtubule affinity-regulating kinases are potential druggable targets for Alzheimer’s disease

Abstract

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that affects normal functions of the brain. Currently, AD is one of the leading causes of death in developed countries and the only one of the top ten diseases without a means to prevent, cure, or significantly slow down its progression. Therefore, newer therapeutic concepts are urgently needed to improve survival and the quality of life of AD patients. Microtubule affinity-regulating kinases (MARKs) regulate tau-microtubule binding and play a crucial role in neurons. However, their role in hyperphosphorylation of tau makes them potential druggable target for AD therapy. Despite the relevance of MARKs in AD pathogenesis, only a few small molecules are known to have anti-MARK activity and not much has been done to progress these compounds into therapeutic candidates. But given the diverse role of MARKs, the specificity of novel inhibitors is imperative for their successful translation from bench to bedside. In this regard, a recent co-crystal structure of MARK4 in association with a pyrazolopyrimidine-based inhibitor offers a potential scaffold for the development of more specific MARK inhibitors. In this manuscript, we review the biological role of MARKs in health and disease, and draw attention to the largely unexplored area of MARK inhibitors for AD.

http://ift.tt/2sMGm0z

Assessment of early diastolic intraventricular pressure gradient in the left ventricle among patients with repaired tetralogy of Fallot

Abstract

Assessment of left ventricular (LV) dysfunction is vital in patients with repaired tetralogy of Fallot (rTOF). The early diastolic intraventricular pressure gradient (IVPG) in the LV plays an important role in diastolic function. IVPG is calculated as the intraventricular pressure difference divided by the LV length, which allows to account for differences in LV size and therefore calculate IVPG in children. We aimed to investigate the mechanisms of LV diastolic dysfunction by measuring mid-to-apical IVPG as an indicator of the active suction force sucking blood from the left atrium into the LV. We included 38 rTOF patients and 101 healthy controls. The study population was stratified based on age group into children (4–9 years), adolescents (10–15 years), and adults (16–40 years). IVPGs were calculated based on mitral inflow measurements obtained using color M-mode Doppler echocardiography. Although total IVPGs did not differ between rTOF patients and controls, mid-to-apical IVPGs in adolescents and adults were smaller among rTOF patients than among controls (0.15 ± 0.05 vs. 0.21 ± 0.06 mmHg/cm, p < 0.05; 0.09 ± 0.07 vs. 0.17 ± 0.05 mmHg/cm, p < 0.001; respectively). Additionally, only mid-to-apical IVPG correlated linearly with peak circumferential strain (ρ = 0.217, p = 0.011), longitudinal strain (ρ = −0.231, p = 0.006), torsion (ρ = −0.200, p = 0.018), and untwisting rate in early diastole (ρ = −0.233, p = 0.006). In rTOF, the mechanisms underlying diastolic dysfunction involve reduced active suction force, which correlates with reduced LV deformation in all directions.

http://ift.tt/2rSgmNa

An Approach for Enhancement of Microcalcifications in Mammograms

Abstract

Breast cancer is one of the prominent causes of female mortality in the world, and microcalcification clusters are the important indicators for breast cancer. Mammography is a useful procedure for revealing these indicators at an early stage. But the manual interpretation of microcalcifications is difficult due to low contrast with the background parenchymal tissue. This makes it hard to judge the size, shape and morphology of the microcalcifications. In this paper a methodology, which is a combination of morphological operations, unsharp masking and Gaussian filter, has been proposed for enhancement of mammograms to bring out the tiny details of microcalcifications present in a variety of nonhomogeneous background tissues while restoring their shape and size. For experiment the mammogram images, collected from Digital Database for Screening Mammography, have been used and the results are compared to standard methods like contrast limited adaptive histogram equalization, multi scale top-hat transform based algorithm and bi-histogram equalization with adaptive sigmoid functions. The results from both the qualitative and quantitative evaluations suggest that the proposed methodology is very effective.

http://ift.tt/2sSd4OA

Experimental Study of Nonlinear Flow in Micropores Under Low Pressure Gradient

Abstract

As throat radius decrease to micro-nanoscale, seepage in unconventional reservoirs such as ultra-low permeability and tight reservoirs differs from conventional ones. Flow experiment in micropores is a promising approach to study characteristics of microflow. In this paper, a visual experimental device was established. Water flow through micropores with radius of 1.38–10.03  \(\upmu \hbox {m}\) was investigated, under 0.033–16 MPa/m. The results showed that in microscale, water flow did not agree with Poiseuille equation. Flow rate was lower than theoretical value and showed nonlinear characteristics. In the near wall area, due to the attraction of solid wall, a stagnant fluid layer was formed. It occupied flow space and thus lowered flow rate. Its thickness declined with pressure gradient increasing, which led to nonlinear flow characteristics. When the pressure gradient was very high, the thickness stopped declining and kept constant. Afterward, the flow transited to linear. In pores with smaller radius, the steady stagnant layer was thinner, but took a larger proportion of the flow space. For tubes of \(r = 1.38, 4.81, 10.03\,\upmu \hbox {m}\) , the thickness of steady stagnant layer was 0.11, 0.23, 0.27  \(\upmu \hbox {m}\) , respectively.

