Κυριακή 4 Μαρτίου 2018
Perspectives on the etiology of chronic rhinosinusitis: An immune barrier hypothesis
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The efficacy of topical antibiofilm agents in a sheep model of rhinosinusitis
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Microarray analysis of distinct gene transcription profiles in non-eosinophilic chronic sinusitis with nasal polyps
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Analysis of T-helper responses and FOXP3 gene expression in patients with Japanese cedar pollinosis
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Pathophysiology of nasal polyposis: The role of desmosomal junctions
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Olfactory bulb volume in patients with sinonasal disease
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Squamous metaplasia and chronic rhinosinusitis: A clinicopathological study
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Posttraumatic anosmia secondary to central nervous system injury
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Postoperative antibiotic care after functional endoscopic sinus surgery
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Sonography versus plain x rays in diagnosis of nasal fractures
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Acoustic rhinometry of Asian noses
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Balloon catheter dilatation for frontal sinus ostium stenosis in the office setting
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In vivo laser tissue welding in the rabbit maxillary sinus
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Attachment-oriented endoscopic surgical strategy for sinonasal inverted papilloma
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Combined image guidance and intraoperative computed tomography in facilitating endoscopic orientation within and around the paranasal sinuses
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Construct validation of a low-fidelity endoscopic sinus surgery simulator
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Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors
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Comparison of laryngeal mask with endotracheal tube for anesthesia in endoscopic sinus surgery
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Results of endoscopic maxillary mega-antrostomy in recalcitrant maxillary sinusitis
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Relationship between mucosal inflammation, computed tomography, and symptomatology in chronic rhinosinusitis without polyps
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Commentary on letter to editor titled “The clinical value of the RGB value of an image of the interarytenoid area for diagnosis of laryngopharyngeal reflux”
We are thankful to Dr. Zhengcai-Lou and Dr. Zihan-Lou for their interest in our article. It would be our pleasure to take this opportunity to comment on them.
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Esaote, Barco partner on new MyLab 9 system
Ultrasound and MRI vendor Esaote and image display firm Barco previewed the...
Read more on AuntMinnieEurope.com
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Pulmonary Function Diagnosis Based on Respiratory Changes in Lung Density With Dynamic Flat-Panel Detector Imaging: An Animal-Based Study
Objectives The aims of this study were to address the relationship between respiratory changes in image density of the lungs and tidal volume, to compare the changes between affected and unaffected lobes, and to apply this new technique to the diagnosis of atelectasis. Materials and Methods Our animal care committee approved this prospective animal study. Sequential chest radiographs of 4 pigs were obtained under respiratory control with a ventilator using a dynamic flat-panel detector system. Porcine models of atelectasis were developed, and the correlation between the tidal volume and changes in pixel values measured in the lungs were analyzed. The mean difference in respiratory changes in pixel values between both lungs was tested using paired t tests. To facilitate visual evaluation, respiratory changes in pixel values were visualized in the form of a color display, that is, as changes in color scale. Results Average pixel values in the lung regions changed according to forced respiration. High linearity was observed between changes in pixel values and tidal volume in the normal models (r = 0.99). Areas of atelectasis displayed significantly reduced changes in pixel values (P
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Evaluation of Fixed-Dose Four-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal in Patients with Intracranial Hemorrhage
Publication date: Available online 3 March 2018
Source:The Journal of Emergency Medicine
Author(s): Rachael Scott, Brian Kersten, Jeanne Basior, Megan Nadler
BackgroundDifferent strategies exist for dosing four-factor prothrombin complex concentrate (PCC4) for international normalized ratio (INR) reversal in the setting of life-threatening bleeding. Fixed doses ranging from 1000 IU to 1750 IU have demonstrated efficacy similar to weight-based dosing, however, few studies look exclusively at intracranial hemorrhage (ICH).ObjectiveOur aim was to evaluate whether a fixed dose of 1000 IU of PCC4 achieves INR reversal similar to weight-based dosing in patients with ICH who were anticoagulated with warfarin.MethodsWe compared a weight-based dose vs. 1000 IU PCC4 between January 2014 and January 2017. The primary end point was achieving an INR < 1.5. Secondary end points included in-hospital mortality, patient disposition, and reversal defined by INR < 1.6.ResultsA total of 31 patients were included in the weight-based group and 30 were included in the fixed-dose group, with baseline INRs of 2.98 and 2.84, respectively (p = 0.39). Twenty-two patients (71%) achieved an INR < 1.5 in the weight-based group vs. 16 (53%) in the fixed-dose group (p = 0.15), while 25 (81%) achieved an INR < 1.6 in the weight-based group vs. 22 (73%) in the fixed-dose group (p = 0.49). There was no difference in the number of patients discharged to home (19% vs. 20%; p = 0.95) or in-hospital mortality (26% vs. 27%; p = 0.93).ConclusionsWe found a non−statistically significant difference in warfarin reversal to an INR goal of < 1.5 when comparing a fixed dose of 1000 IU PCC4 and a weight-based dose for ICH. Further studies correlating clinical outcomes with INR reversal are needed.
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Source:The Journal of Emergency Medicine
Author(s): Rachael Scott, Brian Kersten, Jeanne Basior, Megan Nadler
BackgroundDifferent strategies exist for dosing four-factor prothrombin complex concentrate (PCC4) for international normalized ratio (INR) reversal in the setting of life-threatening bleeding. Fixed doses ranging from 1000 IU to 1750 IU have demonstrated efficacy similar to weight-based dosing, however, few studies look exclusively at intracranial hemorrhage (ICH).ObjectiveOur aim was to evaluate whether a fixed dose of 1000 IU of PCC4 achieves INR reversal similar to weight-based dosing in patients with ICH who were anticoagulated with warfarin.MethodsWe compared a weight-based dose vs. 1000 IU PCC4 between January 2014 and January 2017. The primary end point was achieving an INR < 1.5. Secondary end points included in-hospital mortality, patient disposition, and reversal defined by INR < 1.6.ResultsA total of 31 patients were included in the weight-based group and 30 were included in the fixed-dose group, with baseline INRs of 2.98 and 2.84, respectively (p = 0.39). Twenty-two patients (71%) achieved an INR < 1.5 in the weight-based group vs. 16 (53%) in the fixed-dose group (p = 0.15), while 25 (81%) achieved an INR < 1.6 in the weight-based group vs. 22 (73%) in the fixed-dose group (p = 0.49). There was no difference in the number of patients discharged to home (19% vs. 20%; p = 0.95) or in-hospital mortality (26% vs. 27%; p = 0.93).ConclusionsWe found a non−statistically significant difference in warfarin reversal to an INR goal of < 1.5 when comparing a fixed dose of 1000 IU PCC4 and a weight-based dose for ICH. Further studies correlating clinical outcomes with INR reversal are needed.
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Deconstructing Patterns: Cultural clash makes a fascinating show
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Old Scientist: The rise of the machines from railway timetables
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Evaluation of Fixed-Dose Four-Factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal in Patients with Intracranial Hemorrhage
Source:The Journal of Emergency Medicine
Author(s): Rachael Scott, Brian Kersten, Jeanne Basior, Megan Nadler
BackgroundDifferent strategies exist for dosing four-factor prothrombin complex concentrate (PCC4) for international normalized ratio (INR) reversal in the setting of life-threatening bleeding. Fixed doses ranging from 1000 IU to 1750 IU have demonstrated efficacy similar to weight-based dosing, however, few studies look exclusively at intracranial hemorrhage (ICH).ObjectiveOur aim was to evaluate whether a fixed dose of 1000 IU of PCC4 achieves INR reversal similar to weight-based dosing in patients with ICH who were anticoagulated with warfarin.MethodsWe compared a weight-based dose vs. 1000 IU PCC4 between January 2014 and January 2017. The primary end point was achieving an INR < 1.5. Secondary end points included in-hospital mortality, patient disposition, and reversal defined by INR < 1.6.ResultsA total of 31 patients were included in the weight-based group and 30 were included in the fixed-dose group, with baseline INRs of 2.98 and 2.84, respectively (p = 0.39). Twenty-two patients (71%) achieved an INR < 1.5 in the weight-based group vs. 16 (53%) in the fixed-dose group (p = 0.15), while 25 (81%) achieved an INR < 1.6 in the weight-based group vs. 22 (73%) in the fixed-dose group (p = 0.49). There was no difference in the number of patients discharged to home (19% vs. 20%; p = 0.95) or in-hospital mortality (26% vs. 27%; p = 0.93).ConclusionsWe found a non−statistically significant difference in warfarin reversal to an INR goal of < 1.5 when comparing a fixed dose of 1000 IU PCC4 and a weight-based dose for ICH. Further studies correlating clinical outcomes with INR reversal are needed.
