Texture analysis and machine learning to characterize suspected thyroid nodules and differentiated thyroid cancer: where do we stand?

Publication date: Available online 7 December 2017
Source:European Journal of Radiology
Author(s): Martina Sollini, Luca Cozzi, Arturo Chiti, Margarita Kirienko
In thyroid imaging, "texture" refers to the echographic appearence of the parenchyma or a nodule. However, definition of the image characteristics is operator dependent and influenced by the operator's experience. In a more objective texture analysis, a variety of mathematical methods are used to describe image inhomogeneity, allowing assessment of an image by means of quantitative parameters. Moreover, this approach may be used to develop an efficient computer-aided diagnosis (CAD) system to yield a second opinion when differentiating malignant and benign thyroid lesions. The aim of this review is to summarize the available literature data on texture analysis, with and without CAD, in patients with suspected thyroid nodules or differentiated thyroid cancer, and to assess the current state of the approach.



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Secondary hyperparathyroidism causing increased jaw bone density and mandibular pain: A case report

We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography showed increased cortical density of the mandibular lower border. Scintigraphy and SPECT-CT revealed metabolic hyperactivity in that region without pathological lymph nodes. A bone biopsy of the mandibular lower border did not show inflammation or cytological atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism due to hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared.

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Time resolution requirements for civilian radioxenon emission data for the CTBT verification regime

Publication date: February 2018
Source:Journal of Environmental Radioactivity, Volume 182
Author(s): Pieter De Meutter, Johan Camps, Andy Delcloo, Benoît Deconninck, Piet Termonia
The capability of the noble gas component of the International Monitoring System as a verification tool for the Comprehensive Nuclear-Test-Ban Treaty is deteriorated by a background of radioxenon emitted by civilian sources. One of the possible approaches to deal with this issue, is to simulate the daily radioxenon concentrations from these civilian sources at noble gas stations by using atmospheric transport models. In order to accurately quantify the contribution from these civilian sources, knowledge on the releases is required. However, such data are often not available and furthermore it is not clear what temporal resolution such data should have. In this paper, we assess which temporal resolution is required to best model the ¹³³Xe contribution from civilian sources at noble gas stations in an operational context. We consider different sampling times of the noble gas stations and discriminate between nearby and distant sources. We find that for atmospheric transport and dispersion problems on a scale of 1000 km or more, emission data with subdaily temporal resolution is generally not necessary. However, when the source-receptor distance decreases, time-resolved emission data become more important. The required temporal resolution of emission data thus depends on the transport scale of the problem. In the context of the Comprehensive Nuclear-Test-Ban Treaty, where forty noble gas stations will monitor the whole globe, daily emission data are generally sufficient, but for certain meteorological conditions, better temporally resolved emission data are required.



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68 Ga-PSMA PET-CT Imaging of Metastatic Adenoid Cystic Carcinoma

Abstract

A patient with a history of adenoid cystic carcinoma of the nasal cavity presented himself with bone pain and an elevated PSA level. On suspicion of metastatic prostate cancer a ⁶⁸Ga-PSMA PET-CT was performed. The PET-CT showed numerous lung and non-sclerotic bone metastasis. Biopsy of a bone metastasis was performed and pathology showed adenoid cystic carcinoma instead of prostate cancer. Immunohistochemical PSMA staining of the primary tumour showed intense PSMA expression in adenoid cystic carcinoma tumour cells. Because of the high PSMA expression of adenoid cystic carcinoma, ⁶⁸Ga-PSMA PET-CT might be a promising imaging modality for this malignancy.

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SPECT/CT in the Treatment of Differentiated Thyroid Cancer

Abstract

Single-photon emission computed tomography with integrated computed tomography (SPECT/CT) systems has been applied in a wide range of clinical circumstances, and differentiated thyroid cancer (DTC) is one of the most important indications of SPECT/CT imaging. In the treatment of DTC, SPECT/CT images have been reported to have many advantages over conventional planar whole-body scintigraphy based on its precise localization and characterization of abnormal foci of radioactive iodine (RAI) accumulation, influencing the staging, risk stratification, and clinical management as well as reader confidence. On the other hand, SPECT/CT has limitations including additional radiation exposure from the CT component, additional imaging time, and cost-related issues. Each SPECT/CT image acquired at different time points throughout the management of DTC may have a different clinical meaning and significance. This review article addresses the clinical usefulness of RAI SPECT/CT images acquired during the pre-ablation period, post-therapy period, and long-term follow-up period, respectively.

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Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis

Objectives Idiopathic pulmonary fibrosis (IPF) is a progressive lethal chronic lung disease with unclear pathogenesis. Radiological hallmark is the pattern of usual interstitial pneumonia accentuated in peripheral and basal areas with otherwise preserved lung structure. One hypothesis is that alveolar collapse and consequent induration lead to fibrotic transformation of lung tissue. The aim of the study was to investigate normal-appearing tissue during expiration for signs of collapsibility and differences from other diseases or controls. Materials and Methods We retrospectively assessed a total of 43 patients (15 IPFs, 13 chronic obstructive pulmonary diseases, and 15 controls) with nonenhanced computed tomography (CT) in inspiration and expiration, performed for routine clinical workup. Densitometry of visually unaffected lung tissue was conducted in all lung lobes with a region of interest of 15-mm in diameter on soft tissue kernel reconstruction (slice thickness, 1 mm) during inspiration and expiration. Results One-factor analysis of variance analysis yielded significant difference in attenuation changes between inspiration and expiration of unaffected lung parenchyma among all subject groups in all lung lobes. For IPF patients, the highest differences in densities were observed in the lower lobes, which is the predominantly affected site of usual interstitial pneumonia. In the chronic obstructive pulmonary disease group, the density remained rather equal in the entire lung. Conclusions High CT attenuation changes between inspiration and expiration in IPF patients might suggest altered lung parenchyma in normal-appearing tissue on CT. Density changes during the respiratory cycle might be explained by alveolar collapse of radiologically unaffected lung tissue possibly preceding fibrosis. These results support the concept of alveolar collapse preceding lung fibrosis in IPF.

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Qualitative and Quantitative Evaluation of Structural Myocardial Alterations by Grating-Based Phase-Contrast Computed Tomography

Objectives Grating-based phase-contrast computed tomography (gb-PCCT) relies on x-ray refraction instead of absorption to generate high-contrast images in biological soft tissue. The aim of this study was to evaluate the potential of gb-PCCT for the depiction of structural changes in heart disease. Materials and Methods Four human heart specimens from patients with hypertensive disease, ischemic disease, dilated heart disease, and cardiac lipomatosis were examined. The gb-PCCT setup consisted of an x-ray tube (40 kV, 70 mA), grating-interferometer, and detector, and allowed simultaneous acquisition of phase- and absorption-contrast data. With histopathology as the standard of reference, myocardium (MC), fibrotic scar (FS), interstitial fibrosis (IF), and fatty tissue (FT) were visually and quantitatively evaluated. Systematic differences in absorption- and phase-contrast Hounsfield units (HUabs and HUp) were assessed. Results Thirteen corresponding cross-sections were included, and MC, FS, IF, and FT were found in 13 (100%), 4 (30.8%), 7 (53.8%), and 13 (100%) cross-sections, respectively. Mean HUp/HUabs were 52.5/54.1, 86.6/69.7, 62.4/62.3, and −38.6/−258.9 for MC, FS, IF, and FT, respectively. An overlap in HUabs was observed for MC and IF (P = 0.84) but not for HUp (P

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Iterative Reconstruction May Improve Diagnosis of Gout: An Ex Vivo (Bio)Phantom Dual-Energy Computed Tomography Study

Objectives We hypothesize that, compared with filtered back projection (FBP), iterative reconstruction (IR) increases the detected volume of uric acid, which serves as a measure of the sensitivity of the method, and therefore allows examinations with lower radiation exposure. Thus, the aim of our study was to evaluate the role of IR in dual-energy computed tomography (DECT) for gout assessment and volumetry in an ex vivo gout model using an epoxy phantom and a biophantom. Materials and Methods We prepared specimens with different concentrations of monosodium uric acid in ultrasound gel (30%–50%) and inserted them into an epoxy-based phantom and a porcine foreleg. Computed tomography scanning was performed on a 320-row single-source DECT scanner in volume mode with an ascending order of tube currents. Image data sets were reconstructed using FBP and IR with 2 iteration levels (IR1 and IR2). Measurements in regions of interest (ROIs) and volumetric measurements were performed using either fixed parameters for the analysis software (epoxy phantom) or parameters specifically adapted for each data set (porcine phantom). Seven retrospectively identified clinical data sets were used for validation in patients. Rm-ANOVA was used for statistical analysis. No institutional review board approval was required. Results We found no differences in Hounsfield units between the different reconstruction algorithms (P = 0.09 and 0.05 for 80 and 135 kVp, respectively) and the calculated dual-energy gradient (P = 0.27). Filtered back projection detected less uric acid compared with IR (with fixed parameters: 6.0 ± 0.3 cm3 for FBP and 6.1 ± 0.2 for IR1 and IR2; with adapted thresholds: 1.2 ± 0.3 cm3 for FBP and 1.8 ± 0.1 and 2.0 ± 0.1 for IR1 and IR2, respectively). The differences were significant for all measurements (P = 0.0003). Also in the test cases, FBP detected significantly fewer tophi (mean volume, 1.38 ± 2.1 cm3) compared with IR1 (1.86 ± 2.9) and IR2 (2.07 ± 3.1) (P = 0.04). Conclusions Iterative reconstruction has the potential to improve the sensitivity of a DECT scan for gouty tophi, to decrease radiation exposure, or to combine both options.