http://ift.tt/2smsslj

Focus issue European Journal of Trauma and Emergency Surgery on “Volume Resuscitation and Coagulation”

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Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS

Abstract

Background

There are considerable phenotypic and neuroimmune overlaps between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS). While the precise aetiologies of both MS and ME/CFS are unclear, evidence suggests that deterioration in cognitive function is widely prevalent in patients with either condition. Little is known about differing risk factors or exposures, which may lead to severe cognitive or sleep symptoms. This study aims to gauge the extent of cognitive and sleep symptoms in ME/CFS and MS patients participating in the UK ME/CFS Biobank and identify the characteristics of those experiencing severe symptoms.

Methods

This was a cross-sectional study of 395 UK ME/CFS Biobank participants, recruited from primary care and the community, using similar standardised protocols, and matched by age, sex and geographical area. Data were collected from participants using a standardized written questionnaire at clinical visits. Cognitive symptoms included problems with short-term memory, attention, and executive function. Sleep symptoms included unrefreshing sleep and poor quality or inadequate duration of sleep. All participants reported symptoms based on an ordinal severity scale. Multivariable logistic regression was carried out in the ME/CFS group to investigate socio-demographic factors associated with severe symptoms.

Results

All cognitive and sleep symptoms were more prevalent in the ME/CFS group, with 'trouble concentrating' (98.3%) the most commonly reported symptom. Severe symptoms were also more commonly reported in the ME/CFS group, with 55% reporting 'severe, unrefreshing sleep'. Similarly, in the MS group, the most commonly reported severe symptoms were sleep-related. Logistic regression analysis revealed that ME/CFS patients aged over 50 years were more than three times as likely to experience severe symptoms than those younger than 30 (OR 3.23, p = 0.031). Current smoking was associated with severe symptoms, increasing the risk by approximately three times (OR 2.93, p = 0.003) and those with household incomes of more than £15,000 per year were less likely to experience severe symptoms compared to those earning less than this (OR 0.31, p = 0.017).

Conclusions

Cognitive and sleep symptoms are more common in ME/CFS patients than in MS patients and healthy controls, providing further support for existing evidence of central nervous system abnormalities in ME/CFS. Our findings suggest that people with ME/CFS who are smokers, or have a low income, are more likely to report severe cognitive and sleep symptoms. Future research should aim to develop strategies to prevent the progression of severe cognitive and sleep symptoms through early interventions that prioritise patients identified as being at highest risk.

http://ift.tt/2toBTiA

Seroprevalence of Neospora caninum and Toxoplasma gondii in exotic ruminants and camelids in the Czech Republic

Abstract

Neospora caninum and Toxoplasma gondii are the protozoan parasites with definitive hosts from order Carnivora. Due to vertical transmission, both parasites can cause abortions and neonatal mortality that lead to significant productive and economic losses in the domestic ruminants. The aim of this study was to describe N. caninum and T. gondii seroprevalence in the group of frequently farmed captive exotic ruminants (n = 184) including Bovidae (barbary sheep, bezoar goat, common eland, American bison, water buffalo, and yak) and Camelidae (bactrian camel, guanaco, llama, and alpaca). Antibodies were tested by indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA). Higher prevalence of T. gondii antibodies (31% in IFAT and 52% in ELISA) was detected compared to N. caninum (24% in IFAT and 17% in cELISA). Mixed infection was found in 18 (10%) and 22 (12%) animals by IFAT and ELISA, respectively. Higher seroprevalence of both N. caninum and T. gondii was found in Camelidae compared to Bovidae. To author knowledge, this is the first detection of T. gondii and N. caninum antibodies in common elands and bezoar goats.