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Deconstructing Patterns: Cultural clash makes a fascinating show
From a film of hands describing a fly’s eyes to a sound installation about DNA, the Crick Institute’s show uses art to explore patterns at the microscopic level
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Old Scientist: The rise of the machines from railway timetables
On their way to world domination, computers practised on boring jobs we were glad to give them, as a scan through March issues of New Scientist show
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Understand the use of #ecigarettes for tobacco cessation, including; how they work, the different generations of… https://t.co/AsqgaRbEr9
Understand the use of #ecigarettes for tobacco cessation, including; how they work, the different generations of… https://t.co/AsqgaRbEr9
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Local quality assurance of serum or plasma (HIL) indices
Publication date: Available online 3 March 2018
Source:Clinical Biochemistry
Author(s): Giuseppe Lippi, Janne Cadamuro, Alexander von Meyer, Ana-Maria Simundic
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Source:Clinical Biochemistry
Author(s): Giuseppe Lippi, Janne Cadamuro, Alexander von Meyer, Ana-Maria Simundic
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Analytical and clinical validation of a dried blood spot assay for the determination of paclitaxel using high-performance liquid chromatography-tandem mass spectrometry
Publication date: Available online 4 March 2018
Source:Clinical Biochemistry
Author(s): Natália B. Andriguetti, Roberta Z. Hahn, Lilian F. Lizot, Suziane Raymundo, Jose L. Costa, Kelly F. da Cunha, Ramon M.M. Vilela, Helena M. Kluck, Gilberto Schwartsmann, Marina V. Antunes, Rafael Linden
BackgroundPaclitaxel (PCT) is a chemotherapeutic drug widely used for the treatment of several types of tumors, and its use is associated with severe adverse events, mainly neurologic and hematopoietic toxicities. The relation between systemic exposure and clinical response to PCT was previously described, making paclitaxel a potential candidate for therapeutic drug monitoring (TDM). The use of dried blood spot (DBS) sampling could allow complex sampling schedules required for TDM of PCT. The aim of this study was to develop and validate an LC-MS/MS assay for the quantification of PCT in DBS.MethodsPCT was extracted from one 8 mm DBS punch with a mixture of methanol and acetonitrile, followed by chromatographic separation in a Kinetex C18 (50 × 4.6 mm, 2.6 μm) column. Detection was performed in a 5500-QTRAP® mass spectrometer, with a run time of 2.3 min.ResultsThe assay was linear in the range of 2.5 to 400 ng mL−1. Precision (CV%) and accuracy at the concentration levels of 7.5, 40 and 150 ng mL−1 were 1.69–4.9% and 106.25 to 109.92%, respectively. PCT was stable for 21 days at 25 and 45 °C. The method was applied to DBS samples obtained from 34 patients under PCT chemotherapy. The use of a simple correction factor, derived from the correlation between PCT concentrations in plasma and DBS in this set of patients, allowed unbiased estimation of PCT plasma concentrations from DBS measurements, with similar clinical decisions using either plasma or DBS measurements.ConclusionsDBS testing of PCT concentrations represents a promising alternative for the dissemination of PCT dose individualization.
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Source:Clinical Biochemistry
Author(s): Natália B. Andriguetti, Roberta Z. Hahn, Lilian F. Lizot, Suziane Raymundo, Jose L. Costa, Kelly F. da Cunha, Ramon M.M. Vilela, Helena M. Kluck, Gilberto Schwartsmann, Marina V. Antunes, Rafael Linden
BackgroundPaclitaxel (PCT) is a chemotherapeutic drug widely used for the treatment of several types of tumors, and its use is associated with severe adverse events, mainly neurologic and hematopoietic toxicities. The relation between systemic exposure and clinical response to PCT was previously described, making paclitaxel a potential candidate for therapeutic drug monitoring (TDM). The use of dried blood spot (DBS) sampling could allow complex sampling schedules required for TDM of PCT. The aim of this study was to develop and validate an LC-MS/MS assay for the quantification of PCT in DBS.MethodsPCT was extracted from one 8 mm DBS punch with a mixture of methanol and acetonitrile, followed by chromatographic separation in a Kinetex C18 (50 × 4.6 mm, 2.6 μm) column. Detection was performed in a 5500-QTRAP® mass spectrometer, with a run time of 2.3 min.ResultsThe assay was linear in the range of 2.5 to 400 ng mL−1. Precision (CV%) and accuracy at the concentration levels of 7.5, 40 and 150 ng mL−1 were 1.69–4.9% and 106.25 to 109.92%, respectively. PCT was stable for 21 days at 25 and 45 °C. The method was applied to DBS samples obtained from 34 patients under PCT chemotherapy. The use of a simple correction factor, derived from the correlation between PCT concentrations in plasma and DBS in this set of patients, allowed unbiased estimation of PCT plasma concentrations from DBS measurements, with similar clinical decisions using either plasma or DBS measurements.ConclusionsDBS testing of PCT concentrations represents a promising alternative for the dissemination of PCT dose individualization.
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Controversies and Advances in Head and Neck Surgery.
Controversies and Advances in Head and Neck Surgery.
Otolaryngol Head Neck Surg. 1999 Jun;120(6):847
Authors:
PMID: 29498321 [PubMed]
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Spanish Society of Otorhinolaryngology Head and Neck Surgery.
Spanish Society of Otorhinolaryngology Head and Neck Surgery.
Otolaryngol Head Neck Surg. 1999 Jun;120(6):788
Authors:
PMID: 29498320 [PubMed]
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Anatomy and Histopathology of the Head and Neck and Temporal Bone.
Anatomy and Histopathology of the Head and Neck and Temporal Bone.
Otolaryngol Head Neck Surg. 1999 Jun;120(6):840
Authors:
PMID: 29498319 [PubMed]
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International Multidisciplinary Symposium.
International Multidisciplinary Symposium.
Otolaryngol Head Neck Surg. 1999 Jun;120(6):888
Authors:
PMID: 29498318 [PubMed]
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Management of the Tinnitus Patient.
Management of the Tinnitus Patient.
Otolaryngol Head Neck Surg. 1999 Jun;120(6):814
Authors:
PMID: 29498317 [PubMed]
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A new year, a new Journal.
A new year, a new Journal.
Rhinology. 2018 Mar 03;:
Authors: Fokkens WJ
Abstract
Let us start this first editorial of 2018 with wishing you all a marvelous year where most of your dreams come true. In the last years, the editors of Rhinology felt often very unhappy when again we had to refuse papers send to us for Rhinology. Unfortunately, every year we can only accept around 15% of the papers we receive. With pain in our hearts, we often have to refuse papers of good quality but just not innovative enough or with slight methodological imperfections. The editorial board of Rhinology recognized this feeling and we decided to start a new journal: Rhinology Online to have space for all those papers that are good but just do not make the cut for Rhinology. Rhinology Online is a journal of the European Rhinologic Society, and will provide a platform for the dissemination of rhinologic research and reviews, as well as position papers, task force reports and guidelines, amongst an international scientific audience.
PMID: 29500878 [PubMed - as supplied by publisher]
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Impact of wastewater effluent containing aged nanoparticles and other components on biological activities of the soil microbiome, Arabidopsis plants, and earthworms.
Impact of wastewater effluent containing aged nanoparticles and other components on biological activities of the soil microbiome, Arabidopsis plants, and earthworms.
Environ Res. 2018 Feb 28;164:197-203
Authors: Liu J, Williams PC, Geisler-Lee J, Goodson BM, Fakharifar M, Peiravi M, Chen D, Lightfoot DA, Gemeinhardt ME
Abstract
The amount of engineered nanomaterials (ENMs) in the environment has been increasing due to their industrial and commercial applications. Different types of metallic nanoparticles (NPs) have been detected in effluents from wastewater treatment plants (WWTPs). The effluents have been reclaimed for crop irrigation in many arid and semi-arid areas. Here, a soil micro-ecosystem was established including a microbiome, 4 Arabidopsis thaliana plants, and 3 Eisenia fetida earthworms, for a duration of 95 days. The impact of wastewater effluent (WE) containing aged NPs was studied. WE was taken from a local WWTP and exhibited the presence of Ti, Ag, and Zn up to 97.0 ± 9.4, 27.4 ± 3.9, and 4.1 ± 3.6 µg/L, respectively, as well as the presence of nanoscale particles (1-100 nm in diameter). The plants were irrigated with WE or deionized water (DIW). After 95 days, significantly higher concentrations of extractable Ti and Zn (439.2 ± 24.4 and 9.0 ± 0.5 mg/kg, respectively) were found in WE-irrigated soil than those in DIW-irrigated soil (161.2 ± 2.1 and 4.0 ± 0.1 mg/kg). The extractable Ag concentrations did not differ significantly between the WE- and DIW-irrigated soil. Although microbial biomass carbon and nitrogen were not significantly reduced, the population distribution of the microbial communities was shifted in WE-irrigated soil compared to the control. The abundance of cyanobacteria (Cyanophyta) was increased by 12.5% in the WE-irrigated soil as manifested mainly by an increase of Trichodesmium spp., and the abundance of unknown archaea was enhanced from 26.7% in the control to 40.5% in the WE-irrigated soil. The biomasses of A. thaliana and E. fetida were not significantly changed by WE exposure. However, A. thaliana had a noticeable shortened life cycle, and corrected total cell fluorescence was much higher in the roots of WE-irrigated plants compared to the control. These impacts on the soil micro-ecosystem may have resulted from the aged NPs and/or the metal ions released from these NPs, as well as other components in the WE. Taken together, these results should help inform the reuse of WE containing aged NPs and other components in sustainable agriculture.
PMID: 29501007 [PubMed - as supplied by publisher]
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A synthetic stroma-free germinal center niche for efficient generation of humoral immunity ex vivo.
A synthetic stroma-free germinal center niche for efficient generation of humoral immunity ex vivo.
Biomaterials. 2018 Feb 21;164:106-120
Authors: Roh KH, Song HW, Pradhan P, Bai K, Bohannon CD, Dale G, Leleux J, Jacob J, Roy K
Abstract
B cells play a major role in the adaptive immune response by producing antigen-specific antibodies against pathogens and imparting immunological memory. Following infection or vaccination, antibody-secreting B cells and memory B cells are generated in specialized regions of lymph nodes and spleens, called germinal centers. Here, we report a fully synthetic ex-vivo system that recapitulates the generation of antigen-specific germinal-center (GC) like B cells using material-surface driven polyvalent signaling. This synthetic germinal center (sGC) reaction was effectively induced using biomaterial-based artificial "follicular T helper cells (TFH)" that provided both natural CD40-CD40L ligation as well as crosslinking of CD40 and by mimicking artificial "follicular dendritic cells (FDC)" to provide efficient, polyvalent antigen presentation. The artificial sGC reaction resulted in efficient B cell expansion, immunoglobulin (Ig) class switching, and expression of germinal center phenotypes. Antigen presentation during sGC reaction selectively enhanced the antigen-specific B cell population and induced somatic hyper-mutations for potential affinity maturation. The resulting B cell population consisted primarily of GC-like B cells (centrocytes) as well as some plasma-like B cells expressing CD138. With concurrent cell sorting, we successfully created highly enriched populations of antigen-specific B cells. Adoptive transfer of these GC-like B cells into non-irradiated isogeneic or non-lethally irradiated congenic recipient mice showed successful engraftment and survival of the donor cells for the 4 week test period. We show that this material-surface driven sGC reaction can be successfully applied to not only splenic B cells but also B cells isolated from more therapeutically relevant sources such as peripheral blood mononuclear cells (PBMCs), thus making our current work an exciting prospect in the new era of personalized medicine and custom-immunotherapy.
