Two 3-hydroxyflavone derivatives as two-photon fluorescence turn-on chemosensors for cysteine and homocysteine in living cells

Publication date: 1 May 2018
Source:Talanta, Volume 181
Author(s): Qianqian Wu, Kangnan Wang, Zian Wang, Yatong Sun, Duxia Cao, Zhiqiang Liu, Ruifang Guan, Songfang Zhao, Xueying Yu
Two 3-hydroxyflavone derivatives as one- and two-photon fluorescent chemosensors for cysteine (Cys) and homocysteine (Hcy) were synthesized. The recognition properties and mechanism of the chemosensors for Cys and Hcy were investigated systematically. The experiment results indicate that 3-hydroxyflavone compound 1 (6-bromo-2-(9-ethyl-9H-carbazol-3-yl)-3-hydroxy-chromen-4-one) after the addition of nickel ions exhibits good recognition properties for Cys and Hcy with fluorescence enhancement and 65nm absorption peak blue shift based on nickel displacement reaction mechanism. The detection limits (DL) with fluorescence as detected signal are 4.06 × 10⁻³µM (Cys, linear range of 10–80µM) and 5.8 × 10⁻³µM (Hcy, linear range of 10–100µM), respectively. But acrylate substituted 3-hydroxyflavone compound 2 (4-oxo-2-(4-diethylamino-phenyl)-4H-chromen-3-yl acrylate) can specially identify Cys with fluorescence turn-on (DL = 1.87 × 10⁻³µM, linear range of 4–22µM) based on Cys leading to acrylate hydrolysis mechanism and succedent excited-state intramolecular proton transfer process of 3-hydroxyflavone compound. Then Cys and Hcy biological thiols can be recognized at one time by these two 3-hydroxyflavone derivatives. The bioimaging experiment indicates that both the compounds can be successfully applied to the detection of Cys/Hcy in living cells and compound 2 also can be applied to bioimaging Cys in zebrafish by one- and two-photon fluorescence mode. Then these two compounds have a potential in the application of biological sample analysis.

Graphical abstract

http://ift.tt/2Be5mhE

Front Matter 1 - Full Title Page (regular issues)/Special Issue Title page (special issues)

Publication date: 1 April 2018
Source:Talanta, Volume 180





http://ift.tt/2mTryti

Diagnostic Value of Dual-input Computed Tomography Perfusion on Detecting Bronchial-Pulmonary Artery Fistula in Tuberculosis Patients with Massive Hemoptysis

Publication date: Available online 19 January 2018
Source:Academic Radiology
Author(s): Haixian Qu, Maoqiang Wang, Zhijun Wang, Guokun Ao, Xiaodong Yuan, Qiang Li, Zepeng Ma, Qianru Xu, Jieyu Yan, Yanhua Bai
Rationale and ObjectivesThis prospective study aimed to evaluate the diagnostic performance of dual-input computed tomography perfusion technique (DI-CTP) in identifying the bronchial-pulmonary artery fistula in patients tuberculosis with massive hemoptysis.Material and MethodsTwenty patients with tuberculosis with massive hemoptysis were enrolled from January 2015 to December 2015. The association between DI-CTP parameters and the diagnostic outcomes of digital subtraction angiography was assessed. Diagnostic efficacy of DI-CTP was evaluated by receiver operating curve (ROC) analyses using the diagnostic outcomes of digital subtraction angiography, which is the gold standard for identifying bronchial-pulmonary artery fistula.ResultsCompared to lung segments with normal blood flow (n = 304), those with bronchial-pulmonary artery fistula (n = 164) had a reduced pulmonary flow value, perfusion index (PI) value, and an elevated bronchial artery (BF) value in the DI-CTP scan, which was further confirmed by multivariate logistic regression. ROC analysis showed that PI and bronchial artery has an excellent diagnostic performance (both area under the ROC curve > 0.9, P < .001) and high sensitivity and specificity (from 0.79 to 0.95 at the optimal cutoff). PI has the best diagnostic performance, with an overall diagnostic accuracy of 0.91.ConclusionsDI-CTP scan possesses the diagnostic value for detecting bronchial-pulmonary artery fistula in patients with tuberculosis with massive hemoptysis, providing an alternative diagnostic method.



http://ift.tt/2mS3LJx

TATP isotope ratios as influenced by worldwide acetone variation

Publication date: 1 May 2018
Source:Talanta, Volume 181
Author(s): John D. Howa, Janet E. Barnette, Lesley A. Chesson, Michael J. Lott, James R. Ehleringer
Isotope ratio analysis has been shown to discriminate samples of forensic interest and to link many synthesized and natural materials to their precursors when traditional chemical and physical analyses cannot. Successful application of stable isotope analysis to chemicals of interest requires a background of likely variations in stable isotope ratios; often, this background population can be generated from analysis of possible precursors and the relationships of stable isotopes of precursor(s) to product(s), which may depend on synthesis techniques. Here we measured the carbon (¹³C/¹²C) and hydrogen (²H/¹H) isotope ratios of the oft-illicitly manufactured explosive triacetone triperoxide, TATP, and one of its precursors, acetone. As acetone is the sole source of carbon and hydrogen to TATP, a survey of acetone from 12 countries was conducted to explore the breadth of ¹³C/¹²C and ²H/¹H variation in the precursor, and therefore, its product. Carbon and hydrogen isotope ratios were measured using continuous flow isotope ratio mass spectrometry (IRMS) techniques. We observed greater ranges in both C and H isotope ratios of acetone than previously published; we also found that country-of-purchase was a large contributing factor to the observed variation, larger than acetone grade and brand. Following clandestine production methods, we observed that the stable isotope ratios of TATP retained the stable isotope signatures of acetone used in synthesis. We confirmed the robustness of TATP carbon isotope ratios to both recrystallization and time-dependent sublimation, important considerations when faced with the task of practical sampling of potential unexploded TATP from a crime scene.

Graphical abstract

http://ift.tt/2mTFzqD

A comprehensive methodology for the chiral separation of 40 tobacco alkaloids and their carcinogenic E/Z-(R,S)-tobacco-specific nitrosamine metabolites

Publication date: 1 May 2018
Source:Talanta, Volume 181
Author(s): Garrett Hellinghausen, Daipayan Roy, Yadi Wang, Jauh T. Lee, Diego A. Lopez, Choyce A. Weatherly, Daniel W. Armstrong
The predominant enantiomer of nicotine found in nature is (S)-nicotine and its pharmacology has been widely established. However, pharmacologic information concerning individual enantiomers of nicotine-related compounds is limited. Recently, a modified macrocyclic glycopeptide chiral selector was found to be highly stereoselective for most tobacco alkaloids and metabolites. This study examines the semi-synthetic and native known macrocyclic glycopeptides for chiral recognition, separation, and characterization of the largest group of nicotine-related compounds ever reported (tobacco alkaloids, nicotine metabolites and derivatives, and tobacco-specific nitrosamines). The enantioseparation of nicotine is accomplished in less than 20s for example. All liquid chromatography separations are mass spectrometry compatible for the tobacco alkaloids, as well as their metabolites. Ring-closed, cyclized structures were identified and separated from their ring-open, straight chain equilibrium structures. Also, E/Z-tobacco-specific nitrosamines and their enantiomers were directly separated. E/Z isomers also are known to have different physical and chemical properties and biological activities. This study provides optimal separation conditions for the analysis of nicotine-related isomers, which in the past have been reported to be ineffectively separated which can result in inaccurate results. The methodology of this study could be applied to cancer studies, and lead to more information about the role of these isomers in other diseases and as treatment for diseases.