http://ift.tt/2sOZewS

Toxoplasma gondii and schizophrenia: a review of published RCTs

Abstract

Over the last 60 years, accumulating evidence has suggested that acute, chronic, and maternal Toxoplasma gondii infections predispose to schizophrenia. More recent evidence suggests that chronically infected patients with schizophrenia present with more severe disease. After acute infection, parasites form walled cysts in the brain, leading to lifelong chronic infection and drug resistance to commonly used antiparasitics. Chronic infection is the most studied and closely linked with development and severity of schizophrenia. There are currently four published randomized controlled trials evaluating antiparasitic drugs, specifically azithromycin, trimethoprim, artemisinin, and artemether, in patients with schizophrenia. No trials have demonstrated a change in psychopathology with adjunctive treatment. Published trials have either selected drugs without evidence against chronic infection or used them at doses too low to reduce brain cyst burden. Furthermore, trials have failed to achieve sufficient power or account for confounders such as previous antipsychotic treatment, sex, age, or rhesus status on antiparasitic effect. There are currently no ongoing trials of anti-Toxoplasma therapy in schizophrenia despite ample evidence to justify further testing.

http://ift.tt/2toXTcT

Frequency of Toxoplasma gondii in the retina in eye banks in Brazil

Abstract

Ocular toxoplasmosis is the main cause of posterior uveitis worldwide frequently leading to vision loss. In Brazil, the seroprevalence of Toxoplasma gondii infection ranges from 50 to 80% depending of the region studied. The frequency of toxoplasmic retinal scar may reach 18% of the adults in the South of Brazil. Our goal was to determine the frequency of T. gondii DNA in retinas from eye banks from different regions in Brazil. A total of 162 eyes were obtained from eye banks in Manaus (n = 60), Sao Paulo (n = 60), Chapeco (n = 26), and Joinville (n = 16). The retinas were macroscopically analyzed and collected for DNA extraction. Real-time PCR (qPCR) was performed using the T. gondii B1 marker. By qPCR, a higher frequency of T. gondii DNA in the retinas from the eye bank of Joinville (25%) was found when compared to Manaus (5%). The retinas from Sao Paulo and Chapeco were qPCR negative. Clinical examination determined the retina lesions to be compatible with toxoplasmosis in the following frequencies: Joinville (62.5%), Manaus (10%), Sao Paulo (6.7%), and Chapeco (15.4%).

http://ift.tt/2sPfgGG

Malaria 2017: Update on the Clinical Literature and Management

Abstract

Purpose of Review

Malaria is a prevalent disease in travelers to and residents of malaria-endemic regions. Health care workers in both endemic and non-endemic settings should be familiar with the latest evidence for the diagnosis, management and prevention of malaria. This article will discuss the recent malaria epidemiologic and medical literature to review the progress, challenges, and optimal management of malaria.

Recent Findings

There has been a marked decrease in malaria-related global morbidity and mortality secondary to malaria control programs over the last few decades. This exciting progress is tempered by continued levels of high transmission in some regions, the emergence of artemisinin-resistant Plasmodium falciparum malaria in Southeast Asia, and the lack of a highly protective malaria vaccine. In the United States (US), the number of travelers returning with malaria infection has increased over the past few decades. Thus, US health care workers need to maintain expertise in the diagnosis and treatment of this infection.

Summary

The best practices for treatment and prevention of malaria need to be continually updated based on emerging data. Here, we present an update on the recent literature on malaria epidemiology, drug resistance, severe disease, and prevention strategies.

http://ift.tt/2tJ1Rwy

A novel technique for ultrasound-guided central venous catheterization under short-axis out-of-plane approach: “stepwise flashing with triangulation”

Abstract

In ultrasound-guided central venous catheterization, there is no standard technique either for the needle tip visualization or for the adequate needle angle and entry to the skin with short-axis view under out-of-plane technique. In the present study, we propose a novel technique named "stepwise flashing with triangulation", and the efficacy of this technique is assessed. Before and after a didactic session in which the technique was explained, 12 novice residents were asked to position the needle tip on or into the imitation vessels and to avoid deeper penetration by using an agar tissue phantom with ultrasound guidance. "Stepwise flashing" technique was for stepwise visualization of the needle tip, and "triangulation" technique was for adequate needle angle and entry to the skin. After the session, the success rate was increased and a deeper penetration rate was decreased. This technique will help us to facilitate vascular access and to avoid complications in clinical settings.

http://ift.tt/2toffH3

Bristle splaying and its effect on pre-existing gingival recession—a 12-month randomized controlled trial

Abstract

Objective

The link between bristle splaying and gingival recession is unclear.

Methods

In a 12-month, parallel group, randomized, controlled clinical trial, 110 systemically healthy participants with pre-existing gingival recessions (pre-GR) were assigned to brush their teeth with either a manual (MT) or a powered toothbrush (PT). Every 3 months, toothbrushes and brush heads were replaced. Wear was measured using the Bristle-Splaying-Index (BSI), matched between groups and correlated to the change of pre-GR.