PMID: 29500990 [PubMed - as supplied by publisher]
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Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: A case-crossover study.
Ambient concentrations of particulate matter and hospitalization for depression in 26 Chinese cities: A case-crossover study.
Environ Int. 2018 Feb 28;114:115-122
Authors: Wang F, Liu H, Li H, Liu J, Guo X, Yuan J, Hu Y, Wang J, Lu L
Abstract
OBJECTIVE: Air pollution with high ambient concentrations of particulate matter (PM) has been frequently reported in China. However, no Chinese study has looked into the short-term effect of PM on hospitalization for depression. We used a time-stratified case-crossover design to identify possible links between ambient PM levels and hospital admissions for depression in 26 Chinese cities.
METHODS: Electronic hospitalization summary reports (January 1, 2014-December 31, 2015) were used to identify hospital admissions related to depression. Conditional logistic regression was applied to determine the association between PM levels and hospitalizations for depression, with stratification by sex, age, and comorbidities.
RESULTS: Both PM2.5 and PM10 levels were positively associated with the number of hospital admissions for depression. The strongest effect was observed on the day of exposure (lag day 0) for PM10, with an interquartile range increase in PM10 associated with a 3.55% (95% confidence interval: 1.69-5.45) increase in admissions for depression. For PM2.5, the risks of hospitalization peaked on lag day 0 (2.92; 1.37-4.50) and lag day 5 (3.65; 2.09-5.24). The elderly (>65) were more sensitive to PM2.5 exposure (9.23; 5.09-13.53) and PM10 exposure (6.35; 3.31-9.49) on lag day 0, and patients with cardiovascular disease were likely to be hospitalized for depression following exposure to high levels of PM10 (4.47; 2.13-6.85).
CONCLUSIONS: Short-term elevations in PM may increase the risk of hospitalization for depression, particularly in the elderly and in patients with cardiovascular disease.
PMID: 29500987 [PubMed - as supplied by publisher]
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A new mechanical indentation framework for functional assessment of articular cartilage.
A new mechanical indentation framework for functional assessment of articular cartilage.
J Mech Behav Biomed Mater. 2018 Feb 23;81:83-94
Authors: Arabshahi Z, Afara IO, Moody HR, Schrobback K, Kashani J, Fischer N, Oloyede A, Klein TJ
Abstract
The conventional mechanical properties of articular cartilage, such as compressive stiffness, have been shown to have limited capacity to distinguish visually normal from degraded cartilage samples. In this study, a new mechanical indentation framework for assessing functional properties of articular cartilage during loading/unloading, i.e. deformation and recovery, was established. The capacity of a ring-shaped indenter integrated with an ultrasound transducer to distinguish mechanically intact from proteoglycan-depleted tissue was investigated. To achieve this, normal and enzymatically degraded bovine osteochondral samples were subjected to loading/unloading while the response of the tissue at the middle was captured by ultrasound at the same time. The enzymatic degradation model was characterized by amount of proteoglycan content, glycosaminoglycan release and proteomic analysis. The mechanical response of a wider continuum of articular cartilage in the loaded area and its surrounding region was captured in this framework leading to investigate two parameters, L and TS, related to the surrounding tissue of the loaded area for functional assessment of cartilage. L is the distance between the ultrasound transducer and articular cartilage surface and TS is the transient strain of articular cartilage during loading and unloading. Classification Analysis based on Principal Component Analysis was used to investigate the capacity of the new parameters to assess the functionality of the tissue. Multivariate statistics based on Partial Least Squares regression was employed to identify the correlation between the response of the tissue in the indented area and its surrounding cartilage. The results of this study indicate that L during loading (deformation) can differentiate normal and mildly proteoglycan-depleted samples from severely depleted samples and L during unloading (recovery) can distinguish between normal and proteoglycan-depleted tissue. However, TS during deformation and recovery is unable to discriminate normal cartilage samples from proteoglycan-depleted tissue. The results also demonstrate a strong correlation between mechanical properties of the loaded area with the response of its surrounding cartilage during recovery. It is therefore concluded that L in this newly established framework can discriminate between normal and proteoglycan-depleted cartilage samples. However, more samples will be needed to verify the demarcation between samples degraded for varying amount of time.
PMID: 29500981 [PubMed - as supplied by publisher]
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Light therapy for older patients with non-seasonal depression: A systematic review and meta-analysis.
Light therapy for older patients with non-seasonal depression: A systematic review and meta-analysis.
J Affect Disord. 2018 Feb 17;232:291-299
Authors: Zhao X, Ma J, Wu S, Chi I, Bai Z
Abstract
BACKGROUND: Light therapy has become an increasingly common treatment for adults with depression, yet the role of light therapy for non-seasonal depression among older adults remains unclear.
OBJECTIVE: This meta-analysis sought to evaluate the effectiveness of light therapy among older patients with non-seasonal depression.
METHODS: We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, CNKI and CBM from the inception of each database to May 2017. Two researchers conducted the literature screening, data extraction, and methodological quality assessment independently. We used the Cochrane Collaboration's bias assessment tool to evaluate the risk of bias for included studies, and Review Manager 5.2.3 Software for the meta-analysis.
RESULTS: Six trials with a total of 359 patients were included, and five studies were assessed as being of low risk for bias. We evaluated the effect of light therapy on depression by the reduction of depressive symptoms (SMD = 0.45; 95% CI= [0.14, 0.75]). The subgroup analysis did not find significant moderating effects of depression with intervention intensity, light type, measuring scale or intervention duration.
LIMITATIONS: Most of the study samples were not representative of the larger population of adults and therefore caution should be used when interpreting the findings.
CONCLUSIONS: Light therapy has a positive effect on geriatric non-seasonal depression. Studies with larger sample sizes are needed to confirm the curative effect of light therapy in the future.
PMID: 29500957 [PubMed - as supplied by publisher]
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Simulation of personalised haemodynamics by various mounting positions of a prosthetic valve using computational fluid dynamics.
Simulation of personalised haemodynamics by various mounting positions of a prosthetic valve using computational fluid dynamics.
Biomed Tech (Berl). 2018 Mar 03;:
Authors: Bongert M, Geller M, Pennekamp W, Nicolas V
Abstract
Diseases of the cardiovascular system account for nearly 42% of all deaths in the European Union. In Germany, approximately 12,000 patients receive surgical replacement of the aortic valve due to heart valve disease alone each year. A three-dimensional (3D) numerical model based on patient-specific anatomy derived from four-dimensional (4D) magnetic resonance imaging (MRI) data was developed to investigate preoperatively the flow-induced impact of mounting positions of aortic prosthetic valves to select the best orientation for individual patients. Systematic steady-state analysis of blood flow for different rotational mounting positions of the valve is only possible using a virtual patient model. A maximum velocity of 1 m/s was used as an inlet boundary condition, because the opening angle of the valve is at its largest at this velocity. For a comparative serial examination, it is important to define the standardised general requirements to avoid impacts other than the rotated implantation of the prosthetic aortic valve. In this study, a uniform velocity profile at the inlet for the inflow of the aortic valve and the real aortic anatomy were chosen for all simulations. An iterative process, with the weighted parameters flow resistance (1), shear stress (2) and velocity (3), was necessary to determine the best rotated orientation. Blood flow was optimal at a 45° rotation from the standard implantation orientation, which will offer a supply to the coronary arteries.
PMID: 29500919 [PubMed - as supplied by publisher]
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Examination of Child and Adolescent Hospital Admission Rates in Queensland, Australia, 1995-2011: A Comparison of Coal Seam Gas, Coal Mining, and Rural Areas.
Examination of Child and Adolescent Hospital Admission Rates in Queensland, Australia, 1995-2011: A Comparison of Coal Seam Gas, Coal Mining, and Rural Areas.
Matern Child Health J. 2018 Mar 02;:
Authors: Werner AK, Watt K, Cameron C, Vink S, Page A, Jagals P
Abstract
Objectives At present, coal seam gas (CSG) is the most common form of unconventional natural gas development occurring in Australia. Few studies have been conducted to explore the potential health impacts of CSG development on children and adolescents. This analysis presents age-specific hospitalisation rates for a child and adolescent cohort in three study areas in Queensland. Methods Three geographic areas were selected: a CSG area, a coal mining area, and a rural area with no mining activity. Changes in area-specific hospital admissions were investigated over the period 1995-2011 in a series of negative binomial regression analyses for 19 International Classification of Diseases (ICD) chapters, adjusting for sociodemographic factors. Results The strongest associations were found for respiratory diseases in 0-4 year olds (7% increase [95% CI 4%, 11%] and 6% increase [95% CI 2%, 10%] in the CSG area relative to the coal mining and rural areas, respectively) and 10-14 year olds (9% increase [95% CI 1%, 18%] and 11% increase [95% CI 1%, 21%] in the CSG area compared to the coal mining and rural areas, respectively). The largest effect size was for blood/immune diseases in 5-9 year olds in the CSG area (467% increase [95% CI 139%, 1244%]) compared to the rural area with no mining activity. Conclusions for Practice Higher rates of hospitalisation existed in the CSG area for certain ICD chapters and paediatric age groups, suggesting potential age-specific health impacts. This study provides insights on associations that should be explored further in terms of child and adolescent health.