Graphical abstract

http://ift.tt/2BdxvWk

Editorial Board

Publication date: 1 April 2018
Source:Talanta, Volume 180





http://ift.tt/2BfaC4x

Relevant pericardial effusion caused by cytomegalovirus infection in an immunocompetent patient: a case report

Cytomegalovirus infection is known to cause symptomatic disease in immunocompromised patients, while an infection in immunocompetent individuals normally causes few or no symptoms. We present the case of an im...

http://ift.tt/2Be6dyM

Clinical and molecular implications of structural changes to desmosomes and corneodesmosomes

Abstract

Desmosomes provide the main intercellular adhesive properties between epidermal keratinocytes. Their distribution becomes uneven in severe dermatitis, multiple allergies and metabolic wasting syndrome due to desmoglein 1 deficiency and the loss of intercellular adhesion or acantholysis. When keratinocytes differentiate from granular cells into cornified cells, desmosomes are transformed into corneodesmosomes and can provide stronger intercellular adhesion. Degradation of corneodesmosomes is a tightly regulated process involving a number of proteases and their inhibitors. Peripheral corneodesmosomes are protected from proteolytic degradation by the tight junction-related structures around them, and this construction provides the basis for the normal basket weave-like structure of the stratum corneum. In Netherton syndrome, which is caused by an absence of the protease inhibitor lymphoepithelial Kazal-type-related inhibitor, premature degradation of corneodesmosomes occurs due to the overactivation of proteases involved in corneodesmosome degradation. Inflammatory peeling skin disease is caused by the absence of corneodesmosin, a unique component of corneodesmosomes. In this disease, corneodesmosomes are structurally abnormal, and their adhesiveness is compromised, which leads to intercellular splitting between the stratum corneum and stratum granulosum. The better we understand desmosome and corneodesmosome ultrastructure in normal and diseased skin, the clearer the physiological and pathological mechanisms of epidermal integrity become.

http://ift.tt/2DNrtyj

Possible role of plasmacytoid dendritic cells in pityriasis lichenoides

Summary

Background

Plasmacytoid dendritic cells (pDCs) and their product, type I interferons (IFNs), have been implicated in the pathogenesis of several skin disorders characterized by an interface dermatitis (ID) pattern, such as lichen planus (LP). A type I IFN signature has previously been documented in pityriasis lichenoides (PL). Although pDCs are known to be the main source and most potent producers of local type I IFNs, their role in PL has not been investigated.

Aim

To investigate the role of pDCs in PL.

Methods

In total, 20 cases of PL and 20 comparable cases of LP were immunohistochemically tested for pDC occurrence and type I IFN production using anti-blood-derived dendritic cell antigen-2 (BDCA2; a specific pDC marker) and anti-myxovirus protein A (anti-MxA) antibodies (indirect marker of pDC activity), respectively. MxA is a well-established surrogate marker for local type 1 IFN production. A semiquantitative scoring system was used.

Results

pDCs were present in all 40 cases with no statistically significant difference between the two groups. MxA expression was intense and diffuse in the majority of PL and LP cases.

Conclusions

pDCs constitute a central component of the inflammatory infiltrate in PL, suggesting that PL shares with the other entities that exhibit an ID a common pDC-driven process through type I IFN production, which ultimately leads to the cytotoxic attack.

http://ift.tt/2DkqLHQ

Role of modified Eloesser flap in the treatment of bronchopleural fistula caused by pulmonary coccidioidomycosis

Description

Coccidioidomycosis is a fungal infection by the Coccidioides genus and is usually caused by inhalation of the spores. Patients with diabetes are more likely to present with severe lung disease, especially cavitary lesions.1 2 We depict the case of a 47-year-old man with uncontrolled type 2 diabetes mellitus who presented with a right pulmonary lung abscess due to coccidioidomycosis and underwent a right thoracotomy with partial right upper lobe resection. Intraoperatively the pleura was found to be thickened, and the upper lobe had multiple adhesions and was perforated, creating a purulent bronchopleural fistula. He developed recurrent right-sided empyema due to the fistula and an attempt at a second thoracotomy was unsuccessful. After placement of three failed endobronchial valves, he ultimately had a tunnelled pleural catheter placed. Two weeks later the patient began draining frank pus from the site and a modified Eloesser flap...

http://ift.tt/2DO4hzX

Moyamoya tipping point: fatal bilateral MCA territory infarction following cocaine abuse

Description  

An adult Caucasian man with a history of polysubstance abuse was found unresponsive by the nursing staff at his rehabilitation centre and intubated by emergency medical services. On examination, he was stuporous, his eyes did not open to stimulation, his pupils were reactive, localised to pain with bilateral upper extremities and demonstrated triple flexion to noxious stimuli in the bilateral lower extremities. Urine toxicology was positive for cocaine metabolites. A CT scan of the head was performed, which showed possible hypodensities in the bilateral temporal lobes. MRI of the brain was performed to further characterise these hypodensities, and it revealed bilateral middle cerebral artery (MCA) infarction and generalised cerebral oedema (figure 1). CT angiogram of the head at this point was performed, which showed narrowing of both MCAs and possible moyamoya pattern on the left (figure 2). This moyamoya-like vascular change was suggested by narrowing of the left MCA and hypervascular lenticulostriate...

http://ift.tt/2DPIyYz

Continuous subcutaneous levetiracetam in end-of-life care

Seizures constitute a determining aspect in quality of life and are frequently challenging in palliative care—a field where treatment has yet to be standardised. Levetiracetam—a new generation anticonvulsant—has proved efficacy both through oral, as well as intravenous administration in the general population. This case reports on the use of continuous subcutaneous levetiracetam to effectively control seizures in a terminally ill patient without patent oral route.

http://ift.tt/2DhCHdt

Megaduodenum in a 59-year-old man: a very late postoperative complication after duodenal atresia

Intestinal malformations are common defects of the newborn, treated in experienced centres. Reports on long-term follow-up and associated complications are scarce, possibly leading to misinterpretation of clinical signs and symptoms in adulthood. To prevent treatment errors, it is important that physicians are aware of long-term complications of intestinal malformations.

http://ift.tt/2Di1azw

Retroperitoneal bile leak after laparoscopic cholecystectomy

Bile duct injury (BDI) is a well-recognised complication of laparoscopic cholecystectomy (LC). Following a BDI, bile usually leaks into the peritoneal space and causes biliary peritonitis. This manifests as non-specific abdominal pain and fever occurring several days after the surgery. It can be managed by laparoscopic washout with or without bile duct repair. We present a rare case of retroperitoneal bile leak post-LC. The mechanism of injury here was likely partial avulsion from excessive traction of the cystic duct during intraoperative cholangiogram. Diagnosing retroperitoneal bile leak can be difficult because it is extremely rare and the presenting symptoms can be similar to an intraperitoneal bile leak. A high index of clinical suspicion is required. In cases of suspected bile leak, any mismatch between the exploratory laparoscopic findings and imaging findings should alert surgeons to consider the rare possibility of a retroperitoneal bile leak.

http://ift.tt/2DP09zN

Unusual skin mass (primary cutaneous mucinous carcinoma)

Primary mucinous carcinoma of the skin is a rare malignant tumour of sweat gland origin. Diagnostic concerns include its deceptively benign appearance in some cases and the difficulty in differentiating it from secondary mucinous carcinoma of skin metastasising from a primary source elsewhere. A case of a 75-year-old man is reported who presented with a slowly growing painless mass near the lateral canthus of the right eye for about 2 years. Clinically, a diagnosis of basal cell carcinoma was made whereas histopathology revealed mucinous carcinoma of the skin. The primary source of the tumour could not be found on detailed physical examination and laboratory investigations. Immunohistochemistry, performed later, was consistent with primary cutaneous mucinous carcinoma.