Results

Data from 109 subjects (PT, 55; MT, 54) were analyzed. The overall mean BSI was found to be significantly lower (p < 0.001) in the PT group (median 5.5; second and third quartile 1.9–10.0) as compared to the MT group (21.5; 15.0–30.5). After 12 months, pre-GR decreased significantly in the PT group (∆0.2 ± 0.1 mm; p < 0.001) and remained stable in the MT group (∆0.1 ± 0.1 mm; p > 0.05). In the MT group, higher BSI values were associated with a higher risk for increasing or stable recession over 12 months: odds ratio (95 % CI) = 27.9 (1.7; 452.9); p = 0.019.

Conclusion

After a mean using time of 3 months, the PT group demonstrated a lower BSI than the MT group, and the greater bristle splaying was associated with a higher risk of increased (or stable) GR in subjects using a MT but not a PT.

Clinical relevance

Compared to a manual toothbrush, powered toothbrushes seem to be utilized with less force and can be considered safe to use in patients with pre-existing gingival recession.

http://ift.tt/2sRBd7L

Chair-side generated posterior monolithic lithium disilicate crowns: clinical survival after 6 years

Abstract

Objectives

The objective of this prospective clinical study was to evaluate the clinical performance of chair-side generated monolithic lithium disilicate crowns after 72 months.

Materials and methods

Forty-one posterior full contour crowns made of lithium disilicate ceramic were inserted in 34 patients with a chair-side CAD/CAM technique. One crown per patient was randomly selected for evaluation at baseline, 6, 12, 24, 36, 48, 60 and 72 months according to the modified US Public Health Service criteria.

Results

After a mean examination time of 73.2 months (SD ± 1.7 months), 25 crowns were available for re-examination. Within the observation period, three failures occurred due to one crown fracture after 2.9 years, an abutment fracture after 6.0 years, and one severe endodontic problem after 6.1 years. One lithium disilicate crown showed a loss of retention after 2 years but could be reinserted. There were two events of caries below the crown margin, one after 24 and another one after 48 months. Both teeth received cervical adhesive composite fillings. Two abutment teeth changed their sensibility perception from positive to negative within the first 13 months. The failure-free rate was 87.6%, and the complication-free rate was 70.1% after 6 years according to the Kaplan-Meier analysis.

Conclusions

Due to the fact that there was only one severe technical complication and the severe biological complications were in a normal range, the clinical performance of monolithic lithium disilicate crowns in the posterior region was completely satisfying.

Clinical relevance

The chair-side application of monolithic lithium disilicate crowns can be recommended.

http://ift.tt/2ryHUrB

Management and outcomes of obstructive sleep apnea in children with Robin sequence, a cross-sectional study

Abstract

Objective

The objective of this cross-sectional study is to assess the prevalence, course, and management of obstructive sleep apnea (OSA) in children with Robin sequence (RS) aged 1–18 years.

Materials and methods

A cross-sectional study was conducted in 63 children aged 1 to18 years with RS. Patient data were collected on baseline characteristics and management. OSA was evaluated by polysomnography.

Results

Sixty-three children with RS were included (median age 8.0 years) and divided into two groups based on the initial treatment: prone positioning or respiratory support. Respiratory support was more often indicated in children with a non-isolated RS (p < 0.05). At cross section, in the prone positioning group (n = 32), one child was diagnosed with OSA. In the respiratory support group (n = 31), 13 children (42 %) had respiratory problems of whom 10 needed respiratory support.

Conclusions

Between the age of 1 and 18 years, almost one out of four children with RS still has respiratory problems. Children with RS, who can be treated with prone positioning only as an infant, are not likely to develop obstructive airway problems at a later age. In contrast, children who need respiratory support early after birth are at risk of continuing or re-developing OSA after the age of 1 year.

Clinical relevance

This study shows that those who need respiratory support at an early age need careful monitoring until adulthood.

http://ift.tt/2sS8mQD

Clinical performance of screw-retained and cemented implant-supported zirconia single crowns: 36-month results

Abstract

Objectives

The objective of this clinical study was to evaluate the clinical performance of implant-supported zirconia crowns with a sintered veneering cap. Furthermore, the influence of the type of retention (screw-retained vs cemented single crowns) was analysed.

Materials and methods

Fifty-eight patients were accommodated with 114 implants, inserted in the molar and premolar regions. Zirconia-based crowns with a sintered veneering cap were either screw-retained (n = 53) or cemented (n = 61) on the implant. Recalls were performed every 6 months. The state of soft tissue was documented by the modified plaque and gingiva index (mPI) and sulcus bleeding index (mSBI). The restorations were evaluated for technical failures like veneering porcelain fractures, surface qualities and marginal fitting.