PMID: 29500783 [PubMed - as supplied by publisher]
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Based on Real Time Remote Health Monitoring Systems: A New Approach for Prioritization "Large Scales Data" Patients with Chronic Heart Diseases Using Body Sensors and Communication Technology.
Based on Real Time Remote Health Monitoring Systems: A New Approach for Prioritization "Large Scales Data" Patients with Chronic Heart Diseases Using Body Sensors and Communication Technology.
J Med Syst. 2018 Mar 02;42(4):69
Authors: Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Albahri OS, Albahri AS
Abstract
This paper presents a new approach to prioritize "Large-scale Data" of patients with chronic heart diseases by using body sensors and communication technology during disasters and peak seasons. An evaluation matrix is used for emergency evaluation and large-scale data scoring of patients with chronic heart diseases in telemedicine environment. However, one major problem in the emergency evaluation of these patients is establishing a reasonable threshold for patients with the most and least critical conditions. This threshold can be used to detect the highest and lowest priority levels when all the scores of patients are identical during disasters and peak seasons. A practical study was performed on 500 patients with chronic heart diseases and different symptoms, and their emergency levels were evaluated based on four main measurements: electrocardiogram, oxygen saturation sensor, blood pressure monitoring, and non-sensory measurement tool, namely, text frame. Data alignment was conducted for the raw data and decision-making matrix by converting each extracted feature into an integer. This integer represents their state in the triage level based on medical guidelines to determine the features from different sources in a platform. The patients were then scored based on a decision matrix by using multi-criteria decision-making techniques, namely, integrated multi-layer for analytic hierarchy process (MLAHP) and technique for order performance by similarity to ideal solution (TOPSIS). For subjective validation, cardiologists were consulted to confirm the ranking results. For objective validation, mean ± standard deviation was computed to check the accuracy of the systematic ranking. This study provides scenarios and checklist benchmarking to evaluate the proposed and existing prioritization methods. Experimental results revealed the following. (1) The integration of TOPSIS and MLAHP effectively and systematically solved the patient settings on triage and prioritization problems. (2) In subjective validation, the first five patients assigned to the doctors were the most urgent cases that required the highest priority, whereas the last five patients were the least urgent cases and were given the lowest priority. In objective validation, scores significantly differed between the groups, indicating that the ranking results were identical. (3) For the first, second, and third scenarios, the proposed method exhibited an advantage over the benchmark method with percentages of 40%, 60%, and 100%, respectively. In conclusion, patients with the most and least urgent cases received the highest and lowest priority levels, respectively.
PMID: 29500683 [PubMed - in process]
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Systematic review of qualitative evaluations of reentry programs addressing problematic drug use and mental health disorders amongst people transitioning from prison to communities.
Systematic review of qualitative evaluations of reentry programs addressing problematic drug use and mental health disorders amongst people transitioning from prison to communities.
Health Justice. 2018 Mar 02;6(1):4
Authors: Kendall S, Redshaw S, Ward S, Wayland S, Sullivan E
Abstract
BACKGROUND: The paper presents a systematic review and metasynthesis of findings from qualitative evaluations of community reentry programs. The programs sought to engage recently released adult prison inmates with either problematic drug use or a mental health disorder.
METHODS: Seven biomedical and social science databases, Cinahl, Pubmed, Scopus, Proquest, Medline, Sociological abstracts and Web of Science and publisher database Taylor and Francis were searched in 2016 resulting in 2373 potential papers. Abstract reviews left 140 papers of which 8 were included after detailed review. Major themes and subthemes were identified through grounded theory inductive analysis of results from the eight papers. Of the final eight papers the majority (6) were from the United States. In total, the papers covered 405 interviews and included 121 (30%) females and 284 (70%) males.
RESULTS: Findings suggest that the interpersonal skills of case workers; access to social support and housing; and continuity of case worker relationships throughout the pre-release and post-release period are key social and structural factors in program success.
CONCLUSION: Evaluation of community reentry programs requires qualitative data to contextualize statistical findings and identify social and structural factors that impact on reducing incarceration and improving participant health. These aspects of program efficacy have implications for reentry program development and staff training and broader social and health policy and services.
PMID: 29500640 [PubMed]
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A plea for more uremic toxin research in children with chronic kidney disease.
A plea for more uremic toxin research in children with chronic kidney disease.
Pediatr Nephrol. 2018 Mar 02;:
Authors: Snauwaert E, Van Biesen W, Raes A, Glorieux G, Vanholder R, Vande Walle J, Eloot S
PMID: 29500629 [PubMed - as supplied by publisher]
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Imaging technologies for cardiac fiber and heart failure: a review.
Imaging technologies for cardiac fiber and heart failure: a review.
Heart Fail Rev. 2018 Mar 02;:
Authors: Watson SR, Dormer JD, Fei B
Abstract
There has been an increasing interest in studying cardiac fibers in order to improve the current knowledge regarding the mechanical and physiological properties of the heart during heart failure (HF), particularly early HF. Having a thorough understanding of the changes in cardiac fiber orientation may provide new insight into the mechanisms behind the progression of left ventricular (LV) remodeling and HF. We conducted a systematic review on various technologies for imaging cardiac fibers and its link to HF. This review covers literature reports from 1900 to 2017. PubMed and Google Scholar databases were searched using the keywords "cardiac fiber" and "heart failure" or "myofiber" and "heart failure." This review highlights imaging methodologies, including magnetic resonance diffusion tensor imaging (MR-DTI), ultrasound, and other imaging technologies as well as their potential applications in basic and translational research on the development and progression of HF. MR-DTI and ultrasound have been most useful and significant in evaluating cardiac fibers and HF. New imaging technologies that have the ability to measure cardiac fiber orientations and identify structural and functional information of the heart will advance basic research and clinical diagnoses of HF.
PMID: 29500602 [PubMed - as supplied by publisher]
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A hybrid computational model for collective cell durotaxis.
A hybrid computational model for collective cell durotaxis.
Biomech Model Mechanobiol. 2018 Mar 02;:
Authors: Escribano J, Sunyer R, Sánchez MT, Trepat X, Roca-Cusachs P, García-Aznar JM
Abstract
Collective cell migration is regulated by a complex set of mechanical interactions and cellular mechanisms. Collective migration emerges from mechanisms occurring at single cell level, involving processes like contraction, polymerization and depolymerization, of cell-cell interactions and of cell-substrate adhesion. Here, we present a computational framework which simulates the dynamics of this emergent behavior conditioned by substrates with stiffness gradients. The computational model reproduces the cell's ability to move toward the stiffer part of the substrate, process known as durotaxis. It combines the continuous formulation of truss elements and a particle-based approach to simulate the dynamics of cell-matrix adhesions and cell-cell interactions. Using this hybrid approach, researchers can quickly create a quantitative model to understand the regulatory role of different mechanical conditions on the dynamics of collective cell migration. Our model shows that durotaxis occurs due to the ability of cells to deform the substrate more in the part of lower stiffness than in the stiffer part. This effect explains why cell collective movement is more effective than single cell movement in stiffness gradient conditions. In addition, we numerically evaluate how gradient stiffness properties, cell monolayer size and force transmission between cells and extracellular matrix are crucial in regulating durotaxis.
PMID: 29500553 [PubMed - as supplied by publisher]
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Prevalence and predictors of double incontinence 1 year after first delivery.
Prevalence and predictors of double incontinence 1 year after first delivery.
Int Urogynecol J. 2018 Mar 02;:
Authors: Johannessen HH, Stafne SN, Falk RS, Stordahl A, Wibe A, Mørkved S
Abstract
INTRODUCTION AND HYPOTHESIS: Urinary (UI) and anal incontinence (AI) are common pelvic floor disorders (PFD), and postpartum women experiencing double incontinence (DI), the combination of UI and AI, tend to have more severe symptoms and a greater impact on quality of life. Our objective was to investigate the prevalence and predictors of postpartum DI and UI alone 1 year after first delivery.
METHODS: In this prospective cohort study, 976 women reported the prevalence of DI and UI alone 1 year after their first delivery in one of two hospitals in Norway using the St Marks score and the ICI-Q UI SF.
RESULTS: DI was significantly reduced from 13% in late pregnancy to 8% 1 year later, whereas 30% reported UI at both time points. Incontinence in late pregnancy predicted incontinence 1 year after delivery. Higher age was associated with UI alone. Compared with caesarean delivery, normal vaginal or instrumental delivery increased the risk of UI alone more than three and four times respectively. Obstetric anal sphincter injuries showed a four-fold increase in the risk of DI.
CONCLUSIONS: Nearly 50% reported incontinence symptoms 1 year after first delivery. Continence status during pregnancy was one of the main predictors of postpartum continence status. Mode of delivery increased the risk of postpartum UI, whereas obstetric anal sphincter injuries increased the risk of postpartum DI.
PMID: 29500515 [PubMed - as supplied by publisher]
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A Mathematical Model of the Phosphoinositide Pathway.
A Mathematical Model of the Phosphoinositide Pathway.