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Accuracy and Repeatability of Automated Injector Versus Manual Administration of an MRI Contrast Agent—Results of a Laboratory Study

Objective The aim of this study was to compare flow rates over time and the deviations from the target flow rate of a magnetic resonance imaging contrast agent achieved by an automated injector versus manual injection. Materials and Methods In this laboratory study, the magnetic resonance contrast agent gadobutrol was repeatedly injected by an injector and by 10 experienced technologists. Six scenarios with 2 different target flow rates (1 and 5 mL/s), 2 different contrast volumes (10 and 20 mL), and 2 different intravenous (IV) catheters (22 gauge and 20 gauge) were tested. The flow rates over time were recorded. The target variable was the average absolute deviation and average absolute percentage deviation from the target flow rate. Results The flow rates over time achieved by an injector were almost identical. Slight deviations from the target flow rate occurred during ramp-up and ramp-down only. Those of manual injection showed high variability over the whole course of the injection. In the 1 mL/s scenarios, the injector deviated from the target flow rate by 0.06 mL/s or less (≤6%) and in the 5 mL/s scenarios by 1.02 mL/s or less (

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Multiple Sclerosis: Improved Detection of Active Cerebral Lesions With 3-Dimensional T1 Black-Blood Magnetic Resonance Imaging Compared With Conventional 3-Dimensional T1 GRE Imaging

Objectives The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS). Materials and Methods After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study. Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm3 resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm3 resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests. Results Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P

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Motion-Corrected Real-Time Cine Magnetic Resonance Imaging of the Heart: Initial Clinical Experience

Objectives Free-breathing real-time (RT) imaging can be used in patients with difficulty in breath-holding; however, RT cine imaging typically experiences poor image quality compared with segmented cine imaging because of low resolution. Here, we validate a novel unsupervised motion-corrected (MOCO) reconstruction technique for free-breathing RT cardiac images, called MOCO-RT. Motion-corrected RT uses elastic image registration to generate a single heartbeat of high-quality data from a free-breathing RT acquisition. Materials and Methods Segmented balanced steady-state free precession (bSSFP) cine images and free-breathing RT images (Cartesian, TGRAPPA factor 4) were acquired with the same spatial/temporal resolution in 40 patients using clinical 1.5 T magnetic resonance scanners. The respiratory cycle was estimated using the reconstructed RT images, and nonrigid unsupervised motion correction was applied to eliminate breathing motion. Conventional segmented RT and MOCO-RT single-heartbeat cine images were analyzed to evaluate left ventricular (LV) function and volume measurements. Two radiologists scored images for overall image quality, artifact, noise, and wall motion abnormalities. Intraclass correlation coefficient was used to assess the reliability of MOCO-RT measurement. Results Intraclass correlation coefficient showed excellent reliability (intraclass correlation coefficient ≥ 0.95) of MOCO-RT with segmented cine in measuring LV function, mass, and volume. Comparison of the qualitative ratings indicated comparable image quality for MOCO-RT (4.80 ± 0.35) with segmented cine (4.45 ± 0.88, P = 0.215) and significantly higher than conventional RT techniques (3.51 ± 0.41, P

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Evaluation of Gadolinium Retention After Serial Administrations of a Macrocyclic Gadolinium-Based Contrast Agent (Gadobutrol): A Single-Institution Experience With 189 Patients

Objective There has been controversy as to whether gadobutrol, one of the widely used macrocyclic gadolinium-based contrast agents, can lead to gadolinium retention after serial injections. Our aim was to validate whether serial administrations of gadobutrol can cause signal increase in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted magnetic resonance (MR) images due to gadolinium retention. Materials and Methods A total of 189 patients who had undergone at least 2 contrast-enhanced MR scans using only gadobutrol between August 2009 and August 2016 were retrospectively included. The DN–to–pons and GP-to-thalamus signal intensity (SI) ratio differences on unenhanced T1-weighted MR images were calculated by subtracting the SI ratios at the first MR images from those at the last MR images. One-sample t tests were used to evaluate whether the SI ratio differences differed from 0. Linear regression and Pearson correlations were performed to assess correlations between SI ratio differences and various confounding variables, including the number of MR scans, mean time interval between MR scans, age, sex, history of radiation therapy or chemotherapy, and renal and liver functions. Results Patients underwent a mean of 5.9 ± 6.3 contrast-enhanced MR scans with a mean interval of 42.8 ± 49.5 weeks between the scans. Sixty-three patients underwent 6 or more MR scans, whereas 126 patients underwent fewer than 6 MR scans. Neither the DN-to-pons SI nor the GP-to-thalamus SI ratio differences differed significantly from 0, with mean values of −0.012 ± 0.115 (P = 0.148) and 0.012 ± 0.111 (P = 0.126), respectively. Conclusions Serial administrations of gadobutrol did not result in signal increases in the DN or GP on unenhanced T1-weighted MR images due to gadolinium retention.

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Evaluation of Transient Motion During Gadoxetic Acid–Enhanced Multiphasic Liver Magnetic Resonance Imaging Using Free-Breathing Golden-Angle Radial Sparse Parallel Magnetic Resonance Imaging

Objectives The aims of this study were to observe the pattern of transient motion after gadoxetic acid administration including incidence, onset, and duration, and to evaluate the clinical feasibility of free-breathing gadoxetic acid–enhanced liver magnetic resonance imaging using golden-angle radial sparse parallel (GRASP) imaging with respiratory gating. Materials and Methods In this institutional review board–approved prospective study, 59 patients who provided informed consents were analyzed. Free-breathing dynamic T1-weighted images (T1WIs) were obtained using GRASP at 3 T after a standard dose of gadoxetic acid (0.025 mmol/kg) administration at a rate of 1 mL/s, and development of transient motion was monitored, which is defined as a distinctive respiratory frequency alteration of the self-gating MR signals. Early arterial, late arterial, and portal venous phases retrospectively reconstructed with and without respiratory gating and with different temporal resolutions (nongated 13.3-second, gated 13.3-second, gated 6-second T1WI) were evaluated for image quality and motion artifacts. Diagnostic performance in detecting focal liver lesions was compared among the 3 data sets. Results Transient motion (mean duration, 21.5 ± 13.0 seconds) was observed in 40.0% (23/59) of patients, 73.9% (17/23) of which developed within 15 seconds after gadoxetic acid administration. On late arterial phase, motion artifacts were significantly reduced on gated 13.3-second and 6-second T1WI (3.64 ± 0.34, 3.61 ± 0.36, respectively), compared with nongated 13.3-second T1WI (3.12 ± 0.51, P

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Surgical anatomy of the right gastro-omental artery: a study on 100 cadaver dissections.

Related Articles

Surgical anatomy of the right gastro-omental artery: a study on 100 cadaver dissections.

Surg Radiol Anat. 2017 Dec 05;:

Authors: Settembre N, Labrousse M, Magnan PE, Branchereau A, Champsaur P, Bussani R, Braun M, Malikov S

Abstract
PURPOSE: The gastro-omental artery (GOA) with the greater omentum (GO) is known for its high quality as a vascular graft, its resistance to infections as an omental flap and for its multiple applications in surgery. A better knowledge of anatomical variations of GO and its vascularization can improve the application in surgery and decrease complications. The purpose of this study was to measure diameters and lengths of the right GOA (RGOA) and study the interindividual variability of these anatomical structures.
METHODS: In 100 cadaveric dissections, we carried out dissection of the RGOA and of the GO. In 70 unfixed cadavers, the transillumination technique was used to identify all RGOA branches. In the remaining 30 cadavers, prepared with Winckler's solution, barium sulfate with colored latex was injected. Digital X-ray was used to measure RGOA lengths, internal diameters and the distribution of the omental branches. The gastro-omental vein was also dissected.
RESULTS: The mean proximal and distal diameters of RGOA were 2.68 (± 0.39) mm and 0.94 (± 0.24) mm, respectively. The mean length was 244.3 (± 34.4) mm. The thickness of the omentum ranged from 5 to 15.5 mm. The arteria omentalis magna, defined in this study for the fist time as the longest and widest omental branch, was present in 73.3% cases. The trans-omental arch was present in 6% cases.
CONCLUSIONS: This morphometric study allowed us to define the vascularization and the anatomical variations of RGOA and GO. This may lead to improvement of applications in surgery and decrease complications.

PMID: 29209990 [PubMed - as supplied by publisher]

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Pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: what we need to know.

Related Articles

Pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: what we need to know.

Surg Radiol Anat. 2017 Dec 05;:

Authors: Peyrottes A, Mariage D, Baqué P, Massalou D

Abstract
Median arcuate ligament (MAL) syndrome is a rare and poorly known cause of abdominal pain. MAL narrows the celiac artery (CA), resulting in true distal aneurysms, including pancreaticoduodenal artery (PDA) aneurysms. These aneurysms often have an aggressive course, as rupture can result in hemorrhagic shock. CT scan appears to be the most effective investigation for the diagnosis of PDA aneurysms and may reveal possible celiac artery compression. In this series, we describe four cases of PDA aneurysm: two ruptured aneurysms treated by an endovascular procedure and two non-ruptured aneurysms treated by surgery. It was also decided to treat CA stenosis in three of the four patients based on the clinical presentation (ruptured or non-ruptured) and the presence of peripancreatic collateral vessels on imaging. This strategy contrasts with the approach commonly reported in the literature, in which MAL section is mandatory due to the high risk of ischemia rather than the potential risk of recurrent aneurysm. Medical teams should be aware of this disease to improve diagnosis and patient management.