Results

Neither implant loss nor crown fractures occurred. After a mean clinical service time of 36.9 months, fractures of the veneering porcelain were registered in 1.8 % of the cases. The Kaplan-Meier survival probability regarding eventless restorations was 98.2 %. Chipping of the veneering porcelain was registered in two cemented crowns without statistical influence of the type of retention. The indices showed healthy soft periimplant tissues in both groups.

Conclusions

Implant-supported zirconia crowns with a sintered veneering cap demonstrated good clinical performance. The type of retention had no influence on technical complications.

http://ift.tt/2rz0oIe

Secretomes from mesenchymal stem cells participate in the regulation of osteoclastogenesis in vitro

Abstract

Objectives

The receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors are novel clinically effective agents that inhibit osteoclast differentiation, function, and survival by binding to RANKL. Medication-related osteonecrosis of the jaw (MRONJ), caused as a result of treatment using denosumab, is a newly emerging type of bone necrosis, the exact pathogenesis of which is unknown. Several studies recently showed that the intravenous administration of mesenchymal stem cells (MSCs) improved the osteonecrosis of the jaw, and it was hypothesized that paracrine effects by secretomes from MSCs are the main constituent. Our aim was to investigate the effects of serum-free conditioned media from human MSCs (MSC-CM) and RANKL inhibitors on osteoclast differentiation.

Materials and methods

Cytokines included in MSC-CM were identified using the cytokine array analysis. MSC-CM was added to the culture medium of rat osteoclast precursors containing RANKL inhibitor. Osteoclast differentiation assays, immunohistochemistry, real-time reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, and pit formation assays were performed.

Results

MSC-CM included various cytokines such as the recruitment of cell osteogenesis angiogenesis and cell proliferation. MSC-CM promoted osteoclast differentiation and expression of master regulatory transcriptional factors for osteoclastogenesis. In addition, MSC-CM showed function maintenance in osteoclasts despite the presence of RANKL inhibitors.

Conclusions

Our findings suggest that secretomes in MSC-CM were related to the regulation of osteoclast differentiation, which may reduce the effect of RANKL inhibitors.

Clinical relevance

New combinations of drugs using factors included in MSC-CM have effective therapeutic modality for treating patients with MRONJ.

http://ift.tt/2sRQC8e

Retrospective case-control study of correlation between MTHFR gene and OSCC risk in North India

Abstract

Background

Oral squamous cell carcinoma (OSCC) occurrence appears to be the number one among all cancers in India. Folate is a methyl donor during DNA methylation, as it provides substrate for methylenetetrahydrofolate reductase (MTHFR) to convert 5,10-MTHF to 5-MTHF and subsequently metabolizes it to methionine. The purpose of this study was to identify MTHFR C677T gene polymorphism in patients with OSCC.

Materials and methods

A total of 350 OSCC cases and 350 healthy controls participated in this study. MTHFR C677T single-nucleotide polymorphism was evaluated by PCR-RFLP.

Results

In the present study, MTHFR gene 677CC, CT, and TT genotype frequencies of the total OSCC cases were 74.8; 19.4 and 5.71; and 88.5, 9.42, and 2.0 % in controls. The average frequency of the MTHFR 677T allele was 15.4 % in OSCC cases compared to 6.71 % in the controls. The CT genotype occurrence prevailed more in patients than controls in contrast to TT genotype, although both the genotypes were statistically significant for OSCC. Moreover, we found that T allele was significant in cases of smoking and tobacco chewing.

Conclusions

In this study, we found that the homozygous mutant T allele appeared to have significantly higher risk of OSCC especially in late stages and therefore supporting in OSCC susceptibility and its progression.

http://ift.tt/2ryVqeI

The randomized shortened dental arch study: influence of two different treatments on interdental spacing over 5 years

Abstract

Objectives

Being a secondary outcome in a multicenter randomized controlled trial, the present analysis focused on interdental spacing in the shortened dental arch (SDA). The aim was to evaluate changes in interdental spacing in dependence of two different treatments after an observation period of up to 5 years.

Material and methods

Patients were either treated with a partial removable dental prosthesis (PRDP) for molar replacement (PRDP group) or according to the SDA concept aiming at a premolar occlusion (SDA group) in a randomized manner. Interdental spacing in the anterior region was measured with gauges and categorized as "0" (<0.1 mm), "1" (<0.5 mm), "2" (0.5–1 mm), and "3" (>1 mm). The statistical analysis was performed with analysis of variance models followed by linear contrast.