http://ift.tt/2DPfWia

An adult case with shigellosis-associated encephalopathy

A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient's sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed Shigella flexneri, after which Shigella-associated encephalopathy was suspected. The patient recovered quickly with antibiotic treatment. The incidence of Shigella infections in the Western world is rising due to sexual transmission among men who have sex with men. Shigella-induced encephalopathy is a notorious complication among children with a severe form known as the Ekiri syndrome, though rarely seen in adults. This is the second report of encephalopathy in an adult with S. flexneri enteric infection.

http://ift.tt/2DkESgf

Angiodysplastic Sturge Weber syndrome

Description

A 3-year-old boy presented with global developmental delay, abnormal craniofacial growth and left focal seizures since infancy. He was the first child of a non-consanguineous couple with unremarkable perinatal period. Family history was non-contributory. On examination, he had macrocephaly (head circumference 55 cm, >3 z-score), extensive port-wine stain distributed bilaterally over the face and the trunk, cloverleaf-shaped skull with facial distortion (figure 1A), marked gingival hyperplasia with dental malocclusion (figure 1B), bilateral blue sclera with tortuous engorged veins, brisk muscle stretch reflexes, left hemiparesis and bilateral Babinski's sign. The rest of the systemic examination was unremarkable. A clinical diagnosis of angiodysplastic variant of Sturge Weber syndrome (SWS) with extensive bilateral facial and truncal port-wine stain, glaucoma and focal epilepsy was considered. CT of the brain revealed right-sided subcortical tram-track calcification and concordant parenchymal volume loss (figure 1C). MRI of the brain showed right-sided...

http://ift.tt/2DL5oQZ

Intravitreal bevacizumab for postviral fever retinitis: a novel approach for early resolution of macular oedema

Severe macular oedema causing marked loss of vision is seen in cases of retinitis developing postviral fever. The use of antivascular endothelial growth factor agents for macular oedema and submacular fluid secondary to viral retinitis has not been studied or well established in the past. We report a case series of two patients of postviral retinitis with severe macular oedema resistant to steroid therapy, treated with intravitreal bevacizumab. The patients showed significant symptomatic improvement in the visual acuity. The retinitis lesions resolved slowly and macular oedema regressed. Bevacizumab appears to be a safe and useful agent to manage macular oedema subsequent to postviral retinitis. An early resolution of macular oedema helps in the preservation of visual acuity which left untreated can cause severe visual loss.

http://ift.tt/2DhCDdJ

Abnormal deep dorsal vein resulting in veno-occlusive erectile dysfunction

A 59-year-old man with a 6-year history of erectile dysfunction presented to the andrology outpatient clinic. Multimodality assessment with ultrasound, MRI venography and fluoroscopic venography demonstrated an aberrant emissary vein arising from the corporal bodies causing venogenic erectile dysfunction. Selective coil embolisation of the collateral vein resulted in an almost immediate and sustained improvement in his erections.

http://ift.tt/2DP04ft

Anterior choroidal artery infarction

Description 

A 38-year-old male patient with a history of hypertension presented with left hemiplegia, hemianaesthesia and hemianopia. MRI of the brain showed anterior choroidal artery (AchA) territory infarct (figure 1). MRI brain angiography and 2D echo were normal. Serum fasting lipid profile, sugar levels, thyroid studies, serum homocysteine levels and antinuclear antibody (ANA), double-stranded deoxyribonucleic acid (DsDNA) and antiphospholipid antibody (APLA) were negative. Trans-oesophageal echocardiography and Holter monitoring were normal. Workup for sickle cell anaemia was negative.

Figure 1

Axial diffusion weighted MRI shows restricted diffusion in (A,B) right lateral thalamus, posterior limb of internal capsule; hippocampal gyrus and uncus and (C) paraventricular corona radiata and uncus. (D) Coronal T2 image showing involvement of same areas.

The territory of AchA is shown in figure 2.1

Figure 2

(A) Anterior choroidal artery originates from internal carotid artery...

http://ift.tt/2DjruJi

Sacral bone cyst treatment resulting in paraplegia

Description

A 50-year-old man with a stage 1 solitary right sacral plasmacytoma complained of a sharp, burning lower back pain with radiation into his right lower extremity which worsened with movement. He had initially undergone localised radiation therapy, but the pain did not resolve. Postradiation CT-guided biopsy showed persistence of malignant plasma cells, and he then underwent seven cycles of VRD (dexamethasone, lenalidomide and bortezomib) chemotherapy. After chemotherapy, an 18-fluorodeoxyglucose-positron emission tomography/CT scan showed a new area of uptake in the right sacral ala near the initial plasmacytoma. A subsequent CT-guided biopsy was non-diagnostic, and repeat imaging at the time of presentation showed no interval growth. The lesion was believed to be a residual cyst with inflammatory changes from radiotherapy. Examination revealed no neurological deficits. The patient's pain was thought to be secondary to the cyst (figure 1) and was not relieved with physical therapy, duloxetine...

http://ift.tt/2DPfC2W

Ferroelectrics, multiferroics and artifacts: Lozenge-shaped hysteresis and things that go bump in the night

Publication date: Available online 18 January 2018
Source:Materials Today
Author(s): J.F. Scott, Jonathan Gardner
This review summarizes dielectric studies and related experiments on ferroelectrics and multiferroics about which there has been considerable controversy in the literature, sometimes at unusually impolite and unprofessional levels. In addition it focuses attention on a new anomalous phenomenon – that of ferroelectric hysteresis loops P(E) that are parallelograms with straight sides. In some cases materials have been considered to be multiferroic when the data can be interpreted more simply via other well-known mechanisms. In some cases the systems truly are multiferroic, despite X-ray crystallographic data implying that this is not possible; some properties arise only from the domain walls. And in some cases authors get different results from previous work, simply because they used bulk ceramics instead of very thin films, or epitaxial films instead of randomly oriented ceramics; it is of course preferable if groups exchange specimens before they claim the work of others is simply wrong. Emphasis is on newly discovered lozenge-shaped hysteresis loops, whose parallelepiped geometries are found in four unrelated materials. This review has intentionally not discussed ferroelectric artifacts that appear in atomic force microscopy, since that is actually more extensive in variety and well reviewed this year by Kalinin's group [1].

Graphical abstract

http://ift.tt/2Ds1U8j

Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients

Thyroid , Vol. 0, No. 0.


http://ift.tt/2Dg7MhH

Gender Differences in the Association Between Synthetic Cannabinoid Use and Teen Dating Violence Victimization

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2DhVuFC

Alleviation of iron toxicity in Schinus terebinthifolius Raddi (Anacardiaceae) by humic substances

Abstract

One of the industrial pillars of Espírito Santo state, South East of Brazil, is iron-mining products processing. This activity brings to a high level of coastal pollution due to deposition of iron particulate on fragile ecosystems as mangroves and restinga. Schinus therebinthifolius (aroeira) is a widespread restinga species. This work tested iron toxicity alleviation by vermicompost humic substances (HS) added to aroeira seedlings in hydroponic conditions. Catalase, peroxidase, and ascorbate peroxidase are antioxidant enzymes that work as reactive oxygen species (ROS) scavengers: they increase their activity as an answer to ROS concentration rise that is the consequence of metal accumulation or humic substance stimulation. S. terebinthifolius seedlings treated with HS and Fe augmented their antioxidant enzyme activities significantly less than seedlings treated separately with HS and Fe; their significantly lower Fe accumulation and the slight increase of root and leaf area confirm the biostimulating effect of HS and their role in blocking Fe excess outside the roots. The use of HS can be useful for the recovery of areas contaminated by heavy metals.