PMID: 29209989 [PubMed - as supplied by publisher]

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Evaluation of amyloid status in a cohort of elderly individuals with memory complaints: validation of the method of quantification and determination of positivity thresholds

Abstract

Objective

Our aim is to validate the process steps implemented by the French CATI platform to assess amyloid status, obtained from 18F-Florbetapir PET scans, in a cohort of 318 cognitively normal subjects participating in the INSIGHT-preAD study. Our objective was to develop a method with partial volume effect correction (PVEC) on untransformed PET images, using an automated pipeline ("RACHEL") adapted to large series of patients and including quality checks of results.

Methods

We compared RACHEL using different options (with and without PVEC, different sets of regions of interest), to two other methods validated in the literature, referred as the "AVID" and "CAEN" methods. A standard uptake value ratio (SUVR) was obtained with the different methods for participants to another French study, IMAP, including 26 normal elderly controls (NEC), 11 patients with mild cognitive impairment (MCI) and 16 patients with Alzheimer's disease (AD). We determined two cutoffs for RACHEL method by linear correlation with the other methods and applied them to the INSIGHT-preAD subjects.

Results

RACHEL including PVEC and a combination of the whole cerebellum and the pons as a reference region allowed the best discrimination between NEC and AD participants. A strong linear correlation was found between RACHEL and the other two methods and yielded the two cutoffs of 0.79 and 0.88. According to the more conservative threshold, 19.8% of the INSIGHT-preAD subjects would be considered amyloid positive, and 27.7% according to the more liberal threshold.

Conclusions

With our method, we clearly discriminated between NEC with negative amyloid status and patients with clinical AD. Using a linear correlation with other validated cutoffs, we could infer our own positivity thresholds and apply them to an independent population. This method might be useful to the community, especially when the optimal cutoff could not be obtained from a population of healthy young adults or from correlation with post-mortem results.

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Updates on the Management of Advanced, Metastatic, and Radioiodine Refractory Differentiated Thyroid Cancer.

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Updates on the Management of Advanced, Metastatic, and Radioiodine Refractory Differentiated Thyroid Cancer.

Front Endocrinol (Lausanne). 2017;8:312

Authors: Tumino D, Frasca F, Newbold K

Abstract
Differentiated thyroid cancer (DTC) accounts for 95% of all thyroid cancers and is generally an indolent tumor, treated effectively with surgery, radioactive iodine, and thyroid-stimulating hormone suppressive therapy. However, 5-10% of patients have advanced disease, with aerodigestive tract invasion, distant metastases, or radioiodine refractory disease, with poor prognosis. This review focuses on the approaches for treating advanced DTC, including management of gross extra-thyroidal extension, recurrent loco-regional or distant metastatic disease, the role of external beam radiation therapy and systemic treatment. Locally ablative treatment modalities, including surgery, radiation therapy, and thermal ablation are evolving and can be used in selected patients. In recent years, new therapeutic agents with molecular targets have become available and two multi-kinase inhibitors, Sorafenib and Lenvatinib, have been licensed for iodine refractory DTC showing an advantage in terms of progression-free survival, although an impact on overall survival has not been proven yet. Management of advanced thyroid cancer can be challenging but a multidisciplinary approach can significantly improve outcomes for this patient population.

PMID: 29209273 [PubMed]

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Quality of life outcomes after endoscopic approaches to intracranial tumors.

Quality of life outcomes after endoscopic approaches to intracranial tumors.

Curr Opin Otolaryngol Head Neck Surg. 2017 Nov 27;:

Authors: Schaberg MR

Abstract
PURPOSE OF REVIEW: To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients' perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures.
RECENT FINDINGS: The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL.
SUMMARY: It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial.

PMID: 29210717 [PubMed - as supplied by publisher]

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Vitamins for cancer prevention and treatment: an insight.

Vitamins for cancer prevention and treatment: an insight.

Curr Mol Med. 2017 Dec 04;:

Authors: Jain A, Tiwari A, Verma A, Jain SK

Abstract
Over a few decades a strong interlink between oxidative damage and cancer has been investigated by various scientists across the world on the basis of epidemiological observations of the effects of fruits and vegetables used in the diet for cancer patients. Primarily, Vitamin C, Vitamin D and Vitamin E are reported to be involved in the amelioration of side effects which occur in chemotherapy and radiation therapy of lungs, stomach, prostate, colorectal, gastric head and neck cancers. The vitamins acting as antioxidant adjuvants are found to have apoptotic and anti-angiogenesis potential as well as inhibitory effects against metastasis in cancer cells. This chapter explicitly discusses the key aspects concerned with the vitamins in relation to cancer prevention and treatment. It describes vitamins and their natural resources, role of vitamins in the body, and vitamins as prime ingredients in the diet and their effects on cancer biology with reference to recent research reports. Moreover, this paper also includes the emerging potential of pharmaceutical advances to enhance bioavailability of the vitamins to cancer patients with improved safety and efficacy. Clinicians and researchers must mull over the nutritional requirements of individual cancer patient so as to treat cancer and increase life expectancy.

PMID: 29210648 [PubMed - as supplied by publisher]

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Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients.

Comparison of endoscopic and open resection of sinonasal squamous cell carcinoma: a propensity score-matched analysis of 652 patients.

Int Forum Allergy Rhinol. 2017 Dec 06;:

Authors: Kılıç S, Kılıç SS, Baredes S, Chan Woo Park R, Mahmoud O, Suh JD, Gray ST, Eloy JA

Abstract
BACKGROUND: The use of endoscopic resection as an alternative to open surgery for sinonasal malignancies has increased in the past 20 years.
METHODS: The National Cancer Database was queried for cases of sinonasal squamous cell carcinoma (SNSCC) without cervical or distant metastases that were treated surgically between 2010 and 2014. They were split into 2 groups based on surgical approach: open or endoscopic. Demographics, facility and insurance type, stage, tumor characteristics, postoperative treatment, 30-day readmission rate, 30- and 90-day mortality, and overall survival (OS) were compared between the 2 groups. Cox proportional hazard analysis was performed. Propensity score matching (PSM) was used to mimic a randomized, controlled trial.
RESULTS: A total of 1,483 patients were identified: 353 (23.8%) received endoscopic and 1130 (76.2%) received open surgery. Age, gender, race, geographic region, tumor size, surgical margins, postoperative chemoradiation, and 30-day readmissions did not vary significantly between the 2 groups. Open surgery was more common in academic centers (62.8% vs 54.2%; p = 0.004), less common for tumors of the ethmoid and sphenoid sinus (p < 0.0001), less common for stage IVB tumors, and associated with longer hospital stay (mean, 4.67 days vs 2.50 days; p < 0.0001). Five-year OS (5Y-OS) was not significantly different between the 2 approaches (p = 0.953; open: 5Y-OS, 56.5%; 95% confidence interval, 51.3% to 61.6%; endoscopic: 5Y-OS, 46.0%; 95% confidence interval, 33.2% to 58.8%). In the PSM cohort of 652 patients, there was also no significant difference in OS (p = 0.850).
CONCLUSION: Endoscopic surgery is an effective alternative to open surgery, even after accounting for confounding factors that may favor its use over the open approach. It is also associated with a shorter hospital stay.

PMID: 29210531 [PubMed - as supplied by publisher]

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The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery.

The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery.

Int Forum Allergy Rhinol. 2017 Dec 06;:

Authors: Ha T, Valentine R, Moratti S, Hanton L, Robinson S, Wormald PJ

Abstract
BACKGROUND: Adhesion formation and ostial stenosis are common causes of surgical failure after endoscopic sinus surgery (ESS). Postoperative topical steroid application has been shown to improve wound healing. Chitosan-dextran gel (CD gel) is an effective hemostatic nasal dressing. This study aims to determine the effect of the addition of budesonide to CD gel on postoperative ostial stenosis and adhesion formation following ESS.
METHODS: This prospective, blinded, randomized controlled trial was conducted between October 2012 and April 2015. Thirty-six patients over 18 years undergoing ESS were randomized to receive either: no treatment, CD gel, CD gel with 1 mg/ 2 mL budesonide, or topical steroid cream to their left or right sinuses (different treatment each side). Each sinus ostium and endoscopic features of wound healing was measured intraoperation, and 2 weeks, 3 months, and 12 months postoperation.
RESULTS: Data was analyzed using the analysis of variance (ANOVA) and post hoc Tukey honestly significant difference (HSD) tests. There was a significant reduction in stenosis within all 3 sinuses ostia sites when CD + budesonide was compared to control, with the greatest effect seen at 12 months: The mean ± standard deviation (SD) percentage of baseline areas at 12 months were 76% ± 6.2% vs 37% ± 23.5%, 76% ± 6.3% vs 52% ± 4.9%, and 83% ± 6.5% vs 58% ± 5.0% (all p < 0.05), for CD + budesonide compared to control in the frontal, sphenoid, and maxillary sinuses, respectively. The incidence of adhesions was 4% in the CD + budesonide group compared to 15% in the control group.
CONCLUSION: This study has shown that CD gel, when combined with topical budesonide solution, improves long-term sinus ostial patency and prevents ostial stenosis post-ESS.

PMID: 29210513 [PubMed - as supplied by publisher]

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Endoscopic modified Lothrop procedure after failure of primary endoscopic sinus surgery: a meta-analysis.

Endoscopic modified Lothrop procedure after failure of primary endoscopic sinus surgery: a meta-analysis.