Sci Rep. 2018 Mar 02;8(1):3904
Authors: Olivença DV, Uliyakina I, Fonseca LL, Amaral MD, Voit EO, Pinto FR
Abstract
Phosphoinositides are signalling lipids that constitute a complex network regulating many cellular processes. We propose a computational model that accounts for all species of phosphoinositides in the plasma membrane of mammalian cells. The model replicates the steady-state of the pathway and most known dynamic phenomena. Sensitivity analysis demonstrates model robustness to alterations in the parameters. Model analysis suggest that the greatest contributor to phosphatidylinositol 4,5-biphosphate (PI(4,5)P2) production is a flux representing the direct transformation of PI into PI(4,5)P2, also responsible for the maintenance of this pool when phosphatidylinositol 4-phosphate (PI(4)P) is decreased. PI(5)P is also shown to be a significant source for PI(4,5)P2 production. The model was validated with siRNA screens that knocked down the expression of enzymes in the pathway. The screen monitored the activity of the epithelium sodium channel (ENaC), which is activated by PI(4,5)P2. While the model may deepen our understanding of other physiological processes involving phosphoinositides, we highlight therapeutic effects of ENaC modulation in Cystic Fibrosis (CF). The model suggests control strategies where the activities of the enzyme phosphoinositide 4-phosphate 5-kinase I (PIP5KI) or the PI4K + PIP5KI + DVL protein complex are decreased and cause an efficacious reduction in PI(4,5)P2 levels while avoiding undesirable alterations in other phosphoinositide pools.
PMID: 29500467 [PubMed - in process]
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Sophora flavescens protects against mycobacterial Trehalose Dimycolate-induced lung granuloma by inhibiting inflammation and infiltration of macrophages.
Sophora flavescens protects against mycobacterial Trehalose Dimycolate-induced lung granuloma by inhibiting inflammation and infiltration of macrophages.
Sci Rep. 2018 Mar 02;8(1):3903
Authors: Liu D, Chan BC, Cheng L, Tsang MS, Zhu J, Wong CW, Jiao D, Chan HY, Leung PC, Lam CW, Wong CK
Abstract
The immune system responds to Mycobacterium tuberculosis (MTB) infection by forming granulomas to quarantine the bacteria from spreading. Granuloma-mediated inflammation is a cause of lung destruction and disease transmission. Sophora flavescens (SF) has been demonstrated to exhibit bactericidal activities against MTB. However, its immune modulatory activities on MTB-mediated granulomatous inflammation have not been reported. In the present study, we found that flavonoids from Sophora flavescens (FSF) significantly suppressed the pro-inflammatory mediators released from mouse lung alveolar macrophages (MH-S) upon stimulation by trehalose dimycolate (TDM), the most abundant lipoglycan on MTB surface. Moreover, FSF reduced adhesion molecule (LFA-1) expression on MH-S cells after TDM stimulation. Furthermore, FSF treatment on TDM-activated lung epithelial (MLE-12) cells significantly downregulated macrophage chemoattractant protein (MCP-1/CCL2) expression, which in turn reduced the in vitro migration of MH-S to MLE-12 cells. In addition, FSF increased the clearance of mycobacterium bacteria (Mycobacterium aurum) in macrophages. FSF mainly affected the Mincle-Syk-Erk signaling pathway in TDM-activated MH-S cells. In TDM-induced mouse granulomas model, oral administration with FSF significantly suppressed lung granulomas formation and inflammation. These findings collectively implicated an anti-inflammatory role of FSF on MTB-mediated granulomatous inflammation, thereby providing evidence of FSF as an efficacious adjunct treatment during mycobacterial infection.
PMID: 29500453 [PubMed - in process]
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Significance of risk polymorphisms for depression depends on stress exposure.
Significance of risk polymorphisms for depression depends on stress exposure.
Sci Rep. 2018 Mar 02;8(1):3946
Authors: Gonda X, Hullam G, Antal P, Eszlari N, Petschner P, Hökfelt TG, Anderson IM, Deakin JFW, Juhasz G, Bagdy G
Abstract
Depression is a polygenic and multifactorial disorder where environmental effects exert a significant impact, yet most genetic studies do not consider the effect of stressors which may be one reason for the lack of replicable results in candidate gene studies, GWAS and between human studies and animal models. Relevance of functional polymorphisms in seven candidate genes previously implicated in animal and human studies on a depression-related phenotype given various recent stress exposure levels was assessed with Bayesian relevance analysis in 1682 subjects. This Bayesian analysis indicated a gene-environment interaction whose significance was also tested with a traditional multivariate analysis using general linear models. The investigated genetic factors were only relevant in the moderate and/or high stress exposure groups. Rank order of genes was GALR2 > BDNF > P2RX7 > HTR1A > SLC6A4 > CB1 > HTR2A, with strong relevance for the first four. Robust gene-gene-environment interaction was found between BDNF and HTR1A. Gene-environment interaction effect was confirmed, namely no main effect of genes, but a significant modulatory effect on environment-induced development of depression were found. Our data support the strong causative role of the environment modified by genetic factors, similar to animal models. Gene-environment interactions point to epigenetic factors associated with risk SNPs. Galanin-2 receptor, BDNF and X-type purin-7 receptor could be drug targets for new antidepressants.
PMID: 29500446 [PubMed - in process]
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Exposure of Insects to Radio-Frequency Electromagnetic Fields from 2 to 120 GHz.
Exposure of Insects to Radio-Frequency Electromagnetic Fields from 2 to 120 GHz.
Sci Rep. 2018 Mar 02;8(1):3924
Authors: Thielens A, Bell D, Mortimore DB, Greco MK, Martens L, Joseph W
Abstract
Insects are continually exposed to Radio-Frequency (RF) electromagnetic fields at different frequencies. The range of frequencies used for wireless telecommunication systems will increase in the near future from below 6 GHz (2 G, 3 G, 4 G, and WiFi) to frequencies up to 120 GHz (5 G). This paper is the first to report the absorbed RF electromagnetic power in four different types of insects as a function of frequency from 2 GHz to 120 GHz. A set of insect models was obtained using novel Micro-CT (computer tomography) imaging. These models were used for the first time in finite-difference time-domain electromagnetic simulations. All insects showed a dependence of the absorbed power on the frequency. All insects showed a general increase in absorbed RF power at and above 6 GHz, in comparison to the absorbed RF power below 6 GHz. Our simulations showed that a shift of 10% of the incident power density to frequencies above 6 GHz would lead to an increase in absorbed power between 3-370%.
PMID: 29500425 [PubMed - in process]
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Ductile and brittle transition behavior of titanium alloys in ultra-precision machining.
Ductile and brittle transition behavior of titanium alloys in ultra-precision machining.
Sci Rep. 2018 Mar 02;8(1):3934
Authors: Yip WS, To S
Abstract
Titanium alloys are extensively applied in biomedical industries due to their excellent material properties. However, they are recognized as difficult to cut materials due to their low thermal conductivity, which induces a complexity to their deformation mechanisms and restricts precise productions. This paper presents a new observation about the removal regime of titanium alloys. The experimental results, including the chip formation, thrust force signal and surface profile, showed that there was a critical cutting distance to achieve better surface integrity of machined surface. The machined areas with better surface roughness were located before the clear transition point, defining as the ductile to brittle transition. The machined area at the brittle region displayed the fracture deformation which showed cracks on the surface edge. The relationship between depth of cut and the ductile to brittle transaction behavior of titanium alloys in ultra-precision machining(UPM) was also revealed in this study, it showed that the ductile to brittle transaction behavior of titanium alloys occurred mainly at relatively small depth of cut. The study firstly defines the ductile to brittle transition behavior of titanium alloys in UPM, contributing the information of ductile machining as an optimal machining condition for precise productions of titanium alloys.
PMID: 29500386 [PubMed - in process]
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gDNA qPCR is statistically more reliable than mRNA analysis in detecting leukemic cells to monitor CML.
gDNA qPCR is statistically more reliable than mRNA analysis in detecting leukemic cells to monitor CML.
Cell Death Dis. 2018 Mar 02;9(3):349
Authors: Rainero A, Angaroni F, Conti A, Pirrone C, Micheloni G, Tararà L, Millefanti G, Maserati E, Valli R, Spinelli O, Buklijas K, Michelato A, Casalone R, Barlassina C, Barcella M, Sirchia S, Piscitelli E, Caccia M, Porta G
Abstract
Chronic Myeloid Leukemia (CML) is a stem cell cancer that arises when t(9;22) translocation occurs in a hematopoietic stem cells. This event results in the expression of the BCR-ABL1 fusion gene, which codes for a constitutively active tyrosine kinase that is responsible for the transformation of a HSC into a CML stem cell, which then gives rise to a clonal myeloproliferative disease. The introduction of Tyrosine Kinase Inhibitors (TKIs) has revolutionized the management of the disease. However, these drugs do not seem to be able to eradicate the malignancy. Indeed, discontinuation trials (STIM; TWISER; DADI) for those patients who achieved a profound molecular response showed 50% relapsing within 12 months. We performed a comparative analysis on 15 CML patients and one B-ALL patient, between the standard quantitative reverse-transcriptase PCR (qRT-PCR) and our genomic DNA patient-specific quantitative PCR assay (gDNA qPCR). Here we demonstrate that gDNA qPCR is better than standard qRT-PCR in disease monitoring after an average follow-up period of 200 days. Specifically, we statistically demonstrated that DNA negativity is more reliable than RNA negativity in indicating when TKIs therapy can be safely stopped.
PMID: 29500381 [PubMed - in process]
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Correction for Delay and Dispersion Results in More Accurate Cerebral Blood Flow Ischemic Core Measurement in Acute Stroke.
Correction for Delay and Dispersion Results in More Accurate Cerebral Blood Flow Ischemic Core Measurement in Acute Stroke.
Stroke. 2018 Mar 02;:
Authors: Lin L, Bivard A, Kleinig T, Spratt NJ, Levi CR, Yang Q, Parsons MW
Abstract
BACKGROUND AND PURPOSE: This study aimed to assess how the ischemic core measured by perfusion computed tomography (CTP) was affected by the delay and dispersion effect.