http://ift.tt/2mTviLp

Chemically and size-resolved particulate matter dry deposition on stone and surrogate surfaces inside and outside the low emission zone of Milan: application of a newly developed “Deposition Box”

Abstract

The collection of atmospheric particles on not-filtering substrates via dry deposition, and the subsequent study of the particle-induced material decay, is trivial due to the high number of variables simultaneously acting on the investigated surface. This work reports seasonally resolved data of chemical composition and size distribution of particulate matter deposed on stone and surrogate surfaces obtained using a new method, especially developed at this purpose. A "Deposition Box" was designed allowing the particulate matter dry deposition to occur selectively removing, at the same time, variables that can mask the effect of airborne particles on material decay. A pitched roof avoided rainfall and wind variability; a standardised gentle air exchange rate ensured a continuous "sampling" of ambient air leaving unchanged the sampled particle size distribution and, at the same time, leaving quite calm condition inside the box, allowing the deposition to occur. Thus, the "Deposition Box" represents an affordable tool that can be used complementary to traditional exposure systems. With this system, several exposure campaigns, involving investigated stone materials (ISMs) (Carrara Marble, Botticino limestone, Noto calcarenite and Granite) and surrogate (Quartz, PTFE, and Aluminium) substrates, have been performed in two different sites placed in Milan (Italy) inside and outside the low emission zone. Deposition rates (30–90 μg cm⁻² month⁻¹) showed significant differences between sites and seasons, becoming less evident considering long-period exposures due to a positive feedback on the deposition induced by the deposited particles. Similarly, different stone substrates influenced the deposition rates too. The collected deposits have been observed with optical and scanning electron microscopes and analysed by ion chromatography. Ion deposition rates were similar in the two sites during winter, whereas it was greater outside the low emission zone during summer and considering the long-period exposure. The dimensional distribution of the collected deposits showed a significant presence of fine particles in agreement with deposition rate of the ionic fraction. The obtained results allowed to point out the role of the fine particles fraction and the importance of making seasonal studies.

http://ift.tt/2ropjTi

Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer

Abstract

Background/Objectives

To describe the characteristics, subsequent management and outcomes of patients referred for further management following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Methods

Retrospective analysis of patients referred to a quaternary cancer centre from 2000 to 2015.

Results

In total, 83 lesions in 82 patients were referred for further management; 52 (62%) were SCC and 80 (96%) were located in the head and neck. Reasons for referral included high-risk disease for consideration for adjuvant radiotherapy (37/83, 45%), inadequate resection (28/83, 34%) or recurrence following previous MMS (15/83, 17%). Fewer than 40% of the 69 referrals received from MMS surgeons included photos or an operative report and diagram.

There was discordance in pathology opinion in 11 (13%) of cases. Histopathology from MMS was reviewed in eight cases and there was discordance with the in-hospital pathology opinion in six of these. In-hospital re-excision was performed in 19 cases and in five of these the pathology report on the paraffin-sectioned re-excised tissue was discordant with prior MMS assessment. Significantly, two cases were associated with a misinterpretation of lymphocytic infiltrate as residual disease in patients with chronic lymphocytic leukaemia (CLL).

Conclusion

This study highlights some of the challenges and limitations of MMS. Early referral for multidisciplinary management is recommended when MMS resection margins are inadequate or uncertain, especially for high-risk SCC. We recommend that referrals be accompanied by histological material, as well as a detailed report with operative photos and diagrams. CLL can pose an intraoperative diagnostic challenge. Discrepancies in the interpretation of MMS slides present an opportunity for improvement, and our findings support the role of ongoing quality assurance programs.

http://ift.tt/2DriZA3

Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer

Abstract

Background/Objectives

To describe the characteristics, subsequent management and outcomes of patients referred for further management following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Methods

Retrospective analysis of patients referred to a quaternary cancer centre from 2000 to 2015.

Results

In total, 83 lesions in 82 patients were referred for further management; 52 (62%) were SCC and 80 (96%) were located in the head and neck. Reasons for referral included high-risk disease for consideration for adjuvant radiotherapy (37/83, 45%), inadequate resection (28/83, 34%) or recurrence following previous MMS (15/83, 17%). Fewer than 40% of the 69 referrals received from MMS surgeons included photos or an operative report and diagram.

There was discordance in pathology opinion in 11 (13%) of cases. Histopathology from MMS was reviewed in eight cases and there was discordance with the in-hospital pathology opinion in six of these. In-hospital re-excision was performed in 19 cases and in five of these the pathology report on the paraffin-sectioned re-excised tissue was discordant with prior MMS assessment. Significantly, two cases were associated with a misinterpretation of lymphocytic infiltrate as residual disease in patients with chronic lymphocytic leukaemia (CLL).

Conclusion

This study highlights some of the challenges and limitations of MMS. Early referral for multidisciplinary management is recommended when MMS resection margins are inadequate or uncertain, especially for high-risk SCC. We recommend that referrals be accompanied by histological material, as well as a detailed report with operative photos and diagrams. CLL can pose an intraoperative diagnostic challenge. Discrepancies in the interpretation of MMS slides present an opportunity for improvement, and our findings support the role of ongoing quality assurance programs.

http://ift.tt/2DriZA3

Wideband acoustic absorbance in children with Down syndrome

Publication date: Available online 10 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Alessandra Spada Durante, Mayara Santos, Nayara M.C. de F. Roque, Marcella S. Gameiro, Katia de Almeida, Osmar Mesquita de Sousa Neto
IntroductionTympanometry is currently the most frequently used tool for assessing the status of the middle ear, commonly assessed using a single 226Hz tone. However, the use of the Acoustic Immittance Measures with a wideband stimulus is a promising high-resolution evaluation, especially in individuals known to have middle ear alterations, such as Down syndrome patients.ObjectiveThe aim of this study was to analyze the acoustic absorbance measurements in children with DS.MethodsCross-sectional study, approved by the institution's ethics committee. Data were collected from 30 children, with a mean age of 8.4 years, 15 with Down syndrome (DS-study group) and 15 children with typical development and no hearing complaints (control group). Energy absorbance was measured at frequencies of 226–8000Hz at ambient pressure and at peak pressure as a function of frequency using TITAN equipment. Statistical analysis was performed using the established level of statistical significance of 5%.ResultsWith the 226Hz probe tone, 30 ears of the control group and 22 of the study group exhibited Type A tympanograms, whereas Type B was observed in eight children in the study group. The mean acoustic absorbance ratio of the study group was lower than that of the control group at frequencies centered at 2520Hz (p=0.008) for those with normal tympanometry results, and 226–4000Hz (p<0.03) for those with a Type B tympanometry curve.ConclusionThe low energy absorption in the presence of normal tympanograms in children with DS may suggest middle ear abnormalities.



http://ift.tt/2Behwae

Medical Marijuana: Current Concepts, Pharmacological Actions of Cannabinoid Receptor Mediated Activation, and Societal Implications

Abstract

Purpose of Review

The purpose of the following review is to summarize the history and current policies related to marijuana use and prevalence, basic and clinical science pharmacological literature regarding efficacy, subpopulations of concern, and varying policies regarding its use at present.

Recent Findings

With the increasingly widespread utilization of marijuana, there is also a growing complexity of public health policy, regulation, and necessity to further assess the medical indications and adverse long-term effects of marijuana use.