Int Forum Allergy Rhinol. 2017 Dec 06;:

Authors: Abuzeid WM, Vakil M, Lin J, Fastenberg J, Akbar NA, Fried MP, Fang CH

Abstract
BACKGROUND: The endoscopic modified Lothrop procedure (EMLP) has been used as a salvage technique for frontal sinusitis following failed endoscopic sinus surgery (ESS). We aim to examine the safety and efficacy of the EMLP following failure of primary ESS.
METHODS: All English-language publications from 2000 to 2016 reporting the use of EMLP after primary ESS were identified using the PubMed database and evaluated per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random effects summaries of patient demographics, comorbidities, and surgical outcomes were obtained through meta-analysis.
RESULTS: Eleven studies constituting 778 patients were included and 86.5% had chronic rhinosinusitis (CRS). Mean follow-up duration was 28.4 months. The mean number of surgeries prior to EMLP was 3.5. Symptom improvement was reported in 82.3%. Subgroup analysis of 7 studies in which all 357 patients had CRS revealed a mean follow-up of 31.5 months. Symptom improvement occurred in 75.9% of cases and 23.1% experienced polyp recurrence. The cerebrospinal fluid leak rate was 2.5%. Restenosis of the neo-ostium occurred in 17.1% with complete closure occurring in 3.9% of cases. The reoperation rate after EMLP was 9.0%. Aspirin sensitivity was associated with an increased risk of cerebrospinal fluid (CSF) leak (p = 0.0339) and a reduced incidence of neo-ostium closure (p = 0.0001). Aspirin sensitivity and asthma were associated with a reduced incidence of reoperation (p ≤ 0.001) and increased symptom improvement (p < 0.005). Restenosis or closure of the frontal neo-ostium was associated with less symptom improvement (p < 0.04) but not with reoperation.
CONCLUSION: The EMLP is an effective salvage procedure for refractory frontal sinusitis based on data from higher-volume centers.

PMID: 29210504 [PubMed - as supplied by publisher]

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Melanin-manganese nanoparticles with ultrahigh efficient clearance in vivo for tumor-targeting T1 magnetic resonance imaging contrast agent.

Melanin-manganese nanoparticles with ultrahigh efficient clearance in vivo for tumor-targeting T1 magnetic resonance imaging contrast agent.

Biomater Sci. 2017 Dec 06;:

Authors: Xu W, Sun J, Li L, Peng X, Zhang R, Wang B

Abstract
Endogenous biomaterials in organisms, with native biocompatibility and biodegradability, appear more advantageous in the development of nanoscale diagnostic and therapeutic systems for future clinical translation. Herein, a novel tumor-targeting Magnetic Resonance Imaging (MRI) contrast agent was developed based on Mn2+-chelating ultrasmall water-soluble melanin nanoparticles (MNP-PEG-Mn). The nanoparticles, with a size of about 5.6 nm, presented high chelation stability and showed negligible cytotoxicity as estimated by MTT assay. Moreover, the r1 longitudinal relaxivity (20.56 mM-1 s-1) of MNP-PEG-Mn was much higher than that of Gadodiamide (6.00 mM-1 s-1), which is a clinically approved MRI contrast agent. In vivo MRI experiments revealed excellent tumor-targeting specificity after tumor-bearing mice were intravenously injected with MNP-PEG-Mn. Additionally, MNP-PEG-Mn could be excreted via renal and hepatobiliary pathways with negligible toxicity to body tissues. These preliminary results indicated the clinically translatable potential of MNP-PEG-Mn as a T1 MRI contrast agent for tumor-targeted imaging.

PMID: 29210372 [PubMed - as supplied by publisher]

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Queer reproduction revisited and why race, class and citizenship still matters: A response to Cristina Richie

Abstract

In the dialogue between Timothy F. Murphy and Cristina Richie about queer bioethics and queer reproduction in this journal, significant points of the emergent and extremely important discussions on lesbian, gay, bisexual, transgender (LGBT) and queer bioethics are raised. Richie specifies correctly that queer bioethics can either complement or contradict LGBT bioethics and the queer standpoint against heteroconformity and heterofuturity is decisive here. As the field of queer bioethics is such a recent and essential part of consideration for bioethics and as it is still evolving, the objective of this intervention is to provide both an overview of important milestones of queer bioethics and to highlight that queer bioethics is not mono-logic and monolithic. To exemplify queer bioethic's ‘many-headed monsters’, queer reproduction is revisited and complemented by a European viewpoint. It is central to my argument and here I disagree with Richie that to be against heterofuturity does not necessarily mean to be against queer reproduction. However, I also argue that there are other reasons why queer reproduction should not be pursued at all costs. Finally, I discuss the most recent debates on race, class and citizenship, for example, queer necropolitics. These points still need to be addressed in queer bioethical agendas.

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Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study.

Dabigatran after Short Heparin Anticoagulation for Acute Intermediate-Risk Pulmonary Embolism: Rationale and Design of the Single-Arm PEITHO-2 Study.

Thromb Haemost. 2017 Dec;117(12):2425-2434

Authors: Klok FA, Ageno W, Barco S, Binder H, Brenner B, Duerschmied D, Empen K, Faggiano P, Ficker JH, Galiè N, Ghuysen A, Held M, Heydenreich N, Huisman MV, Jiménez D, Kozak M, Lang IM, Lankeit M, Münzel T, Petris A, Pruszczyk P, Quitzau K, Schellong S, Schmidt KH, Stefanovic BS, Verschuren F, Wolf-Puetz A, Meyer G, Konstantinides SV, PEITHO-2 Investigators

PMID: 29212130 [PubMed - in process]

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In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders.

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders.

Kidney Blood Press Res. 2017 Nov 28;42(5):804-815

Authors: Pengo MF, Ioratti D, Bisogni V, Ravarotto V, Rossi B, Bonfante L, Simioni F, Nalesso F, Maiolino G, Calò LA

Abstract
BACKGROUND/AIMS: In chronic kidney disease (CKD) patients blood pressure variability (BPV) is associated with poor outcome. Sleep disturbances alter BP profiles in hypertensives but their influence on BPV in CKD patients is unknown. We screened a cohort of CKD/ESRD patients to investigate whether sleep quality impacts on BPV.
METHODS: Consecutive CKD patients' sleep quality was assessed using validated questionnaires (Epworth Sleepiness Scale-ESS); International Restless legs scale-IRLS; Functional Outcomes of Sleep Questionnaire-FOSQ: Insomnia Severity Index-ISI; STOP-Bang). All patients underwent ambulatory blood pressure measurement.
RESULTS: 104 out of 143 enrolled patients (78.32% stage-3 CKD; 10.49% Stage-4; 11.19% Stage-5; 6.99% ESRD-under dialysis) completed all the questionnaires. 95.8% were hypertensives, 70% were non-dippers and 27.8% had resistant hypertension. STOP-Bang>4 proved sleep disorders in 84.84% of patients. Patients with IRLS>10 had greater diastolic nocturnal standard deviation (DNSD) and a trend (p=0.05) for systolic nocturnal SD (SNSD). Patients with ISI>14 had greater SNSD and in 28.8% FOSQ showed severely impaired sleep quality. Their systolic nocturnal BPV was significantly greater. ISI was independently associated with SNSD. FOSQ and diastolic nocturnal BPV were negatively correlated at the bivariate analysis and FOSQ independently predicts systolic nocturnal BPV at multivariate regression analysis.
CONCLUSIONS: In CKD patients impaired sleep quality increases BPV, might contribute to their disease progression and worsen prognosis. Searching for sleep problems in CKD patients could help planning their treatment of sleep problems contributing to CV risk reduction. Our data provide the rationale working hypothesis for the need of studies with larger number of patients aimed to demonstrate improved outcome of CKD progression and CV risk with the treatment also of sleep disorders.

PMID: 29212081 [PubMed - as supplied by publisher]

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Occupational health risks and intervention strategies for US taxi drivers.

Occupational health risks and intervention strategies for US taxi drivers.

Health Promot Int. 2017 Dec 02;:

Authors: Murray KE, Buul A, Aden R, Cavanaugh AM, Kidane L, Hussein M, Eastman A, Checkoway H

Abstract
Research has shown that taxi drivers are at risk for numerous health concerns, such as low back and leg pain, linked to their highly sedentary occupation, long work hours and stressors related to the job (e.g. low income, safety threats). The goal of this study was to explore occupational health risks and opportunities for health interventions with taxi drivers using community-based participatory research (CBPR) methods. A mixed methods approach included first a convenience sample of 19 East African taxi drivers participating in focus group discussions. Second, a convenience sample of 75 current taxi drivers (M age = 45.7 years) and 25 non-driver comparison participants (M age = 40.3 years) were recruited to complete a structured self-reported questionnaire and objective measures of health. Health education was provided alongside the research to address common health concerns and to ensure mutual benefit and an action orientation. The focus groups described numerous health concerns that drivers attributed to their occupation, including chronic pain, sleep deprivation, cardiovascular disease, diabetes, kidney disease and eye problems, as the most common. Participants offered ideas for health interventions that include workplace reform and driver education. Quantitative data indicate that 44% of drivers reported their health as 'fair' or 'poor'. Drivers were more likely to report musculoskeletal pain, less sleep, more fatigue and less physical activity as compared to non-drivers. The majority of drivers reported financial and job dissatisfaction. The research provides data to inform targeted health interventions that support the health and safety of taxi drivers.

PMID: 29211840 [PubMed - as supplied by publisher]

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The cardio-metabolic impact of taking commonly prescribed analgesic drugs in 133,401 UK Biobank participants.