METHODS: Ischemic stroke patients having CTP performed within 6 hours of onset were included. The CTP data were processed twice, generating standard cerebral blood flow (sCBF) and delay- and dispersion-corrected CBF (ddCBF), respectively. Ischemic core measured by the sCBF and ddCBF was then compared at the relative threshold <30% of normal tissue. Two references for ischemic core were used: acute diffusion-weighted imaging or 24-hour diffusion-weighted imaging in patients with complete recanalization. Difference of core volume between CTP and diffusion-weighted imaging was estimated by Mann-Whitney U test and limits of agreement. Patients were also classified into favorable and unfavorable CTP patterns. The imaging pattern classification by sCBF and ddCBF was compared by the χ2 test; their respective ability to predict good clinical outcome (3-month modified Rankin Scale score) was tested in logistic regression.
RESULTS: Fifty-five patients were included in this study. Median sCBF ischemic core volume was 38.5 mL (12.4-61.9 mL), much larger than the median core volume of 17.2 mL measured by ddCBF (interquartile range, 5.5-38.8; P<0.001). Moreover, compared with sCBF <30%, ddCBF <30% measured the ischemic core much closer to diffusion-weighted imaging core references, with the mean volume difference of -0.1 mL (95% limits of agreement, -25.4 to 25.2; P=0.97) and 16.7 mL (95% limits of agreement, -21.7 to 55.2; P<0.001), respectively. Imaging patterns defined by sCBF showed a difference to that defined by ddCBF (P<0.001), with 12 patients classified as favorable imaging patterns by ddCBF but as unfavorable by sCBF. The favorable imaging pattern classified by ddCBF, compared with sCBF classification, had higher predictive power for good clinical outcome (odds ratio, 7.8 [2-30.5] and 3.1 [0.9-11], respectively).
CONCLUSIONS: Delay and dispersion correction increases the accuracy of ischemic core measurement on CTP.
PMID: 29500248 [PubMed - as supplied by publisher]
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The Visual Analog Scale as a Comprehensible Patient-Reported Outcome Measure (PROM) in Septorhinoplasty.
The Visual Analog Scale as a Comprehensible Patient-Reported Outcome Measure (PROM) in Septorhinoplasty.
Aesthetic Plast Surg. 2018 Mar 02;:
Authors: Spiekermann C, Amler S, Rudack C, Stenner M
Abstract
The patient's satisfaction with the esthetic result is a major criterion of success in septorhinoplasty. However, the idea of esthetic perfection varies greatly and primarily depends on subjective perception. Hence, patient-reported instruments are important and necessary to assess the outcome in septorhinoplasty. To analyze the potential of the visual analog scale (VAS) as a patient-reported outcome measure in septorhinoplasty, the perception of the nasal appearance was assessed by a VAS pre- and postoperatively in 213 patients undergoing septorhinoplasty. Furthermore, in this prospective study, the patients' satisfaction concerning the procedure's result was analyzed using a five-point Likert scale. Females had lower preoperative VAS scores but a higher increase compared to males. Patients with lower initial VAS scores showed a higher improvement in the VAS score postoperatively compared to patients with higher initial VAS scores. Satisfaction with the result depends on the increase in the VAS score value. The VAS scale is a short and comprehensible tool to assess patients' perception of nasal appearance preoperatively and represents an appropriate instrument to assess the esthetic patient-reported outcome in septorhinoplasty.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
PMID: 29500606 [PubMed - as supplied by publisher]
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[B cells in head and neck oncology].
[B cells in head and neck oncology].
HNO. 2018 Mar 02;:
Authors: Schuler PJ, Brunner C, Hoffmann TK
Abstract
As immunotherapy is becoming increasingly important in the treatment of head and neck cancer, a fundamental understanding of the immunological relationships in the tumor microenvironment is required. The importance of tumor-infiltrating B cells (TIL-B) has been largely neglected so far. In the current literature, however, a significant influence of B cells on tumor growth is described, so that this cell population is now also perceived as a therapeutic target structure. Regulatory B cells (Breg) represent a subset of B cells with immunosuppressive properties. In addition to the secretion of IL-10, Breg can be defined by their ability to produce adenosine. Adenosine is known as an immunosuppressive messenger in the tumor microenvironment whose effect can be prevented by immunotherapeutic approaches. Understanding the tumor immunological relationships, including the different B‑cell functions, can help to effectively combine standard approaches including surgery or radiochemotherapy with immunotherapy. In the present article, recent findings on B cells and adenosine in head and neck cancer are described.
PMID: 29500500 [PubMed - as supplied by publisher]
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Aesthetic and functional outcomes of radial forearm flap donor site reconstruction with biosynthetic skin substitutes.
Aesthetic and functional outcomes of radial forearm flap donor site reconstruction with biosynthetic skin substitutes.
J Plast Reconstr Aesthet Surg. 2018 Feb 13;:
Authors: Zuo KJ, Roy M, Meng F, Bensoussan Y, Hofer SOP
PMID: 29500111 [PubMed - as supplied by publisher]
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Human papillomavirus infection is not associated with laryngeal squamous cell carcinoma in Taiwan.
Human papillomavirus infection is not associated with laryngeal squamous cell carcinoma in Taiwan.
J Microbiol Immunol Infect. 2018 Feb 21;:
Authors: Huang CG, Lee LA, Fang TJ, Li HY, Liao CT, Kang CJ, Yen TC, Tsao KC, Chen TC, Shih SR
Abstract
BACKGROUND/PURPOSE: To examine whether the prevalence rate of human papillomavirus (HPV) infection in Taiwanese patients with primary laryngeal squamous cell carcinoma (LSCC) is different from that in those with a vocal polyp (VP) or vocal fold leukoplakia (VFL).
METHODS: This prospective cohort study recruited 41 consecutive patients with primary LSCC and 27 and 20 patients with VP and VFL, respectively. The HPV L1 gene in surgical specimens was detected using polymerase chain reaction. High-risk HPV DNA in tissue microarray specimens was detected using in situ hybridization. Expression of p16INK4a in tissue microarray specimens was determined through immunohistochemistry.
RESULTS: The prevalence of HPV L1 DNA in the LSCC group was equivalent to that in the VP and VFL groups (7.3% vs. 7.4% vs. 10.0%; P = 0.929; effect size = 0.20). High-risk HPV DNA detected using in situ hybridization was relatively rare in all groups (2.6% vs. 5.3% vs. 0.0%; P = 0.636; effect size = 0.81). The prevalence of p16INK4a positivity was significantly lower in the LSCC group than in the VP and VFL groups (5.1% vs. 58.8% vs. 14.3%; P < 0.001). Multivariate analysis results revealed that age ≥65 years (adjusted odds ratio, 4.09; 95% confidence interval, 1.21-13.91; P = 0.024) and p16INK4a positivity (adjusted odds ratio, 0.10; 95% confidence interval, 0.02-0.53; P = 0.006) were LSCC risk factors.
CONCLUSION: HPV infection is uncommon in Taiwanese patients with LSCC and seems not to be associated with an increased LSCC risk. Larger sample size is warranted for further study.
PMID: 29500045 [PubMed - as supplied by publisher]
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New paste for severe stomatitis in patients undergoing head-and-neck cancer radiotherapy and/or chemotherapy with oral appliance.
New paste for severe stomatitis in patients undergoing head-and-neck cancer radiotherapy and/or chemotherapy with oral appliance.
BMC Cancer. 2018 Mar 02;18(1):245
Authors: Sakuramoto A, Hasegawa Y, Sugahara K, Komoda Y, Hasegawa K, Hikasa S, Kurashita M, Sakai J, Arita M, Yasukawa K, Kishimoto H
Abstract
BACKGROUND: The aim of the present study was to evaluate the physical properties of "admixture paste", which is a commercially available gel containing hinokitiol for use against severe stomatitis, and its characteristics as a moisturizing gel and denture adhesive.
METHODS: The admixture paste, which contained dexamethasone (Dexaltin®), gel for oral care (Refrecare H®) and petrolatum, and its 3 components, either alone or in different combinations, were subjected to viscosity, adhesiveness and elution testing to compare their physical properties. Viscosity was measured with a stress-controlled rheometer. Adhesive force was measured by tension test. Elution under a simulated oral environment was evaluated by monitoring with a fixed-point camera and absorbance. Both adhesiveness and elution were evaluated every hour for 6 h. A linear mixed-effects model was used to assess differences in the time course of elution between samples. In 3 og-rank test was used to compare time to elution into saliva among samples.
RESULTS: The results of viscosity testing demonstrated that the admixture paste had similar viscosity to cream-type denture adhesives and this was temperature independent. In the adhesiveness tests, the admixture paste showed stronger adhesiveness than that of cream-type denture adhesives. In the elution test, the admixture paste demonstrated gradual dissolution and apparent temporal changes for 6 h in a simulated oral environment.
CONCLUSIONS: The results of the present study demonstrated that the admixture paste has adhesive force similar to those of denture adhesives and good local retention in saliva, and that it might be suitable for therapeutic use in patients with severe stomatitis derived from radiotherapy and/or chemotherapy for cancer.
PMID: 29499657 [PubMed - in process]
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Identification of novel enriched recurrent chimeric COL7A1-UCN2 in human laryngeal cancer samples using deep sequencing.
Identification of novel enriched recurrent chimeric COL7A1-UCN2 in human laryngeal cancer samples using deep sequencing.
BMC Cancer. 2018 Mar 02;18(1):248
Authors: Tao Y, Gross N, Fan X, Yang J, Teng M, Li X, Li G, Zhang Y, Huang Z
Abstract
BACKGROUND: As hybrid RNAs, transcription-induced chimeras (TICs) may have tumor-promoting properties, and some specific chimeras have become important diagnostic markers and therapeutic targets for cancer.
METHODS: We examined 23 paired laryngeal cancer (LC) tissues and adjacent normal mucous membrane tissue samples (ANMMTs). Three of these pairs were used for comparative transcriptomic analysis using high-throughput sequencing. Furthermore, we used real-time polymerase chain reaction (RT-PCR) for further validation in 20 samples. The Kaplan-Meier method and Cox regression model were used for the survival analysis.