Summary

Health care providers as well as the general public must be prepared to become familiar and up-to-date with medical literature, legislation, and educational material regarding medical marijuana.

http://ift.tt/2mSmiWy

Aesthetic Refinements after Radial Free Flap Phalloplasty: Optimizing the Donor Site and the Phallus

Background: Phalloplasty with radial forearm flap is the gold standard for female-to-male sex reassignment surgery. However, it leaves a stigmatizing forearm scar, and as the new phallus is created with the forearm's skin and fat, it does not look like that of a biological man. The aesthetic appearance of the donor site and the neophallus can be optimized after phalloplasty. In this study, we review refinement techniques (RTs) performed after radial forearm flap phalloplasty. Methods: We present a historical cohort of patients who underwent the following RTs: forearm fat grafting and localized laser in the forearm's scars, and micropigmentation of the neophallus. Patient's aesthetic satisfaction was evaluated using the Patient and Observer Scar Assessment Scale for the forearm's refinements and the Male Genital Self-Image Scale for the neophallus. Results: Between January 2014 and January 2016, 8 patients underwent forearm fat grafting with localized laser, and 7 patients micropigmentation of the neophallus after radial flap phalloplasties. All Patient and Observer Scar Assessment Scale parameters showed a statistically significant reduction between preoperative and postoperative values. Male Genital Self-Image Scale survey showed that all patients felt positively about their genitals after micropigmentation. Patients who underwent refinement procedures were highly satisfied with the aesthetic outcome and felt more confident. They also claim that they would choose to have the refinement procedure done again. Conclusions: The proposed RTs are minimally invasive interventions to complement and enhance female-to-male sex reassignment surgery with very few complications and excellent aesthetic results of both the forearm scars and the constructed phallus.

http://ift.tt/2riE6yV

A Systematic Review of Autologous Platelet-Rich Plasma and Fat Graft Preparation Methods

Background: The addition of platelet-rich plasma (PRP) to adipose tissue may improve fat graft survival, although graft retention rates vary markedly between studies. To what extent this outcome heterogeneity reflects differing methodological factors remains unknown. This systematic review aims to synthesize and critically review methodological approaches to autologous PRP and fat cotransplantation in both human and animal studies. Methods: In accordance with PRISMA guidelines, Ovid MEDLINE, Scopus, and Cochrane Library databases were searched from inception to April 2017. Data were extracted from all in vivo studies involving autologous PRP and fat cotransplantation. A secondary aim was to assess reporting of technical detail; authors were not contacted to provide missing data. Results: From 335 articles, 23 studies were included in the qualitative synthesis. Some 21 were performed in humans and 2 in rabbits. Six studies were randomized control trials; the remainder reported on observational data. Methods of PRP extraction and activation varied markedly between studies. Fat graft preparation was comparatively more consistent. Methods of PRP and fat mixing differed significantly, especially with regards to relative volume/volume ratios. Conclusions: Our study represents the first systematic review of methodological factors in autologous PRP and fat cotransplantation. It demonstrates that technical factors in graft preparation and administration vary significantly between in vivo studies. Such methodological heterogeneity may explain observed differences in experimental and clinical outcomes. Reporting of key procedural information is inconsistent and often inadequate. These issues make meaningful evaluation of the PRP-enhanced fat grafting literature difficult and may limit its translation into clinical practice.

http://ift.tt/2FRBgnL

Treatment of persistent organic pollutants in wastewater using hydrodynamic cavitation in synergy with advanced oxidation process

Abstract

Persistent organic pollutants (POPs) are very tenacious wastewater contaminants. The consequences of their existence have been acknowledged for negatively affecting the ecosystem with specific impact upon endocrine disruption and hormonal diseases in humans. Their recalcitrance and circumvention of nearly all the known wastewater treatment procedures are also well documented. The reported successes of POPs treatment using various advanced technologies are not without setbacks such as low degradation efficiency, generation of toxic intermediates, massive sludge production, and high energy expenditure and operational cost. However, advanced oxidation processes (AOPs) have recently recorded successes in the treatment of POPs in wastewater. AOPs are technologies which involve the generation of OH radicals for the purpose of oxidising recalcitrant organic contaminants to their inert end products. This review provides information on the existence of POPs and their effects on humans. Besides, the merits and demerits of various advanced treatment technologies as well as the synergistic efficiency of combined AOPs in the treatment of wastewater containing POPs was reported. A concise review of recently published studies on successful treatment of POPs in wastewater using hydrodynamic cavitation technology in combination with other advanced oxidation processes is presented with the highlight of direction for future research focus.

http://ift.tt/2FUxrym

Cytological diagnosis of erythema nodosum leprosum in clinically unsuspected cases: A report of two cases

Shruti Semwal, Deepti Joshi, Garima Goel, Neha Mittal, Kaushik Majumdar, Neelkamal Kapoor

Journal of Cytology 2018 35(1):63-65

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The manifestations of this disease varies across the spectrum of tuberculoid (TT) to lepromatous (LL) leprosy.The course of this indolent disease is interrupted by acute exacerbations in the form of leprare actions. Erythema nodosum leprosum (ENL), a type 2 lepra reaction, occurs in lepromatous or borderline lepromatous cases, usually in response to multidrug therapy. Early detection and timely management of these patients is important to reduce the associated morbidity. We report two clinically unusual cases of ENL on fine-needle aspiration cytology. In one case, antileprosy treatment was completed 10 years back, whereas in the other case, ENL was the presenting feature of the disease. Cytological examination of swelling in both the cases showed neutrophils, lymphoid cells, clusters of foamy macrophages, histiocytes, and giant cells. Fite stain was positive, which confirmed the cytological diagnosis of ENL.

http://ift.tt/2mTCxTq

Martian Popping Thing

Manoj G Madakshira, Imtiaz Ahmed

Journal of Cytology 2018 35(1):53-54



http://ift.tt/2BdHFG8

Toluidine blue with a synergistic effect in morphological assessment of oral cytosmears

TN Ratna Kumari, BR Ahmed Mujib

Journal of Cytology 2018 35(1):8-14

Objectives: One percent toluidine blue being the most effective adjunct is often used to detect dysplasia. Not much attention has been given to the effect of toluidine blue in enhancement of cytological smears. The present study assessed the smears before and after application of toluidine blue in smokers against non-smokers using three different stains [Papanicolaou (PAP), Hematoxylin and Eosin (H and E), and Giemsa]. Study Design: Twenty-five individuals from each group participated in the study. The oral cytosmears were obtained before and after application of toluidine blue and assessed for clumping of squamous cells, cellular and nuclear pleomorphism, micronuclei, binucleation, bacterial colony units, and keratin flakes. Results: In smokers, the maximum enhancement in cytological smears post-toluidine blue application was shown by Giemsa stain than PAP and H and E stains. Among the individual parameters, nuclear pleomorphism exhibited greatest significant difference between smokers and non-smokers. Conclusion: Toluidine blue enhanced the staining characteristics both in terms of sensitivity and specificity and thereby was found to be synergistic in assessment of cytosmears. The cellular alterations noticed in the smears of smokers with clinically normal buccal mucosa can be used as a means of education tool in counselling for smoking cessation.

http://ift.tt/2mUGffw

To evaluate the applicability of parameters of cytological grading systems on aspirates of breast carcinoma