The cardio-metabolic impact of taking commonly prescribed analgesic drugs in 133,401 UK Biobank participants.

PLoS One. 2017;12(12):e0187982

Authors: Cassidy S, Trenell MI, Anderson KN

Abstract
OBJECTIVE: There has been a significant increase in the prescribing of medication for chronic non-cancer pain. In a UK population sample, we aimed to assess cardio-metabolic (CM) health in those taking these chronic pain medications.
METHODS: 133,401 participants from the UK Biobank cohort were studied. BMI, waist cm and hypertension were compared between those on drugs prescribed for chronic pain and CM drugs to those on CM drugs only. Multiple confounders were controlled for.
RESULTS: Those taking opiates and CM drugs had the worst CM health profile with a 95%, 82% and 63% increased odds of reporting obesity, 'very high risk' waist circumference and hypertension, respectively (OR [95% CI] 1.95 [1.75-2.17], 1.82 [1.63-2.03], 1.63 [1.45-1.84]), compared to those on CM drugs alone. Those taking neuropathic pain medications and CM drugs also demonstrate worse CM profile than those taking CM drugs only.
CONCLUSIONS: The impact of medications for chronic pain and sleep upon CM health and obesity is of concern for these classes of drugs which have been recently labelled as dependency forming medications. The results from this cross sectional study warrants further investigation and adds further support to calls for these medications to be prescribed for shorter periods.

PMID: 29211804 [PubMed - in process]

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Prevention of bladder cancer incidence and recurrence: nutrition and lifestyle.

Prevention of bladder cancer incidence and recurrence: nutrition and lifestyle.

Curr Opin Urol. 2018 Jan;28(1):88-92

Authors: Fankhauser CD, Mostafid H

Abstract
PURPOSE OF REVIEW: We review the influence of nutrition and lifestyle on bladder cancer incidence and recurrence and summarize food items, diets and lifestyle practices that physicians may wish to prioritize for discussion with their patients.
RECENT FINDINGS: Recent study results suggest an association between bladder cancer incidence and several food items including meat, fruit, vegetables, milk products and oil. Micronutrient deficiency is associated with bladder cancer risk; however, it remains unclear if micronutrient supplementation can modify bladder cancer incidence. Furthermore, total fluid intake, alcohol, coffee and tea seem to have no influence on bladder cancer incidence. There is weak evidence that stress, anxiety and lack of sleep may increase the risk of developing bladder cancer, whereas exercise may reduce the risk of dying from it.
SUMMARY: Several dietary items and life styles are associated with bladder cancer incidence and recurrence. However, besides smoking cessation, there is no evidence that a certain diet or lifestyle can decrease bladder cancer incidence.

PMID: 29211694 [PubMed - in process]

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Jeremy Struck a Chord: A Public Health Approach to Professional Musicians.

Jeremy Struck a Chord: A Public Health Approach to Professional Musicians.

Am J Public Health. 2018 Jan;108(1):62-64

Authors: Chertoff J, Urbine D

PMID: 29211521 [PubMed - in process]

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Association of shiftwork and leukocytes among national health and nutrition examination survey respondents.

Association of shiftwork and leukocytes among national health and nutrition examination survey respondents.

Chronobiol Int. 2017 Dec 06;:1-5

Authors: Buss MR, Wirth MD, Burch JB

Abstract
Shift workers may experience disrupted sleep-wake or circadian cycles which, in turn, may lead to major health problems such as hypertension, obesity, and diabetes. Research indicates that shift workers have increased levels of leukocytes. Data from the National Health and Nutrition Examination Survey (2005-2010) examined the relationship between self-reported current shiftwork and leukocytes with adjustment for important confounders. Using linear regression, we found no association between shiftwork and leukocyte counts. Those not working had elevated levels compared to day workers but values in both groups were still within normal ranges. Additional research is needed to fully understand how shiftwork influences changes in leukocyte counts.

PMID: 29211507 [PubMed - as supplied by publisher]

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The Effect of Dietary Nitrate on Nocturnal Sleep-Disordered Breathing and Arterial Oxygen Desaturation at High Altitude.

The Effect of Dietary Nitrate on Nocturnal Sleep-Disordered Breathing and Arterial Oxygen Desaturation at High Altitude.

High Alt Med Biol. 2017 Dec 06;:

Authors: Patrician A, Engan H, Lundsten D, Grote L, Vigetun-Haughey H, Schagatay E

Abstract
Patrician, Alexander, Harald Engan, David Lundsten, Ludger Grote, Helena Vigetun-Haughey, and Erika Schagatay. The effect of dietary nitrate on nocturnal sleep-disordered breathing and arterial oxygen desaturation at high altitude. High Alt Med Biol 00:000-000, 2017.-Sleep-disordered breathing and fluctuations in arterial oxygen saturation (SaO2) are common during sleep among lowlanders ascending to high altitude. Dietary nitrate (NO3-) supplementation has been shown to lower the O2 consumption in various conditions. Our objective was to investigate whether dietary NO3- could reduce sleep-disordered breathing and SaO2 desaturation during sleep at altitude. Cardiorespiratory responses during sleep were measured in 10 healthy lowlanders at 330 m and then again in the Himalayas at 3700-4900 m. Each subject received two 70 mL shots of either beetroot juice (BR; ∼5.0 mmol NO3- per shot) or placebo (PL: ∼0.003 mmol NO3- per shot) in a single-blinded, weighted order over two consecutive nights at altitude. At 2.5-4.5 hours into sleep at altitude, BR increased the SaO2 desaturation drop (4.2 [0.1]% with PL vs. 5.3 [0.4]% with BR; p = 0.024) and decreased the SaO2 desaturation duration (14.1 [0.9] seconds with PL to 11.1 [0.9] seconds with BR; p = 0.0.041). There was a reduction in breaths with flow limitation (p = 0.025), but no changes in Apnea-Hypopnea Index (AHI), mean and minimum SaO2. The study suggests BR supplementation does not improve AHI or oxygenation, but may increase fluctuations in arterial O2 saturation during sleep at altitude in native lowlanders.

PMID: 29211505 [PubMed - as supplied by publisher]

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Precision Medicine for Extracorporeal CO2 Removal for ARDS: CO2 Physiological Considerations.

Precision Medicine for Extracorporeal CO2 Removal for ARDS: CO2 Physiological Considerations.

Am J Respir Crit Care Med. 2017 Dec 06;:

Authors: Morales L, Artigas A, Kaufman DA

PMID: 29211495 [PubMed - as supplied by publisher]

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Perivascular adipose tissue and the dynamic regulation of Kv 7 and Kir channels: Implications to resistant hypertension.

Perivascular adipose tissue and the dynamic regulation of Kv 7 and Kir channels: Implications to resistant hypertension.

Microcirculation. 2017 Dec 06;:

Authors: Gollasch M, Welsh DG, Schubert R

Abstract
Resistant hypertension is defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive drugs at adequate doses. Resistant hypertension is an increasingly common clinical problem in older age, obesity, diabetes, sleep apnea, and chronic kidney disease. Although the direct vasodilator minoxidil was introduced in the early 1970s, only recently has this drug been shown to be particularly effective in a subgroup of patients with treatment-resistant or uncontrolled hypertension. This pharmacological approach is interesting from a mechanistic perspective since minoxidil is the only clinically used K+ channel opener today, which targets a subclass of K+ channels, namely KATP channels in vascular smooth muscle cells (VSMCs). Beside KATP channels, two other classes of VSMC K+ channels could represent novel effective targets for treatment of resistant hypertension, namely Kv 7 (KCNQ) and inward rectifier potassium (Kir 2.1) channels. Interestingly, these channels are unique among VSMC potassium channels. First, both have been implicated in the control of microvascular tone by perivascular adipose tissue. Second, they exhibit biophysical properties strongly controlled and regulated by membrane voltage, but not intracellular calcium. This review focuses on Kv 7 (Kv 7.1-5) and Kir (Kir 2.1) channels in VSMCs as potential novel drug targets for treatment of resistant hypertension, particularly in comorbid conditions such as obesity and metabolic syndrome. This article is protected by copyright. All rights reserved.

PMID: 29211322 [PubMed - as supplied by publisher]

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Risk factors for caries-free time: longitudinal study in early childhood.

Risk factors for caries-free time: longitudinal study in early childhood.

Rev Saude Publica. 2017 Dec 04;51:118

Authors: Cabral MBBS, Mota ELA, Cangussu MCT, Vianna MIP, Floriano FR

Abstract
OBJECTIVE: To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease.
METHODS: The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time.
RESULTS: Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27-2.77), category of day care (HR = 3.88, 95%CI 2.04-7.38), age (HR = 1.77, 95%CI 1.15-2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04-2.51), presence of active white spots (HR = 2.70, 95%CI 1.07-6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02-2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80-7.42) was found for previous caries experience.
CONCLUSIONS: Social variables were considered as of high risk for the development of dental caries.

PMID: 29211203 [PubMed - in process]

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The Effect of Aromatherapy on Sleep Quality of Elderly People Residing in a Nursing Home.

The Effect of Aromatherapy on Sleep Quality of Elderly People Residing in a Nursing Home.