RESULTS: We identified 87 tumor-related TICs and found that COL7A1-UCN2 had the highest frequency in LC tissues (13/23; 56.5%), whereas none of the ANMMTs were positive (0/23; p < 0.0001). COL7A1-UCN2, generated via alternative splicing in LC tissue cancer cells, had disrupted coding regions, but it down-regulated the mRNA expression of COL7A1 and UCN2. Both COL7A1 and UCN2 were down-expressed in LC tissues as compared to their paired ANMMTs. The COL7A1:β-actin ratio in COL7A1-UCN2-positive LC samples was significantly lower than that in COL7A1-UCN2-negative samples (p = 0.019). Likewise, the UCN2:β-actin ratio was also decreased (p = 0.21). Furthermore, COL7A1-UCN2 positivity was significantly associated with the overall survival of LC patients (p = 0.032; HR, 13.2 [95%CI, 1.2-149.5]).
CONCLUSION: LC cells were enriched in the recurrent chimera COL7A1-UCN2, which potentially affected cancer stem cell transition, promoted epithelial-mesenchymal transition in LC, and resulted in poorer prognoses.
PMID: 29499655 [PubMed - in process]
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Adenocarcinoma and polyposis of the colon in a 20-year-old patient with Trisomy 13: a case report
Trisomy 13 is one of the most common autosomal trisomies, and although increasing in number, patients surviving past the neonatal period remain rare. The natural history and expected complications in these pat...
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Classification of Complete Proteomes of Different Organisms and Protein Sets Based on Their Protein Distributions in Terms of Some Key Attributes of Proteins
The existence of complete genome sequences makes it important to develop different approaches for classification of large-scale data sets and to make extraction of biological insights easier. Here, we propose an approach for classification of complete proteomes/protein sets based on protein distributions on some basic attributes. We demonstrate the usefulness of this approach by determining protein distributions in terms of two attributes: protein lengths and protein intrinsic disorder contents (ID). The protein distributions based on L and ID are surveyed for representative proteome organisms and protein sets from the three domains of life. The two-dimensional maps (designated as fingerprints here) from the protein distribution densities in the LD space defined by ln(L) and ID are then constructed. The fingerprints for different organisms and protein sets are found to be distinct with each other, and they can therefore be used for comparative studies. As a test case, phylogenetic trees have been constructed based on the protein distribution densities in the fingerprints of proteomes of organisms without performing any protein sequence comparison and alignments. The phylogenetic trees generated are biologically meaningful, demonstrating that the protein distributions in the LD space may serve as unique phylogenetic signals of the organisms at the proteome level.
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Video from ECR 2018: Fashion & style in radiology
VIENNA - Your style should match your ambition, as the saying goes, but how...
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Guerbet presents contrast management software at ECR
French contrast developer Guerbet is featuring its new Contrast&Care contrast...
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ESNR survey taps into future of imaging for dementia
VIENNA - While there is considerable consensus on which modalities and protocols...
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IJMS, Vol. 19, Pages 732: Integrated Molecular Characterization of Gastrointestinal Stromal Tumors (GIST) Harboring the Rare D842V Mutation in PDGFRA Gene
IJMS, Vol. 19, Pages 732: Integrated Molecular Characterization of Gastrointestinal Stromal Tumors (GIST) Harboring the Rare D842V Mutation in PDGFRA Gene
International Journal of Molecular Sciences doi: 10.3390/ijms19030732
Authors: Valentina Indio Annalisa Astolfi Giuseppe Tarantino Milena Urbini Janice Patterson Margherita Nannini Maristella Saponara Lidia Gatto Donatella Santini Italo do Valle Gastone Castellani Daniel Remondini Michelangelo Fiorentino Margaret von Mehren Giovanni Brandi Guido Biasco Michael Heinrich Maria Pantaleo
Gastrointestinal stromal tumors (GIST) carrying the D842V activating mutation in the platelet-derived growth factor receptor alpha (PDGFRA) gene are a very rare subgroup of GIST (about 10%) known to be resistant to conventional tyrosine kinase inhibitors (TKIs) and to show an indolent behavior. In this study, we performed an integrated molecular characterization of D842V mutant GIST by whole-transcriptome and whole-exome sequencing coupled with protein–ligand interaction modelling to identify the molecular signature and any additional recurrent genomic event related to their clinical course. We found a very specific gene expression profile of D842V mutant tumors showing the activation of G-protein-coupled receptor (GPCR) signaling and a relative downregulation of cell cycle processes. Beyond D842V, no recurrently mutated genes were found in our cohort. Nevertheless, many private, clinically relevant alterations were found in each tumor (TP53, IDH1, FBXW7, SDH-complex). Molecular modeling of PDGFRA D842V suggests that the mutant protein binds imatinib with lower affinity with respect to wild-type structure, showing higher stability during the interaction with other type I TKIs (like crenolanib). D842V mutant GIST do not show any actionable recurrent molecular events of therapeutic significance, therefore this study supports the rationale of novel TKIs development that are currently being evaluated in clinical studies for the treatment of D842V mutant GIST.
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IJMS, Vol. 19, Pages 733: Insights into the Mechanisms of Chloroplast Division
IJMS, Vol. 19, Pages 733: Insights into the Mechanisms of Chloroplast Division
International Journal of Molecular Sciences doi: 10.3390/ijms19030733
Authors: Yamato Yoshida
The endosymbiosis of a free-living cyanobacterium into an ancestral eukaryote led to the evolution of the chloroplast (plastid) more than one billion years ago. Given their independent origins, plastid proliferation is restricted to the binary fission of pre-existing plastids within a cell. In the last 25 years, the structure of the supramolecular machinery regulating plastid division has been discovered, and some of its component proteins identified. More recently, isolated plastid-division machineries have been examined to elucidate their structural and mechanistic details. Furthermore, complex studies have revealed how the plastid-division machinery morphologically transforms during plastid division, and which of its component proteins play a critical role in generating the contractile force. Identifying the three-dimensional structures and putative functional domains of the component proteins has given us hints about the mechanisms driving the machinery. Surprisingly, the mechanisms driving plastid division resemble those of mitochondrial division, indicating that these division machineries likely developed from the same evolutionary origin, providing a key insight into how endosymbiotic organelles were established. These findings have opened new avenues of research into organelle proliferation mechanisms and the evolution of organelles.
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The anatomy of the thoracic duct at the level of the diaphragm: a cadaver study
Publication date: Available online 3 March 2018
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Ingmar L. Defize, Bernadette Schurink, Teus J. Weijs, Tom A.P. Roeling, Jelle P. Ruurda, Richard van Hillegersberg, Ronald L.A.W. Bleys
BackgroundInjury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm.Basic proceduresThe thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers. The level of origin of the thoracic duct and the points where tributaries entered the thoracic duct were measured using landmarks easily identified during surgery: the aortic and esophageal hiatus and the arch of the azygos vein.Main findingsThe thoracic duct was formed in the thoracic cavity by the union of multiple abdominal tributaries in 6 cadavers. In 3 cadavers partially duplicated systems were present that communicated with interductal branches. The thoracic duct was formed by a median of 3 (IQR: 3–5) abdominal tributaries merging 8.3 centimeters (IQR: 7.3–9.3cm) above the aortic hiatus, 1.8 centimeters (IQR: −0.4–2.4cm) above the esophageal hiatus, and 12.3 centimeters (IQR: 14.0–−11.0cm) below the arch of the azygos vein.ConclusionThis study challenges the paradigm that abdominal lymphatics join in the abdomen to pass the diaphragm as a single thoracic duct. In this study, this occurred in 1/7 cadavers. Although small, the results of this series suggest that the formation of the thoracic duct above the diaphragm is more common than previously thought. This knowledge may be vital to prevent and treat post-operative chyle leakage.
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Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Ingmar L. Defize, Bernadette Schurink, Teus J. Weijs, Tom A.P. Roeling, Jelle P. Ruurda, Richard van Hillegersberg, Ronald L.A.W. Bleys
BackgroundInjury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm.Basic proceduresThe thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers. The level of origin of the thoracic duct and the points where tributaries entered the thoracic duct were measured using landmarks easily identified during surgery: the aortic and esophageal hiatus and the arch of the azygos vein.Main findingsThe thoracic duct was formed in the thoracic cavity by the union of multiple abdominal tributaries in 6 cadavers. In 3 cadavers partially duplicated systems were present that communicated with interductal branches. The thoracic duct was formed by a median of 3 (IQR: 3–5) abdominal tributaries merging 8.3 centimeters (IQR: 7.3–9.3cm) above the aortic hiatus, 1.8 centimeters (IQR: −0.4–2.4cm) above the esophageal hiatus, and 12.3 centimeters (IQR: 14.0–−11.0cm) below the arch of the azygos vein.ConclusionThis study challenges the paradigm that abdominal lymphatics join in the abdomen to pass the diaphragm as a single thoracic duct. In this study, this occurred in 1/7 cadavers. Although small, the results of this series suggest that the formation of the thoracic duct above the diaphragm is more common than previously thought. This knowledge may be vital to prevent and treat post-operative chyle leakage.
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Electrochemical testing of a novel alloy in natural and artificial body fluids
Publication date: Available online 3 March 2018
Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Ioana Bunoiu, Mihaela Mindroiu, Claudiu Constantin Manole, Mihai Andrei, Adrian Nicoara, Ecaterina Vasilescu, Monica Popa, Andreea Cristiana Didilescu
There is a recent trend in tissue engineering and regenerative medicine to use nanotechnology and bionanomaterials to obtain materials that mimic the surface properties of a natural tissue. From this perspective, nanolevel tissue engineering can be viewed as a novel anatomy of the future. In this paper, a novel titanium-based alloy is studied following this strategy. The alloy nanostructuration is proposed as an improved alternative for restorative prosthodontics or an implantable biomaterial. Tests in i) standard solution of simulated body fluid (SBF) and ii) natural saliva were performed to investigate the alloy’s electrochemical stability. The results show that nanochannel growth on the alloy surface confers a higher stability than that of the untreated one in both natural and simulated environments.