Priyanshu Srivastava, Binay Kumar, Usha Joshi, Mehar Bano

Journal of Cytology 2018 35(1):15-21

Background: Fine-needle aspiration cytology (FNAC) is still an important first line diagnostic procedure in developing countries. FNAC of breast lesions is quite specific and sensitive investigation and the results are comparable to histopathology. Aim: To evaluate applicability of parameters of different cytological grading (CG) systems, for aspirates of breast cancers, and its correlation with histopathology grading parameters. Materials and Methods: A cross-sectional observational study was carried out on 30 female patients with ductal carcinoma breast, diagnosed on FNAC and subsequently confirmed histopathologically. The cytological smears were graded using six different cytological parameters/criteria described by Robinson et al. (Robinson grading system) and modified Scarff-Bloom-Richardson (SBR) grading system considering three parameters. The results of cytological grade (CG) were compared with parameters of gold standard modified SBR histological grading (HG) system. Results: Important influential cytological parameters to predict final RBS cytological score came out to be chromatin, nucleoli, nuclear size, cell uniformity, and cell dissociation with statistically significant P value (0.0001) except for mitotic count. The important influential predictor of final SBR histological score is nuclear pleomorphism. Conclusion: SBR HG has good correlation with both RBS and SBR CG systems. The cytological nuclear grade provides important prognostic information which is very sensitive and equally specific hence should be done in breast aspirates and is now replaced by Core Needle biopsy. In developing country like India FNAC of breast aspirates still holds diagnostic value in the classification of breast lesions as compared to core guided image biopsy.

http://ift.tt/2mQzGuz

Papillary pattern in acinic cell carcinoma of parotid gland: A potential diagnostic pitfall on FNAC

Anju Bansal, Manveen Kaur, Varsha Dalal, Fouzia Siraj

Journal of Cytology 2018 35(1):57-59

Fine needle aspiration cytology (FNAC) is often the first investigation in the work up of salivary gland lesions. However, its diagnostic accuracy is limited by the high rates of false positives and false negatives. Usually, acinic cell carcinoma is prone to be underdiagnosed because of the cytological similarity of the tumor cells to normal acinar cells, however rarely, a predominant papillary architecture on cytology may cause confusion with adenocarcinomas. We present a case of a 45-year-old male with a painful swelling of the right parotid region. FNA smears revealed a predominant papillary architecture and focal acinar pattern. A provisional diagnosis of acinic cell carcinoma was given, which was confirmed on histopathology. Familiarity with the cytomorphologic features of acinic cell carcinoma is cardinal for an accurate diagnosis and appropriate management.

http://ift.tt/2BdaO4q

Micronucleus study on breast cytology aspirate smears and its diagnostic utility

Mary T Sylvia, Lavanya Baskaran, Ramachandra V Bhat

Journal of Cytology 2018 35(1):22-26

Background: Micronucleus is a small fragment of nucleus present in the cells which have undergone chromosomal damage. It is used as a biomarker of genomic damage. Aims: We aim to study the presence of micronucleus on breast cytology smears and the use of scoring the micronucleus as an additional criteria for the classification of breast lesions with emphasis on borderline gray zone categories. Settings and Design: This is a cross-sectional retrospective descriptive study. Materials and Methods: Retrospective analysis of breast cytology smears received over a period of 2 years formed the basis of the study. Micronucleus scoring was done by counting the number of micronuclei in 1000 epithelial cells under oil immersion and compared in the benign, adenosis, usual/atypical ductal hyperplasia, and the three grades of infiltrating ductal carcinomas. Statistical Analysis: Descriptive analyses and one-way analysis of variance was used for statistical analysis. Results: Of the 243 cases, the average statistically significant (P < 0.05) micronuclei scores of the benign (190), adenosis (7), usual (11)/atypical (5) hyperplasia, grade 1, 2, and 3 carcinomas (30) were 0.5, 2, 2.9, 6.6, 13.2, 20.6, and 27.5, respectively (the corresponding median scores were 0.5, 2, 3, 6, and 20, respectively). Micronucleus score of ≤1 had a high sensitivity (100%) and specificity (99%) in confirmation of benign cases. Micronucleus score of ≥5 and <10 had a moderate sensitivity (60%) but a high specificity of 99% in detecting atypical ductal hyperplasia. Micronucleus score of ≥10 had a high sensitivity (96%) and specificity (99%) of detecting carcinomas. Conclusion: Micronucleus scores showed a gradual increase across the categories proving the gradual occurrence of genomic damage. Micronucleus scoring serves as an additional criterion for the diagnosis of breast lesions.

http://ift.tt/2mQzEmr

Chondromyxoid fibroma of the metatarsal bone: A diagnosis using fine needle aspiration biopsy

Biswajit Dey, Archana H Deshpande, Rupinder K Brar, Amit Ray

Journal of Cytology 2018 35(1):67-68



http://ift.tt/2BdHv1u

Galectin-3 and HBME-1 Expression on agarose cell blocks from fine-needle aspirates of follicular cell-derived thyroid tumors

E Abu-Sinna, MY Hasan, MM El-Deftar, SA Amer, LO Abdelsalam, JA Nakhla

Journal of Cytology 2018 35(1):27-32

Aim: To test the expression of galectin-3 (gal-3) and Hector Battifora mesothelial antigen-1 (HBME-1) on agarose cell blocks (CBs) of fine-needle aspirates aiming to determine their diagnostic value in thyroid follicle cell-derived tumors. Materials and Methods: Forty patients with thyroid nodule were enrolled. Fine-needle aspiration biopsy was done and processed to produce smears and CBs. Immune staining was done on CBs using antibodies to gal-3 and HBME-1. Diagnostic value of tests was determined in comparison to pathology. Results: Current study included 17 papillary thyroid carcinoma (PTC), 15 follicular adenoma, and 8 follicular thyroid carcinoma (FTC). In PTC diagnosis, co-expression of gal-3/HBME-1 had a sensitivity of 94.1%, specificity of 73.3%, positive predictive value (PPV) of 80%, negative predictive value (NPV) 91.7%, and accuracy of 84.4%. In FTC diagnosis, combined gal-3/HBME-1 expression had a sensitivity of 75%, specificity of 78.6%, PPV of 50%, NPV of 91.7%, and accuracy of 77.8%. Co-expression of gal-3/HBME-1 raised the sensitivity of detection of differentiated thyroid carcinomas from 40% with cytomorphology to 92% and accuracy from 62.5% to 85%. Conclusion: The combined immunocytochemical expression of gal-3 and HBME-1 utilizing fine-needle aspirates can improve the sensitivity of detection and diagnostic accuracy of differentiated follicular cell-derived thyroid carcinomas.

http://ift.tt/2mR3qYk

Sputum cytology: Curschmann's spiral or parasite larva?

Rafael Martínez-Girón, Cristina Martínez-Torre

Journal of Cytology 2018 35(1):51-52



http://ift.tt/2BdHrig

Reproducibility of “The bethesda system for reporting thyroid cytopathology:” A retrospective analysis of 107 patients

Pragati Awasthi, Garima Goel, Ujjawal Khurana, Deepti Joshi, Kaushik Majumdar, Neelkamal Kapoor

Journal of Cytology 2018 35(1):33-36

Objectives: Fine-needle aspiration cytology (FNAC) has emerged as an indispensable tool to discriminate thyroid lesions into benign or malignant for appropriate management. The need for simplicity of communication and standardization of terminology for thyroid FNAC reporting led to introduction of "The Bethesda system for reporting Thyroid Cytopathology" (TBSRTC) in a conference held at the National Cancer Institute in 2007. This study aims at establishing the reproducibility of TBSRTC for diagnosing thyroid lesions. Materials and Methods: The present study comprised thyroid FNAC from 107 patients retrospectively over a period of 1.5 year (June 2013 to December 2014), which were reviewed by two trained cytopathologists and re-categorized according to TBSRTC. The interobserver variation and reproducibility of the reporting system was statistically assessed using Cohen's kappa. Results: The cytopathologists were in agreement in 98 out of 107 cases (91.5%). Maximum concordance was noted in benign category (91 of 96 cases; 92.85%), followed by 2 cases each in nondiagnostic/unsatisfactory (ND/US) and follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) category (2.04% each) and 1 case each in atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), suspicious for malignancy (SUS), and malignant category (1.02% each). The highest diagnostic disagreement was noted among ND/US and benign and benign and FN/SFN categories. Conclusion: The utilization of TBSRTC for reporting thyroid cytology should be promoted in our country because it provides a homogeneous, standardized, and unanimous terminology for cytological diagnosis of thyroid lesions. The present study could substantiate the diagnostic reproducibility of this system.