Holist Nurs Pract. 2018 Jan/Feb;32(1):8-16

Authors: Faydalı S, Çetinkaya F

Abstract
BACKGROUND: Sleep is important for health and quality of life in the elderly, and sleep disturbances are reported to be associated with many of the adverse medical conditions.
PURPOSE: This research was carried out to evaluate the effect of inhalation of lavender oil on sleep quality of nursing home residents.
METHODS: A questionnaire was used to evaluate sociodemographic characteristics and sleeping properties of the 30 volunteers, enrolled. Pittsburgh Sleep Quality Index was applied as a pre- and posttest to measure sleep quality of individuals who inhaled lavender oil drops on the pillows every evening for a week before sleeping.
RESULTS: Before and after aromatherapy, the mean Pittsburgh Sleep Quality Index score of the nursing home residents was (Equation is included in full-text article.)= 6.0 ± 5.1 and (Equation is included in full-text article.)= 2.6 ± 3.4, respectively, whereas statistically significant difference was not observed for independent variables. Cronbach α reliability coefficient of the Pittsburgh Sleep Quality Index scale was found to be 0.816.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results indicated an improvement of sleep quality of nursing home residents after the application of aromatherapy with lavender oil.

PMID: 29210873 [PubMed - in process]

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Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review.

Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review.

Anesth Analg. 2017 Nov 22;:

Authors: Gamez BH, Habib AS

Abstract
Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice.

PMID: 29210789 [PubMed - as supplied by publisher]

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Pulmonary aspiration of sinus secretions in patients with cystic fibrosis.

Pulmonary aspiration of sinus secretions in patients with cystic fibrosis.

Int Forum Allergy Rhinol. 2017 Dec 06;:

Authors: Nelson J, Karempalis P, Dunitz J, Hunter R, Boyer H

Abstract
BACKGROUND: Indirect evidence suggests that sinonasal secretions are aspirated into the lungs of patients with cystic fibrosis (CF), contributing to infection, subsequent tissue damage, and decreased lung function. Our objective is to determine whether sinonasal secretions are transferred to the lungs in patients with CF-related sinus disease and healthy subjects, particularly in the recumbent position and during sleep.
METHODS: We performed a prospective, controlled trial to detect pulmonary aspiration of radiolabeled albumin applied to the nasal mucosa of study subjects with chronic sinusitis related to CF and control subjects without sinus disease. Radioactive counts were measured in the lungs and compared to background counts in both groups after 8 hours of rest/sleep.
RESULTS: Complete data was collected on 12 CF patients and 6 controls. Eleven patients with CF demonstrated higher lung counts than background counts. The average counts of radiolabeled albumin in the lungs of CF patients were significantly greater than background counts (p = 0.03). Controls did not demonstrate this finding (p > 0.90), with only one-half demonstrating lung counts greater than background counts.
CONCLUSION: This study provides direct evidence of aspiration of sinonasal secretions into the lungs of patients with CF and healthy adults in the recumbent position. The fact that both patients and controls aspirated secretions suggests that aspiration alone does not account for the pathogenesis of lung disease in CF patients.

PMID: 29210505 [PubMed - as supplied by publisher]

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Detection of early nocturnal hypoventilation in neuromuscular disorders.

Detection of early nocturnal hypoventilation in neuromuscular disorders.

J Int Med Res. 2017 Jan 01;:300060517728857

Authors: Trucco F, Pedemonte M, Fiorillo C, Tan HL, Carlucci A, Brisca G, Tacchetti P, Bruno C, Minetti C

Abstract
Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO2/SpO2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity < 60%). Nocturnal hypoventilation was defined as tcPCO2 > 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO2 < 88% for > 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.

PMID: 29210305 [PubMed - as supplied by publisher]

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Sleep quality is associated with the severity of clinical symptoms in Parkinson's disease.

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Sleep quality is associated with the severity of clinical symptoms in Parkinson's disease.

Acta Neurol Belg. 2017 Dec 05;:

Authors: Junho BT, Kummer A, Cardoso FE, Teixeira AL, Rocha NP

Abstract
Sleep disorders are very common in Parkinson's disease (PD), being associated with several other conditions, mainly psychiatric disorders. The present study was designed to assess sleep quality in Brazilian patients with PD and to evaluate whether sleep changes are associated with clinical variables, especially neuropsychiatric symptoms in PD. Patients diagnosed with PD were subjected to a comprehensive clinical evaluation that included the assessment of motor, cognitive and psychiatric symptoms. Our study showed that sleep complaints are frequent in PD and worse sleep quality is associated with depressive and anxious symptoms, poorer cognitive performance and greater severity of PD symptoms. In the multivariate analysis, older age, greater severity of anxiety and PD remained as significant predictors of worse sleep quality. In conclusion, sleep complaints, depressive and anxiety symptoms are frequent in PD patients. Older age, disease severity and anxiety symptoms are significant predictors of poorer sleep quality in PD patients.

PMID: 29210000 [PubMed - as supplied by publisher]

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Acute effect on ambulatory blood pressure from aerobic exercise: a randomised cross-over study among female cleaners.

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Acute effect on ambulatory blood pressure from aerobic exercise: a randomised cross-over study among female cleaners.

Eur J Appl Physiol. 2017 Dec 05;:

Authors: Lund Rasmussen C, Nielsen L, Linander Henriksen M, Søgaard K, Krustrup P, Holtermann A, Korshøj M

Abstract
PURPOSE: High occupational physical activity (OPA) is shown to increase the risk for elevated blood pressure, cardiovascular diseases and mortality. Conversely, aerobic exercise acutely lowers the blood pressure up to 25 h post exercise. However, it is unknown if this beneficial effect also apply for workers exposed to high levels of OPA. Cleaners constitute a relevant occupational group for this investigation because of a high prevalence of OPA and cardiovascular disease. Accordingly, the objective was to investigate the acute effects on ambulatory blood pressure from a single aerobic exercise session among female cleaners.
METHODS: Twenty-two female cleaners were randomised to a cross-over study with a reference and an aerobic exercise session. Differences in 24-h, work hours, leisure time, and sleep ambulatory blood pressure (ABP) were evaluated using repeated measure 2 × 2 mixed-models.
RESULTS: After the aerobic exercise session, the 24-h systolic ambulatory blood pressure was significantly lowered by 2.4 mmHg (p < 0.01) compared to the reference session. The 24-h diastolic ABP was unaltered. During work hours, a lowered systolic ABP of 2.2 mmHg (p = 0.02) and a higher diastolic ABP of 1.5 mmHg (p = 0.03) were found after the aerobic exercise session. During leisure time, the systolic ABP was lowered by 1.7 mmHg (p = 0.04) and the diastolic ABP was unaltered. During sleep, the systolic and diastolic ABP was unaltered.
CONCLUSION: A single aerobic exercise session lowered 24-h systolic ABP of 2.4 mmHg. Thus, an aerobic exercise session seems to be beneficial for lowering the risk of hypertension among cleaners.

PMID: 29209783 [PubMed - as supplied by publisher]

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Narcolepsy in Saudi patients before and after the 2009 H1N1 vaccination. The experience of 2 referral centers.

Related Articles

Narcolepsy in Saudi patients before and after the 2009 H1N1 vaccination. The experience of 2 referral centers.

Saudi Med J. 2017 Dec;38(12):1196-1200

Authors: Qasrawi SQ, Albarrak AM, Alharbi AS, Nashwan S, Almeneessier AS, Pandi-Perumal SR, Alsaadi MM, BaHammam AS

Abstract
OBJECTIVES: To assess the number of Saudi patients diagnosed with narcolepsy in 2 tertiary centers before and after the introduction of the 2009 A(H1N1)pdm09 vaccine.  Methods: We started collecting data after the first international report of an association between the A(H1N1)pdm09 vaccine and narcolepsy between January 2010 and December 2016. All patients diagnosed with narcolepsy after 2009 were included and data were collected for 7 years to account for any possible delays in the diagnosis of narcolepsy.  Results: One-hundred and seventy-three patients with narcolepsy were identified. The majority (144 patients, 83%) had symptom onset before June 2009. Only 29 patients (17%) had symptom onset after 2009. No difference in the annual number of narcolepsy cases was found  before and after 2009. Conclusion: Based on data obtained from 2 tertiary care sleep disorders center, there was no increase in the number of cases of narcolepsy among Saudis following the introduction of the influenza A(H1N1)pdm09 vaccination.

PMID: 29209667 [PubMed - in process]

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Breathe: palliative care in respiratory medicine.

Related Articles

Breathe: palliative care in respiratory medicine.

Breathe (Sheff). 2017 Dec;13(4):267-268

Authors: Riha RL

Abstract
The December issue of Breathe focuses on palliative care in respiratory disease http://ift.tt/2BI3fDt.

PMID: 29209419 [PubMed]

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Highlights from the 40th ESNR Annual Meeting, the 24th Advanced Course in Diagnostic Neuroradiology and the 9th Advanced Course in Interventional Neuroradiology-Malmö 2017

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Genes, Vol. 8, Pages 370: Are Pericentric Inversions Reorganizing Wedge Shell Genomes?

Genes, Vol. 8, Pages 370: Are Pericentric Inversions Reorganizing Wedge Shell Genomes?

Genes doi: 10.3390/genes8120370

Authors: Daniel García-Souto Concepción Pérez-García Juan J. Pasantes

Wedge shells belonging to the Donacidae family are the dominant bivalves in exposed beaches in almost all areas of the world. Typically, two or more sympatric species of wedge shells differentially occupy intertidal, sublittoral, and offshore coastal waters in any given locality. A molecular cytogenetic analysis of two sympatric and closely related wedge shell species, Donax trunculus and Donax vittatus, was performed. Results showed that the karyotypes of these two species were both strikingly different and closely alike; whilst metacentric and submetacentric chromosome pairs were the main components of the karyotype of D. trunculus, 10–11 of the 19 chromosome pairs were telocentric in D. vittatus, most likely as a result of different pericentric inversions. GC-rich heterochromatic bands were present in both species. Furthermore, they showed coincidental 45S ribosomal RNA (rRNA), 5S rRNA and H3 histone gene clusters at conserved chromosomal locations, although D. trunculus had an additional 45S rDNA cluster. Intraspecific pericentric inversions were also detected in both D. trunculus and D. vittatus. The close genetic similarity of these two species together with the high degree of conservation of the 45S rRNA, 5S rRNA and H3 histone gene clusters, and GC-rich heterochromatic bands indicate that pericentric inversions contribute to the karyotype divergence in wedge shells.