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Source:Annals of Anatomy - Anatomischer Anzeiger
Author(s): Ioana Bunoiu, Mihaela Mindroiu, Claudiu Constantin Manole, Mihai Andrei, Adrian Nicoara, Ecaterina Vasilescu, Monica Popa, Andreea Cristiana Didilescu
There is a recent trend in tissue engineering and regenerative medicine to use nanotechnology and bionanomaterials to obtain materials that mimic the surface properties of a natural tissue. From this perspective, nanolevel tissue engineering can be viewed as a novel anatomy of the future. In this paper, a novel titanium-based alloy is studied following this strategy. The alloy nanostructuration is proposed as an improved alternative for restorative prosthodontics or an implantable biomaterial. Tests in i) standard solution of simulated body fluid (SBF) and ii) natural saliva were performed to investigate the alloy’s electrochemical stability. The results show that nanochannel growth on the alloy surface confers a higher stability than that of the untreated one in both natural and simulated environments.
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A fluorescence ratio-based method to determine microalgal viability and its application to rapid optimization of cryopreservation
Publication date: Available online 3 March 2018
Source:Cryobiology
Author(s): Lingling Zheng, Zhe Lu, Qi Zhang, Tianli Li, Lirong Song
The utility of microalgal biomass and bioproducts depends on long-term maintenance of certain physiological or biochemical features of the species. While unique characteristics may not be durably maintained with general subculture, cryopreservation methods better prevent alterations from desired characteristics. Post-thaw viability is critical to establishing microalgal cultures, and there is a critical need to effectively and rapidly evaluate microalgal viability after the post-thawing process. In the present study, we developed a rapid assay based on the change of fluorescence ratio to determine microalgal viability post-thaw. It was shown that the assessment of microalgal viability by the fluorescence ratio method correlated well with that of the FDA-staining (R2 = 0.978) and regrowth method (R2 = 0.976), demonstrating that the present method could be applied in the high-throughput detection of viability of microalgal strains. Subsequent to establishing this method, we aimed to find out optimal cryopreservation protocol for each strain from a group of 125 microalgal strains. The viability of these strains under different treatments was quickly evaluated by the fluorescence ratio method. Of these strains, 95 attained post-thaw viability over 60%. DMSO was a suitable cryoprotectant for most strains at a concentration ≤10%. Based on the dataset, the relative contribution of 3 variables-genus, cryoprotectants and concentration to post-viability was analyzed with the Random Forest (RF) classification method. All variables together could explain 97.8% of the viability, and type and concentration of cryoprotectant could explain 59.1% in Chlorophyta. This study provided a new approach for viability assay and demonstrated that this method can facilitate to find out the optimal protocols for cryopreservation of microalgal strains.
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Source:Cryobiology
Author(s): Lingling Zheng, Zhe Lu, Qi Zhang, Tianli Li, Lirong Song
The utility of microalgal biomass and bioproducts depends on long-term maintenance of certain physiological or biochemical features of the species. While unique characteristics may not be durably maintained with general subculture, cryopreservation methods better prevent alterations from desired characteristics. Post-thaw viability is critical to establishing microalgal cultures, and there is a critical need to effectively and rapidly evaluate microalgal viability after the post-thawing process. In the present study, we developed a rapid assay based on the change of fluorescence ratio to determine microalgal viability post-thaw. It was shown that the assessment of microalgal viability by the fluorescence ratio method correlated well with that of the FDA-staining (R2 = 0.978) and regrowth method (R2 = 0.976), demonstrating that the present method could be applied in the high-throughput detection of viability of microalgal strains. Subsequent to establishing this method, we aimed to find out optimal cryopreservation protocol for each strain from a group of 125 microalgal strains. The viability of these strains under different treatments was quickly evaluated by the fluorescence ratio method. Of these strains, 95 attained post-thaw viability over 60%. DMSO was a suitable cryoprotectant for most strains at a concentration ≤10%. Based on the dataset, the relative contribution of 3 variables-genus, cryoprotectants and concentration to post-viability was analyzed with the Random Forest (RF) classification method. All variables together could explain 97.8% of the viability, and type and concentration of cryoprotectant could explain 59.1% in Chlorophyta. This study provided a new approach for viability assay and demonstrated that this method can facilitate to find out the optimal protocols for cryopreservation of microalgal strains.
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IJERPH, Vol. 15, Pages 447: Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians
IJERPH, Vol. 15, Pages 447: Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians
International Journal of Environmental Research and Public Health doi: 10.3390/ijerph15030447
Authors: Yu-Tang Shen Kylie Radford Gail Daylight Robert Cumming Tony Broe Brian Draper
Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.
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Priorities for Decreasing Morbidity and Mortality in Children With Advanced HIV Disease
Abstract
Early mortality and morbidity remain high in children initiating antiretroviral therapy (ART), especially in sub-Saharan Africa. Many children still present with advanced human immunodeficiency virus (HIV) disease. Tuberculosis, pneumonia, and severe bacterial infections are the main causes of hospital admission in HIV-infected children. In contrast to adults with advanced HIV disease, cryptococcal disease is not common in childhood, although there is a peak in infancy and adolescence. Interventions such as TB screening in symptomatic children, and isoniazid and cotrimoxazole prophylaxis should be implemented. There is evidence suggesting that rapid initiation (within 1 week) of ART in children with severe malnutrition or those with advanced HIV disease admitted to hospital is not beneficial and should be delayed until their condition has been stabilized. Research informing the prevention of severe bacterial infections, the management of pediatric immune reconstitution inflammatory syndrome, and other potential strategies to decrease morbidity and mortality in HIV-infected children are urgently needed.from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2Fbp0BO
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Managing Advanced HIV Disease in a Public Health Approach
Abstract
In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplified intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2H1YnvE
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Causes and Timing of Mortality and Morbidity Among Late Presenters Starting Antiretroviral Therapy in the REALITY Trial
Abstract
Background
In sub-Saharan Africa, 20%–25% of people starting antiretroviral therapy (ART) have severe immunosuppression; approximately 10% die within 3 months. In the Reduction of EArly mortaLITY (REALITY) randomized trial, a broad enhanced anti-infection prophylaxis bundle reduced mortality vs cotrimoxazole. We investigate the contribution and timing of different causes of mortality/morbidity.
Methods
Participants started ART with a CD4 count <100 cells/µL; enhanced prophylaxis comprised cotrimoxazole plus 12 weeks of isoniazid + fluconazole, single-dose albendazole, and 5 days of azithromycin. A blinded committee adjudicated events and causes of death as (non–mutually exclusively) tuberculosis, cryptococcosis, severe bacterial infection (SBI), other potentially azithromycin-responsive infections, other events, and unknown.
Results
Median pre-ART CD4 count was 37 cells/µL. Among 1805 participants, 225 (12.7%) died by week 48. Fatal/nonfatal events occurred early (median 4 weeks); rates then declined exponentially. One hundred fifty-four deaths had single and 71 had multiple causes, including tuberculosis in 4.5% participants, cryptococcosis in 1.1%, SBI in 1.9%, other potentially azithromycin-responsive infections in 1.3%, other events in 3.6%, and unknown in 5.0%. Enhanced prophylaxis reduced deaths from cryptococcosis and unknown causes (P < .05) but not tuberculosis, SBI, potentially azithromycin-responsive infections, or other causes (P > .3); and reduced nonfatal/fatal tuberculosis and cryptococcosis (P < .05), but not SBI, other potentially azithromycin-responsive infections, or other events (P > .2).
Conclusions
Enhanced prophylaxis reduced mortality from cryptococcosis and unknown causes and nonfatal tuberculosis and cryptococcosis. High early incidence of fatal/nonfatal events highlights the need for starting enhanced-prophylaxis with ART in advanced disease.
Clinical Trials Registration
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Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
Abstract
Background
The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data.
Methods
We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex.
Results
8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease.
Conclusions
The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized.from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2CYncGl
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The Persistent Challenge of Advanced HIV Disease and AIDS in the Era of Antiretroviral Therapy
advanced HIV diseaseAIDScryptococcal meningitistuberculosis
from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2F9VcWr
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from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2F9VcWr
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The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa
Abstract
Background
Antiretroviral treatment (ART) has been massively scaled up to decrease human immunodeficiency virus (HIV)–related morbidity, mortality, and HIV transmission. However, despite documented increases in ART coverage, morbidity and mortality have remained substantial. This study describes trends in the numbers and characteristics of patients with very advanced HIV disease in the Western Cape, South Africa.
Methods
Annual cross-sectional snapshots of CD4 distributions were described over 10 years, derived from a province-wide cohort of all HIV patients receiving CD4 cell count testing in the public sector. Patients with a first CD4 count <50 cells/µL in each year were characterized with respect to prior CD4 and viral load testing, ART access, and retention in ART care.
Results
Patients attending HIV care for the first time initially constituted the largest group of those with CD4 count <50 cells/µL, dropping proportionally over the decade from 60.9% to 26.7%. By contrast, the proportion who were ART experienced increased from 14.3% to 56.7%. In patients with CD4 counts <50 cells/µL in 2016, 51.8% were ART experienced, of whom 76% could be confirmed to be off ART or had recent viremia. More than half who were ART experienced with a CD4 count <50 cells/µL in 2016 were men, compared to approximately one-third of all patients on ART in the same year.
Conclusions
Ongoing HIV-associated morbidity now results largely from treatment-experienced patients not being in continuous care or not being fully virologically suppressed. Innovative interventions to retain ART patients in effective care are an essential priority for the ongoing HIV response.from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2CUx0RD
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