http://ift.tt/2mQzV8X

Fine needle aspiration cytology of basal cell adenoma of parotid simulating adenoid cystic carcinoma

Subrata Pal, Palash Kr Mondal, Abhishek Sharma, Mrinal Sikder

Journal of Cytology 2018 35(1):55-57

Basal cell adenoma is a rare type of monomorphic salivary adenoma most commonly involving the parotid gland. Cytology of basal cell adenoma closely mimics many other benign and malignant basaloid neoplasms. Cytological features of membranous basal cell adenoma simulate adenoid cystic carcinoma in fine needle aspiration cytology (FNAC) smears. Here, we are presenting a rare case of cytodiagnosis of membranous basal cell adenoma of parotid gland in an elderly lady, which mimicked adenoid cystic carcinoma on FNAC. We discuss the cytomorphology of this rare case with an emphasis on cytological difference between membranous basal cell carcinoma and adenoid cystic carcinoma as well as other basaloid neoplasms.

http://ift.tt/2BeHdHP

Anaplastic lymphoma kinase immunocytochemistry in fine needle aspiration diagnosis of anaplastic large-cell lymphoma

Prashant Ramteke, Sanjeev Chitragar, Ashok Singh, Saumyaranjan Mallick, Sandeep R Mathur, Deepali Jain, Venkateswaran K Iyer

Journal of Cytology 2018 35(1):37-40

Background: Anaplastic large-cell lymphoma (ALCL) is a rare subtype of non-Hodgkin's lymphoma (NHL) characterized by the presence of unusual giant cells. It is a CD30+lymphoma of T-cells lineage, which shows anaplastic lymphoma kinase-nucleophosmin (ALK-NPM) rearrangement. ALCL on fine needle aspiration cytology (FNAC) shows unusually large and bizarre tumor cells. Materials and Methods: All aspirates seen over a 6-year period from November 2009 to November 2015 in which a diagnosis of ALCL or Hodgkin's lymphoma (HL) with bizarre giant cells were suspected on cytomorphology were prospectively selected. Twenty such aspirates were subjected to CD-30 and ALK-1 immunocytochemistry (ICC). Subsequent biopsy was available in all cases. Results: Out of 20 cases, seven cases, suspected to be ALCL on FNAC, were confirmed on biopsy. ALK-1 was positive in both cytology and biopsy of 6/7 of these. Two cases suspected to be ALCL on cytomorphology were HL (1) and diffuse large B-cell lymphoma (DLBCL) (1) on biopsy, both of which were ALK-1 negative on cytology. Eight cases of HL and three cases of large-cell NHL, which were all ALK negative on cytology, were confirmed on biopsy. Conclusion: ICC for ALK and CD30 is useful in aspiration cytodiagnosis of ALCL. One CD30 positive DLBCL and one ALK negative ALCL showed concordant results of ICC on cytology and histology.

http://ift.tt/2mQzr2D

Cytomorphology of skin adnexal tumors: A tale of two scalp swellings

Hemlata Panwar, Garima Goel, Kaushik Majumdar, Deepti Joshi, Dinesh Asati, Neelkamal Kapoor

Journal of Cytology 2018 35(1):60-62

The primary and metastatic tumors of the skin can be effectively diagnosed by fine needle aspiration cytology (FNAC); however, the cytomorphological features of skin adnexal tumors are rarely described in the literature. We hereby describe the cytological features of two histologically confirmed cases of benign skin adnexal tumors. Case 1 is of a 46-year-old female who presented with an elevated firm nodule over the scalp. A cytological diagnosis of benign adnexal tumor possibly of sebaceous origin was given. The nodule was excised and histopathological examination confirmed the diagnosis of sebaceoma. Case 2 is of a 19-year-old male who presented with a pigmented scalp swelling. Cytomorphological features were suggestive of benign skin adnexal tumor with foci of melanin pigment. The swelling was excised and histopathological examination confirmed the diagnosis of eccrine poroma. To the best of our knowledge, only one previous report of sebaceoma and no report of eccrine poroma describing the cytological findings of these two tumors exist. We report these two cases of benign skin adnexal tumors to discuss the cytological features and the potential diagnostic dilemma that they pose to the cytologist.

http://ift.tt/2BdHg6A

Role of nuclear morphometry in breast cancer and its correlation with cytomorphological grading of breast cancer: A study of 64 cases

Anamika Kashyap, Manjula Jain, Shailaja Shukla, Manoj Andley

Journal of Cytology 2018 35(1):41-45

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid, inexpensive, and reliable method of diagnosis of breast mass. Cytoprognostic grading in breast cancers is important to identify high-grade tumors. Computer-assisted image morphometric analysis has been developed to quantitate as well as standardize various grading systems. Aims: To apply nuclear morphometry on cytological aspirates of breast cancer and evaluate its correlation with cytomorphological grading with derivation of suitable cutoff values between various grades. Settings and Designs: Descriptive cross-sectional hospital-based study. Materials and Methods: This study included 64 breast cancer cases (29 of grade 1, 22 of grade 2, and 13 of grade 3). Image analysis was performed on Papanicolaou stained FNAC slides by NIS –Elements Advanced Research software (Ver 4.00). Nuclear morphometric parameters analyzed included 5 nuclear size, 2 shape, 4 texture, and 2 density parameters. Results: Nuclear size parameters showed an increase in values with increasing cytological grades of carcinoma. Nuclear shape parameters were not found to be significantly different between the three grades. Among nuclear texture parameters, sum intensity, and sum brightness were found to be different between the three grades. Conclusion: Nuclear morphometry can be applied to augment the cytology grading of breast cancer and thus help in classifying patients into low and high-risk groups.

http://ift.tt/2mQzmfl

Cytopathological diagnosis and differential diagnoses of facial spindle cell lipoma

Manas Bajpai, Nilesh Pardhe

Journal of Cytology 2018 35(1):66-67



http://ift.tt/2BdHbzO

Comparative assessment of conventional papanicolaou and modified ultrafast papanicolaou stains in fine needle aspiration samples and body fluids

P Arul, S Eniya, Magesh Pushparaj, Suresh Masilamani, P Kanmani, C Lingasamy

Journal of Cytology 2018 35(1):46-50

Background: Conventional Papanicolaou (Pap) stain has undergone many modifications; of these, ultrafast Pap stain is the most popular as it shortens the turnaround time of reporting. Application of modified ultrafast Pap (MUFP) stain in the evaluation of fine needle aspiration (FNA) samples and body fluids are scanty. Aim: To evaluate the utility of MUFP stain in various FNA samples and body fluids and compare the findings with those of conventional Pap stain. Materials and Methods: In this cross-sectional study, two wet-fixed and two airdried smears from each sample [301 samples (255 FNA samples and 46 body fluids)] were prepared and stained by the conventional Pap and MUFP stains, respectively. Concordant and discordant rate was calculated. Quality index (QI) of MUFP stain was assessed by background, overall staining, cell morphology, and nuclear characteristics. MUFP-stained smears were also categorized into excellent, good, and fair. Results: The concordance rate for MUFP stain was 100%. QI of MUFP stain for breast, thyroid, lymph node, soft tissue, salivary gland, and body fluids was 0.9, 0.93, 0.95, 1, 0.94, and 1, respectively. Excellent quality of stain was noted in 53.2% and good in 24.6% of the cases allowing easy diagnosis. In 22.2% of fair cases, diagnosis was possible with some difficulties. Conclusion: Our study concluded that MUFP stain could be considered as a rapid and reliable diagnostic tool and can be applied on a regular basis in FNA samples and body fluids to offer immediate diagnosis. However, caution should be taken while reporting certain MUFP-stained smears to avoid over/under diagnosis.