Results

Ninety-one patients (SDA n = 41, PRDP n = 50) were included. Changes of interdental spacing were detected in 70.7 % of all cases. A significant difference between the mean score changes was found in the mandible comparing the PRDP group and the SDA group. The respective mean score changes from baseline to 5 years were 0.23 (SD 0.49) for the PRDP group and 0.02 (SD 0.30) for the SDA group (p = 0.023).

Conclusions

Major interdental spacing could be observed in neither of the groups. The SDA concept resulted in a slightly better outcome.

Clinical relevance

When deciding whether to replace missing molars, the present results give further support to the SDA concept.

http://ift.tt/2ryOX3A

Role of primary cilia in non-dividing and post-mitotic cells

Abstract

The essential role of primary (non-motile) cilia during the development of multi-cellular tissues and organs is well established and is underlined by severe disease manifestations caused by mutations in cilia-associated molecules that are collectively termed ciliopathies. However, the role of primary cilia in non-dividing and terminally differentiated, post-mitotic cells is less well understood. Although the prevention of cells from re-entering the cell cycle may represent a major chore, primary cilia have recently been linked to DNA damage responses, autophagy and mitochondria. Given this connectivity, primary cilia in non-dividing cells are well positioned to form a signaling hub outside of the nucleus. Such a center could integrate information to initiate responses and to maintain cellular homeostasis if cell survival is jeopardized. These more discrete functions may remain undetected until differentiated cells are confronted with emergencies.

http://ift.tt/2tIMlke

Motivations for Interest, Disinterest and Uncertainty in Intrauterine Device Use Among Young Women

Abstract

Objective To elucidate salient contraceptive preferences and priorities as they relate to young women's interest or lack thereof in intrauterine device (IUD) use. Methods Qualitative data were drawn from a 2012 survey on contraceptive preferences and IUD interest. Among 413 young (ages 18–29) women, open-ended responses describing reasons for interest, disinterest or uncertainty in future IUD use were examined using a thematic analysis approach. Results Most participants were unsure about (49.2%) or not interested in (30.0%) future IUD use. Themes regarding IUD interest related to specific facets of IUD use (e.g., risks and side effects, ease of use), as well as broader influences on contraceptive decision-making (e.g., social influences, alignment with pregnancy intentions). For interested participants, a sense of empowerment pervaded the responses, with many references to the ease of use and lack of requisite maintenance. Uninterested participants were concerned about the internal nature of the IUD, with many describing "horror stories" and fears that the IUD would cause injury or infertility. Unsure participants provided more detailed and complex responses, carefully weighing the advantages and disadvantages of IUD use. Uncertainty was often driven by an acknowledged need for specific information, rather than overall lack of knowledge. Conclusions for Practice In this analysis, many women had a clear sense of their contraceptive preferences, which frequently did not align with IUDs. While continuing to remove barriers to IUD access is critical, patient-centered counseling approaches offer the opportunity to support women in best matching with a method that aligns with their preferences.

http://ift.tt/2rOXjU1

Detection and grading of prostate cancer using temporal enhanced ultrasound: combining deep neural networks and tissue mimicking simulations

Abstract

Purpose 

Temporal Enhanced Ultrasound (TeUS) has been proposed as a new paradigm for tissue characterization based on a sequence of ultrasound radio frequency (RF) data. We previously used TeUS to successfully address the problem of prostate cancer detection in the fusion biopsies.

Methods 

In this paper, we use TeUS to address the problem of grading prostate cancer in a clinical study of 197 biopsy cores from 132 patients. Our method involves capturing high-level latent features of TeUS with a deep learning approach followed by distribution learning to cluster aggressive cancer in a biopsy core. In this hypothesis-generating study, we utilize deep learning based feature visualization as a means to obtain insight into the physical phenomenon governing the interaction of temporal ultrasound with tissue.

Results 

Based on the evidence derived from our feature visualization, and the structure of tissue from digital pathology, we build a simulation framework for studying the physical phenomenon underlying TeUS-based tissue characterization.

Conclusion 

Results from simulation and feature visualization corroborated with the hypothesis that micro-vibrations of tissue microstructure, captured by low-frequency spectral features of TeUS, can be used for detection of prostate cancer.

http://ift.tt/2tnUV8I

Frey’s procedure for chronic pancreatitis improves the nutritional status of these patients

Abstract

Purpose

The aim of surgical intervention for chronic pancreatitis (CP) is to relieve symptoms and improve quality of life. However, the precise effect of surgery on the nutritional status of CP patients, which is often impaired by exocrine and endocrine pancreatic dysfunction, has not been elucidated. We conducted this study to evaluate whether Frey's procedure improves the nutritional status of CP patients.