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IJERPH, Vol. 14, Pages 1527: Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data

IJERPH, Vol. 14, Pages 1527: Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121527

Authors: Cheng-Shyuan Rau Shao-Chun Wu Yi-Chun Chen Peng-Chen Chien Hsiao-Yun Hsieh Pao-Jen Kuo Ching-Hua Hsieh

Background: The diagnosis of diabetic hyperglycemia (DH) does not preclude a diabetes patient from having a stress-induced hyperglycemic response. This study aimed to define the optimal level of elevated glucose concentration for determining the occurrence of stress-induced hyperglycemia (SIH) in patients with diabetes. Methods: This retrospective study reviewed the data of all hospitalized trauma patients, in a Level I trauma center, from 1 January 2009 to 31 December 2016. Only adult patients aged ≥20 years, with available data on serum glucose and glycated hemoglobin A1c (HbA1c) levels upon admission, were included in the study. Long-term average glucose levels, as A1c-derived average glucose (ADAG), using the equation, ADAG = ((28.7 × HbA1c) − 46.7), were calculated. Patients with high glucose levels were divided into three SIH groups with diabetes mellitus (DM), based on the following definitions: (1) same glycemic gap from ADAG; (2) same percentage of elevated glucose of ADAG, from which percentage could also be reflected by the stress hyperglycemia ratio (SHR), calculated as the admission glucose level divided by ADAG; or (3) same percentage of elevated glucose as patients with a defined SIH level, in trauma patients with and without diabetes. Patients with incomplete registered data were excluded. The primary hypothesis of this study was that SIH in patients with diabetes would present worse mortality outcomes than in those without. Detailed data of SIH in patients with diabetes were retrieved from the Trauma Registry System. Results: Among the 546 patients with DH, 332 (32.0%), 188 (18.1%), and 106 (10.2%) were assigned as diabetes patients with SIH, based on defined glucose levels, set at 250 mg/dL, 300 mg/dL, and 350 mg/dL, respectively. In patients with defined cut-off glucose levels of 250 mg/dL and 300 mg/dL, SIH was associated with a 3.5-fold (95% confidence interval (CI) 1.61–7.46; p = 0.001) and 3-fold (95% CI 1.11–8.03; p = 0.030) higher odds of mortality, adjusted by sex, age, pre-existing comorbidities, and injury severity score, than the 491 patients with diabetic normoglycemia (DN). However, in patients with a defined cut-off glucose level of 350 mg/dL, adjusted mortality in SIH in DM was insignificantly different than that in DM. According to the receiver operating characteristic (ROC) curve analysis, a blood sugar of 233 mg/dL, a glycemic gap of 79 (i.e., blood sugar of 251 mg/dL), and a SHR of 1.45 (i.e., blood sugar of 250 mg/dL) were identified as cut-offs for mortality outcomes, with AUCs of 0.622, 0.653, and 0.658, respectively. Conclusions: In this study, a cut-off glucose level of 250 mg/dL was selected to provide a better definition of SIH in DM than glucose levels of 300 mg/dL or 350 mg/dL.

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IJERPH, Vol. 14, Pages 1517: The Effect of Branding to Promote Healthy Behavior: Reducing Tobacco Use among Youth and Young Adults

IJERPH, Vol. 14, Pages 1517: The Effect of Branding to Promote Healthy Behavior: Reducing Tobacco Use among Youth and Young Adults

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121517

Authors: Donna Vallone Marisa Greenberg Haijun Xiao Morgane Bennett Jennifer Cantrell Jessica Rath Elizabeth Hair

Policy interventions such as public health mass media campaigns disseminate messages in order to improve health-related knowledge, attitudes, beliefs and behaviors at the population level. Only more recently have campaigns that promote health-related behaviors adopted branding, a well-established marketing strategy, to influence how consumers think and feel about a message. This study examines whether positive brand equity for the national truth® campaign is associated with lower likelihood of cigarette use over time using the nationally representative Truth Longitudinal Cohort of youth and young adults, aged 15–21. Logistic regression models were used to examine the relationship between brand equity and the likelihood of reporting past 30-day smoking over a 12-month period. Respondents who reported positive brand equity were significantly less likely to report past 30-day smoking 12 months later (OR = 0.66, p &lt; 0.05), controlling for covariates known to influence tobacco use behavior. Findings also translate the effect size difference to a population estimate of more than 300,000 youth and young adults having been prevented from current smoking over the course of a year. Building brand equity is a strategic process for health promotion campaigns, not only to improve message recall and salience but also to influence behavioral outcomes.

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IJERPH, Vol. 14, Pages 1526: Pets, Purity and Pollution: Why Conventional Models of Disease Transmission Do Not Work for Pet Rat Owners

IJERPH, Vol. 14, Pages 1526: Pets, Purity and Pollution: Why Conventional Models of Disease Transmission Do Not Work for Pet Rat Owners

International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14121526

Authors: Charlotte Robin Elizabeth Perkins Francine Watkins Robert Christley

In the United Kingdom, following the emergence of Seoul hantavirus in pet rat owners in 2012, public health authorities tried to communicate the risk of this zoonotic disease, but had limited success. To explore this lack of engagement with health advice, we conducted in-depth, semi-structured interviews with pet rat owners and analysed them using a grounded theory approach. The findings from these interviews suggest that rat owners construct their pets as different from wild rats, and by elevating the rat to the status of a pet, the powerful associations that rats have with dirt and disease are removed. Removing the rat from the contaminated outside world moves their pet rat from being ‘out of place’ to ‘in place’. A concept of ‘bounded purity’ keeps the rat protected within the home, allowing owners to interact with their pet, safe in the knowledge that it is clean and disease-free. Additionally, owners constructed a ‘hierarchy of purity’ for their pets, and it is on this structure of disease and risk that owners base their behaviour, not conventional biomedical models of disease.

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Perturbations in Endothelial Dysfunction-Associated Pathways in the Nitrofen-Induced Congenital Diaphragmatic Hernia Model

Although it is well known that nitrofen induces congenital diaphragmatic hernia (CDH), including CDH-associated lung hypoplasia and pulmonary hypertension (PH) in rodents, the mechanism of pathogenesis remains largely unclear. It has been reported that pulmonary artery (PA) endothelial cell (EC) dysfunction contributes to the development of PH in CDH. Thus, we hypothesized that there is significant alteration of endothelial dysfunction-associated proteins in nitrofen-induced CDH PAs. Pregnant SD rats received either nitrofen or olive oil on gestational day 9.5. The newborn rats were sacrificed and divided into a CDH (n = 81) and a control (n = 23) group. After PA isolation, the expression of PA endothelial dysfunction-associated proteins was assessed on Western blot and immunostaining. We demonstrate that the expression of C-reactive protein and endothelin-1 and its receptors, ET_A and ET_B, were significantly increased in the CDH PAs. Levels of phosphorylated myosin light chain were significantly elevated, but those of phosphorylated endothelial nitric oxide synthase, caveolin-1, and mechanistic target of rapamycin were significantly decreased in the CDH PAs. In this work, we elucidate alterations in the expression of endothelial dysfunction-associated proteins specific to nitrofen-induced CDH rodent PAs, thereby advancing our understanding of the critical role of endothelial dysfunction-associated pathways in the pathogenesis of nitrofen-induced CDH.
J Vasc Res 2018;55:26-34

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Viruses, Vol. 9, Pages 376: Host Cell Restriction Factors that Limit Influenza A Infection

Viruses, Vol. 9, Pages 376: Host Cell Restriction Factors that Limit Influenza A Infection

Viruses doi: 10.3390/v9120376

Authors: Fernando Villalón-Letelier Andrew Brooks Philippa Saunders Sarah Londrigan Patrick Reading

Viral infection of different cell types induces a unique spectrum of host defence genes, including interferon-stimulated genes (ISGs) and genes encoding other proteins with antiviral potential. Although hundreds of ISGs have been described, the vast majority have not been functionally characterised. Cellular proteins with putative antiviral activity (hereafter referred to as “restriction factors”) can target various steps in the virus life-cycle. In the context of influenza virus infection, restriction factors have been described that target virus entry, genomic replication, translation and virus release. Genome wide analyses, in combination with ectopic overexpression and/or gene silencing studies, have accelerated the identification of restriction factors that are active against influenza and other viruses, as well as providing important insights regarding mechanisms of antiviral activity. Herein, we review current knowledge regarding restriction factors that mediate anti-influenza virus activity and consider the viral countermeasures that are known to limit their impact. Moreover, we consider the strengths and limitations of experimental approaches to study restriction factors, discrepancies between in vitro and in vivo studies, and the potential to exploit restriction factors to limit disease caused by influenza and other respiratory viruses.

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Kolonstent als „bridge to surgery“ vs. notfallmäßige Resektion bei Patienten mit maligner Kolonstenose

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RCGP bans Babylon from sponsoring annual conference

The private healthcare company Babylon will no longer be a sponsor of the Royal College of General Practitioners’ (RCGP) annual conference, the college has said.Kamila Hawthorne, RCGP vice chair,...

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Patient centred diagnosis of dementia: we must listen to patients’ wishes

Berger and colleagues discuss conversations around shared decision making.1 Patient centred diagnosis in old age psychiatry covers not only which investigations to do but also what to conclude from...

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Pediatric Radiology Editorial Board — acknowledgments and updates

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Chest computed tomography angiography in children on extracorporeal membrane oxygenation (ECMO)

Abstract

Performing chest CT angiography on pediatric patients on extracorporeal membrane oxygenation (ECMO) can be challenging. Successfully performing CT angiography in these children requires substantial communication and coordination between the radiologists and clinical care providers. Additionally, the radiologist must understand the child’s anatomy and disease pathophysiology, flow dynamics of the ECMO circuit, image acquisition timing, contrast injection site, and volume, rate and duration of contrast administration. In this article we highlight the vital factors the radiologist needs to consider to optimize the chest CT angiography in pediatric patients on ECMO.

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Ultrasound evaluation of stress injuries and physiological adaptations in the fingers of adolescent competitive rock climbers

Abstract

Background

The impact of high-intensity, repetitive training on the fingers of adolescent climbers is relatively unknown.

Objective

To evaluate this effect by ultrasound (US) and to confirm some findings by magnetic resonance imaging (MRI).

Materials and methods

The US study was performed in 20 adolescent rock climbers (ages 10–17 years) and 6 non-climbing controls (ages 11–15 years). US was used to examine the third digit of the right hand for differences in thickness of soft tissue, flexor and extensor tendon, volar plate and bony and growth plate adaptations. In four climbers with finger deformity or pain, 3-T MR images were compared with US findings. Number of hours/week and years of climbing were used to group climbers in three levels (3=most intense training). Mann-Whitney test was used for statistical analysis.

Results

Compared with non-climbing controls, climbers demonstrated significantly thicker flexor tendons, volar plates and soft tissues. Joint effusions were found in 13/19 (68%) climbers. Significant phalangeal malalignment was seen in 10/19 (53%) climbers. Growth plate deformities were identified in three level 3 climbers. US findings correlated with MRI for effusions, phalangeal growth plate injury, malalignment and adaptive changes. MRI additional showed capsule rupture (n=1), stress fracture (n=1) and phalangeal physeal stress injury (n=1).

Conclusion

Competitive rock climbing results in physiological adaptations in the fingers, an example being significant soft-tissue hypertrophy of the flexor. US demonstrated several non-physiological changes in response to repetitive stress in half of the climbers. MRI showed additional stress injuries to the growth plate, joints and bone.

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Highlights from the 40th ESNR Annual Meeting, the 24th Advanced Course in Diagnostic Neuroradiology and the 9th Advanced Course in Interventional Neuroradiology-Malmö 2017

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Cell biology: Bulky tether proteins aid membrane fusion

The energy source that drives vesicle fusion with a target organelle in vivo has been unclear. It emerges that proteins that tether fusing structures together also decrease the energy needed for the final fusion step.

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Lead selection of antiparasitic compounds from a focused library of benzenesulfonyl derivatives of heterocycles

A library of 89 synthetic benzenesulfonyl derivatives of heterocycles with drug-like properties was assayed for in vitro antiparasitic activity and the results were added to our previously reported derivatives for a comprehensive SAR evaluation. Four compounds showed an IC50 between 0.25 and 3μM against Leishmania donovani and low cytotoxicity. Compound G{16} (1-(2,3,5,6-tetramethylphenylsulfonyl)-2-methylindoline), was particularly interesting with an IC50 similar to the reference drug miltefosine. Seven compounds showed an IC50 below 6µM against Trypanosoma cruzi, and three of them (E{3}, E{9} and G{3}) were identified as lead scaffolds for further optimization based on their activity-toxicity profile. Two promising structures (B{15} and G{15}) showed moderate inhibitory activity against Plasmodium falciparum. In general, the presence of a benzenesulfonyl moiety improves the antiparasitic activity of the heterocycles included in this study (with the exception of Trypanosoma brucei rhodesiense), validating the criteria used in the selection of the privileged structures and diversification used to generate this library. SAR analysis showed that the presence of lipophilic and electron withdrawing groups were favorable for the antiparasitic activity.

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Different but overlapping populations of Strongyloides stercoralis in dogs and humans-Dogs as a possible source for zoonotic strongyloidiasis

Strongyloidiasis is a much-neglected soil born helminthiasis caused by the nematode Strongyloides stercoralis. Human derived S. stercoralis can be maintained in dogs in the laboratory and this parasite has been reported to also occur in dogs in the wild. Some authors have considered strongyloidiasis a zoonotic disease while others have argued that the two hosts carry host specialized populations of S. stercoralis and that dogs play a minor role, if any, as a reservoir for zoonotic S. stercoralis infections of humans. We isolated S. stercoralis from humans and their dogs in rural villages in northern Cambodia, a region with a high incidence of strongyloidiasis, and compared the worms derived from these two host species using nuclear and mitochondrial DNA sequence polymorphisms. We found that in dogs there exist two populations of S. stercoralis, which are clearly separated from each other genetically based on the nuclear 18S rDNA, the mitochondrial cox1 locus and whole genome sequence. One population, to which the majority of the worms belong, appears to be restricted to dogs. The other population is indistinguishable from the population of S. stercoralis isolated from humans. Consistent with earlier studies, we found multiple sequence variants of the hypervariable region I of the 18 S rDNA in S. stercoralis from humans. However, comparison of mitochondrial sequences and whole genome analysis suggest that these different 18S variants do not represent multiple genetically isolated subpopulations among the worms isolated from humans. We also investigated the mode of reproduction of the free-living generations of laboratory and wild isolates of S. stercoralis. Contrary to earlier literature on S. stercoralis but similar to other species of Strongyloides, we found clear evidence of sexual reproduction. Overall, our results show that dogs carry two populations, possibly different species of Strongyloides. One population appears to be dog specific but the other one is shared with humans. This argues for the strong potential of dogs as reservoirs for zoonotic transmission of S. stercoralis to humans and suggests that in order to reduce the exposure of humans to infective S. stercoralis larvae, dogs should be treated for the infection along with their owners.

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Antibiotics, Vol. 6, Pages 34: Evaluation of Antibiotic Residues in Raw Meat Using Different Analytical Methods

Antibiotics, Vol. 6, Pages 34: Evaluation of Antibiotic Residues in Raw Meat Using Different Analytical Methods

Antibiotics doi: 10.3390/antibiotics6040034

Authors: Tsepo Ramatla Lubanza Ngoma Modupeade Adetunji Mulunda Mwanza

Antibiotic residue in meat is a serious public health concern due to its harmful effects on consumer health. This study aimed at estimating the residue levels of four commonly used antibiotics in meat samples using three analytical methods (ELISA, TLC and HPLC). A total of 150 samples of raw meat from sales points were analysed for ciprofloxacin, streptomycin, tetracycline, and sulphanilamide residues. Overall, ELISA analysis showed that 56, 34, 18, and 25.3% of the samples tested positive for ciprofloxacin, streptomycin, sulphanilamide and tetracycline residues respectively while TLC and HPLC detected 21.4, 29.4, 92.5, and 14.6%, and 8.3, 41.1, 88.8, and 14.6% of the samples as containing the residues, with ciprofloxacin and sulphanilamide having the lowest and highest occurrence, respectively. Furthermore, the concentrations of antibiotic residues were in the ranges of 19.8–92.8, 26.6–489.1, 14.2–1280.8, and 42.6–355.6 μg/kg with ELISA, while HPLC detected concentration ranges of 20.7–82.1, 41.8–320.8, 65.2–952.2 and 32.8–95.6 μg/kg for sulphanilamide, tetracycline, streptomycin, and ciprofloxacin, respectively. Mean ciprofloxacin and streptomycin residue levels were above the Codex/SA MRL recommended limit, while 3% of the samples contained multidrug residues. Although some of the mean residues levels were below the permissible limits, the co-occurrence of multidrug residues in some of the samples calls for concern.

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The SH3-binding domain of Cx43 participates in loop/tail interactions critical for Cx43-hemichannel activity

Abstract

Connexin 43 (Cx43) hemichannels establish local signaling networks via the release of ATP and other molecules, but their excessive opening may result in cell death. Hence, the activity of Cx43-hemichannels ought to be critically controlled. This involves interactions between the C-terminal tail (CT) and the cytoplasmic loop (CL), more particularly the L2 domain within CL. Previous work revealed an important role for the last nine amino acids of the Cx43 CT by targeting the L2 domain, as these nine amino acids were sufficient to restore the activity of CT-truncated Cx43-hemichannels. However, we discovered that deletion of the last 19 amino acids of the CT only partially lowered the binding to the L2 domain, indicating that a second L2-binding region is present in the CT. We here provide evidence that the SH3-binding domain is another CT region that targets the L2 domain. At the functional level, the SH3-binding domain was able to restore the activity of CT-truncated Cx43-hemichannels and alleviate the inhibition of full-length Cx43-hemichannels by high intracellular Ca²⁺ concentration ([Ca²⁺]_i) as demonstrated by various approaches including patch clamp studies of unitary Cx43-hemichannel activity. Finally, we show that in full-length Cx43-hemichannels, deletion of either the SH3-binding domain or the CT9 region suppresses the hemichannel activity, while deletion of both domains completely annihilates the hemichannel activity. These results demonstrate that the Cx43 SH3-binding domain, in addition to the CT9 region, critically controls hemichannel activity at high [Ca²⁺]_i, which may be involved in pathological hemichannel opening.

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