Methods

The nutritional status of 35 patients who underwent Frey's procedure for CP at our institute between April 2005 and December 2014, was assessed by the controlling nutritional status (CONUT) scoring before and 1 year after the surgery, and compared with that of seven CP patients who underwent pancreatoduodenectomy. The occurrence of postoperative hepatic steatosis was also monitored.

Results

The nutritional status improved after Frey's procedure, but not after pancreatoduodenectomy. The median postoperative CONUT score after Frey's procedure was significantly lower than the preoperative score (1.0 ± 0.5 vs. 4.0 ± 2.5; p < 0.001).

Conclusion

Frey's procedure is superior to pancreatoduodenectomy for improving the nutritional status of CP patients.

http://ift.tt/2tnYBHm

Phase III trial comparing UFT + PSK to UFT + LV in stage IIB, III colorectal cancer (MCSGO-CCTG)

Abstract

Purpose

Oral adjuvant uracil and tegafur plus leucovorin (UFT/LV) is not inferior to standard weekly fluorouracil and folinate for stage II/III colon cancer. However, protein-bound polysaccharide K (PSK) has been evaluated as postoperative adjuvant therapy for colorectal cancer. This report is the first of MCSGO-CCTG, which compared UFT/LV to UFT/PSK as adjuvant chemotherapy for stage IIB or III colorectal cancer in patients who had undergone Japanese D2/D3 lymph node dissection.

Methods

The primary endpoint was the 3-year disease-free survival (DFS). A randomized non-inferiority study compared UFT/LV to UFT/PSK. The overall survival, adverse events, compliance, and quality of life were also investigated as the secondary endpoints.

Results

Between March 2006 and December 2010, 357 patients were randomized to UFT/PSK (n = 178) or UFT/LV (n = 179) (median age 65 years, colon/rectum 67.4/32.6%, stage IIB/IIIA/IIIB/IIIC 11.1/15.7/55.0/18.2%). The 3-year DFS rate was 82.3% in those receiving UFT/LV and 72.1% in those receiving UFT/PSK. The non-inferiority of UFT/PSK adjuvant therapy to UFT/LV therapy was not verified (−9.06%, 90% confidence interval −17.06 to −1.06%). The 3-year overall survival rate was 95.4% in those receiving UFT/LV and 90.7% in those receiving UFT/PSK.

Conclusions

As adjuvant chemotherapy for stage IIB and III colorectal cancer patients, UFT/PSK adjuvant therapy was not non-inferior to UFT/LV therapy with respect to the DFS.

http://ift.tt/2sOwofI

Use of Electrical Impedance Spectroscopy in vivo to Distinguish Active and Rest Stages of Salivary Glands

Abstract

Xerostomia, or dry mouth syndrome, is one of the radiation therapy (RT)-induced side effects experienced by head and neck cancer patients. Measuring the severity of xerostomia can be performed by several techniques such as measuring the differential weight of dental rolls placed in the mouth for a fixed time period, measuring the electromyographic activity of musculus digastricus, using parotid cup, and electrophysiological measurements by electrical impedance. The present study focuses on detecting the change in bioimpedance around the oral cavity when salivation is induced using lime juice on healthy human subjects. In this study, impedance changes between stimulated and resting states of the salivary glands for 31 healthy volunteers were measured and analyzed. Pre- and post-stimulation impedance measurement was performed on healthy volunteer subjects using impedance spectroscopy over 50 frequencies ranging from 10 kHz to 1 MHz. The electrical properties of salivary glands were extracted by fitting the measured admittance data to the well-known Cole model. Comparison of measured electrical properties of gland at the resting and stimulated states reveals the changes in the intra- and extra-cellular spaces of salivary gland as a result of saliva secretion. Statistical analysis of the spectroscopy data collected shows that there is a significant difference in electrical properties of tissue between resting and stimulated states of the salivary activity. These electrical impedance spectroscopy measurements will be used to benchmark changes of impedance due to salivary gland stimulation.

http://ift.tt/2tofcL9

Incidental durotomy in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcomes in the Spine Tango registry

Abstract

Purpose

The three aims of this Spine Tango registry study of patients undergoing decompression for spinal stenosis were to: report the rate of dural tear (DT) stratified by treatment centre; find factors associated with an increased likelihood of incurring a DT; and compare treatment outcomes in relation to DT (none vs. repaired vs. unrepaired DT).

Methods

Multivariate logistic regression was used to assess the association between DT and patient and treatment characteristics. Patient-rated and surgical outcomes were compared in patients with no DT, repaired DT, and unrepaired DT, while adjusting for case-mix.

Results

DT occurred in 328/3254 (10.1%) of included patients. The rate for all 29 contributing hospitals was within 95% confidence intervals of the average. The likelihood of DT increased by 2% per year of age, 1.78 times with previous spine surgery, 1.67 for a minimally/less invasive surgery, 1.58 times with laminectomy, and 1.40, and 2.12 times for BMI 31–35, and >35 in comparison with BMI 26–30, respectively. The majority of DTs (272/328; 82.9%) were repaired. Repairing the DT was associated with a longer duration of surgery (p < 0.001). More patients with repaired than with unrepaired DTs were satisfied with treatment, but the difference was not statistically significant. There was no association between DT and patient-reported outcomes.

Conclusion

The unadjusted rate of incidental DT during decompression for LSS was homogeneous across the participating centres and was associated with age, BMI, previous surgery at the same spinal level, minimally/less invasive surgery, and laminectomy. Non-repair of DTs had no negative association with treatment outcome; however, the unrepaired DTs may have been those that were smaller in size.

http://ift.tt/2slzKFH

Malaria 2017: Update on the Clinical Literature and Management

Abstract

Purpose of Review

Malaria is a prevalent disease in travelers to and residents of malaria-endemic regions. Health care workers in both endemic and non-endemic settings should be familiar with the latest evidence for the diagnosis, management and prevention of malaria. This article will discuss the recent malaria epidemiologic and medical literature to review the progress, challenges, and optimal management of malaria.

Recent Findings

There has been a marked decrease in malaria-related global morbidity and mortality secondary to malaria control programs over the last few decades. This exciting progress is tempered by continued levels of high transmission in some regions, the emergence of artemisinin-resistant Plasmodium falciparum malaria in Southeast Asia, and the lack of a highly protective malaria vaccine. In the United States (US), the number of travelers returning with malaria infection has increased over the past few decades. Thus, US health care workers need to maintain expertise in the diagnosis and treatment of this infection.

Summary

The best practices for treatment and prevention of malaria need to be continually updated based on emerging data. Here, we present an update on the recent literature on malaria epidemiology, drug resistance, severe disease, and prevention strategies.

http://ift.tt/2tJ1Rwy

Optical properties of boron-group (V) hexagonal nanowires: DFT investigation

Abstract

The paper presents structural, electronic and optical properties of boron-group V hexagonal nanowires (h-NW) within the framework of density functional theory. The h-NW of boron-group V compounds with an analogous diameter of 12 Å have been designed in (1 1 1) plane. Stability analysis performed through formation energies reveal that, the stability of these structures decreases with increasing atomic number of the group V element. The band nature predicts that these nanowires are good electrical conductors. Optical behaviour of the nanowires has been analysed through absorption coefficient, reflectivity, refractive index, optical conductivity and electron energy loss spectrum (EELS), that are computed from the frequency-dependent complex dielectric function. The analysis reveals high reactivity of BP and BAs h-NWs to the incident light especially in the IR and visible ranges, and the optical transparency of BN h-NW in the visible and UV ranges.

http://ift.tt/2svEnLV

Modulation of rotavirus severe gastroenteritis by the combination of probiotics and prebiotics

Abstract

Annual mortality rates due to infectious diarrhea are about 2.2 million; children are the most vulnerable age group to severe gastroenteritis, representing group A rotaviruses as the main cause of disease. One of the main factors of rotavirus pathogenesis is the NSP4 protein, which has been characterized as a viral toxin involved in triggering several cellular responses leading to diarrhea. Furthermore, the rotavirus protein NSP1 has been associated with interferon production inhibition by inducing the degradation of interferon regulatory factors IRF3, IRF5, and IRF7. On the other hand, probiotics such as Bifidobacterium and Lactobacillus species in combination with prebiotics such as inulin, HMO, scGOS, lcFOS have been associated with improved generalized antiviral response and anti-rotavirus effect by the reduction of rotavirus infectivity and viral shedding, decreased expression of NSP4 and increased levels of specific anti-rotavirus IgAs. Moreover, these probiotics and prebiotics have been related to shorter duration and severity of rotavirus diarrhea, to the prevention of infection and reduced incidence of reinfections. In this review we will discuss in detail about the rotavirus pathogenesis and immunity, and how probiotics such as Lactobacillus and Bifidobacterium species in combination with prebiotics have been associated with the prevention or modulation of rotavirus severe gastroenteritis.

http://ift.tt/2sRkEc6