http://ift.tt/2mQzhZ5

Diagnostic role of intraoperative imprint cytology in an unusual case of chondrosarcoma presenting as acute onset stridor

Paul K Benjith, Nikhil Moorchung, Angshuman Dutta, Deepti Mutreja

Journal of Cytology 2018 35(1):69-70



http://ift.tt/2BeBYYz

The effects of sediment transport on temporal variation in radiocesium concentrations in very shallow water off the southern coast of Fukushima, Japan

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Akira Matsumoto, Hiroshi Myouse, Hisayuki Arakawa, Ken Higuchi, Naoto Hirakawa, Yoshiaki Morioka, Takuji Mizuno
We studied the very shallow coastal water off Iwaki City, Fukushima Prefecture, and investigated: (1) temporal variation in ¹³⁷Cs concentrations; (2) particle-size distribution of sediments; and (3) the effect on variation by waves, component-fractionated concentration of radiocesium and mineral composition at three sampling stations (Yotsukura, Ena rocky reef and Ena sandy station). There was a decline in ¹³⁷Cs concentrations in sediment samples at all sampling stations between 425 and 1173 days after the accident. All stations had fluctuations in ¹³⁷Cs concentrations between 425 and 800 days. At Ena sandy station and Ena rocky reef stations the declines in ¹³⁷Cs concentrations slowed from about 800 days after the accident. Fluctuations in particle median diameters were seen, as well as in ¹³⁷Cs concentrations. At Yotsukura, where the fluctuation in median diameter was small, a constant decrease in ¹³⁷Cs concentrations was observed. We considered that bioturbation may contribute the constant decrease. At Ena sandy station, where the fluctuation of the median diameter was large, the fluctuation in ¹³⁷Cs concentrations was also large. The movement of sediments was evaluated by the Shields parameter, and results indicated that at any station where the sediment was moved more frequently, the fluctuation in ¹³⁷Cs concentrations was also large. The highly contaminated small particles moved from our stations due to wave action between 425 and 800 days after the accident. The remaining relatively large particles might contribute to the slowing down in reduction of ¹³⁷Cs concentrations from 800 days after the accident. However, the ¹³⁷Cs concentrations in sediments in very shallow water off the southern coast of Fukushima may continue to decline over time.



http://ift.tt/2BcVCEn

High-resolution 129I bomb peak profile in an ice core from SE-Dome site, Greenland

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Angel T. Bautista, Yasuto Miyake, Hiroyuki Matsuzaki, Yoshinori Iizuka, Kazuho Horiuchi
¹²⁹I in natural archives, such as ice cores, can be used as a proxy for human nuclear activities, age marker, and environmental tracer. Currently, there is only one published record of ¹²⁹I in ice core (i.e., from Fiescherhorn Glacier, Swiss Alps) and its limited time resolution (1–2 years) prevents the full use of ¹²⁹I for the mentioned applications. Here we show ¹²⁹I concentrations in an ice core from SE-Dome, Greenland, covering years 1956–1976 at a time resolution of ∼6 months, the most detailed record to date. Results revealed ¹²⁹I bomb peaks in years 1959, 1962, and 1963, associated to tests performed by the former Soviet Union, one year prior, in its Novaya Zemlya test site. All ¹²⁹I bomb peaks were observed in winter (1958.9, 1962.1, and 1963.0), while tritium bomb peaks, another prominent radionuclide associated with nuclear bomb testing, were observed in spring or summer (1959.3, and 1963.6; Iizuka et al., 2017). These results indicate that ¹²⁹I bomb peaks can be used as annual and seasonal age markers for these years. Furthermore, we found that ¹²⁹I recorded nuclear fuel reprocessing signals and that these can be potentially used to correct timing of estimated ¹²⁹I releases during years 1964–1976. Comparisons with other published records of ¹²⁹I in natural archives showed that ¹²⁹I can be used as common age marker and tracer for different types of records. Most notably, the 1963 ¹²⁹I bomb peak can be used as common age marker for ice and coral cores, providing the means to reconcile age models and associated trends from the polar and tropical regions, respectively.

Graphical abstract

http://ift.tt/2mSsdee

Experience of on-site disposal of production uranium-graphite nuclear reactor

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Alexander O. Pavliuk, Sergey G. Kotlyarevskiy, Evgeny V. Bespala, Elena V. Zakharova, Vyacheslav M. Ermolaev, Anna G. Volkova
The paper reported the experience gained in the course of decommissioning EI-2 Production Uranium-Graphite Nuclear Reactor. EI-2 was a production Uranium-Graphite Nuclear Reactor located on the Production and Demonstration Center for Uranium-Graphite Reactors JSC (PDC UGR JSC) site of Seversk City, Tomsk Region, Russia. EI-2 commenced its operation in 1958, and was shut down on December 28, 1990, having operated for the period of 33 years all together. The extra pure grade graphite for the moderator, water for the coolant, and uranium metal for the fuel were used in the reactor. During the operation nitrogen gas was passed through the graphite stack of the reactor. In the process of decommissioning the PDC UGR JSC site the cavities in the reactor space were filled with clay-based materials. A specific composite barrier material based on clays and minerals of Siberian Region was developed for the purpose. Numerical modeling demonstrated the developed clay composite would make efficient geological barriers preventing release of radionuclides into the environment.



http://ift.tt/2Bc6AKB

Comparisons between a new point kernel-based scheme and the infinite plane source assumption method for radiation calculation of deposited airborne radionuclides from nuclear power plants

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Xiaole Zhang, George Efthimiou, Yan Wang, Meng Huang
Radiation from the deposited radionuclides is indispensable information for environmental impact assessment of nuclear power plants and emergency management during nuclear accidents. Ground shine estimation is related to multiple physical processes, including atmospheric dispersion, deposition, soil and air radiation shielding. It still remains unclear that whether the normally adopted "infinite plane" source assumption for the ground shine calculation is accurate enough, especially for the area with highly heterogeneous deposition distribution near the release point. In this study, a new ground shine calculation scheme, which accounts for both the spatial deposition distribution and the properties of air and soil layers, is developed based on point kernel method. Two sets of "detector-centered" grids are proposed and optimized for both the deposition and radiation calculations to better simulate the results measured by the detectors, which will be beneficial for the applications such as source term estimation. The evaluation against the available data of Monte Carlo methods in the literature indicates that the errors of the new scheme are within 5% for the key radionuclides in nuclear accidents. The comparisons between the new scheme and "infinite plane" assumption indicate that the assumption is tenable (relative errors within 20%) for the area located 1 km away from the release source. Within 1 km range, the assumption mainly causes errors for wet deposition and the errors are independent of rain intensities. The results suggest that the new scheme should be adopted if the detectors are within 1 km from the source under the stable atmosphere (classes E and F), or the detectors are within 500 m under slightly unstable (class C) or neutral (class D) atmosphere. Otherwise, the infinite plane assumption is reasonable since the relative errors induced by this assumption are within 20%. The results here are only based on theoretical investigations. They should be further thoroughly evaluated with real measurements in the future.

Graphical abstract

http://ift.tt/2mXlpMP

Evaluation of abundance of artificial radionuclides in food products in South Korea and sources

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): S.H. Lee, J.S. Oh, K.B. Lee, J.M. Lee, S.H. Hwang, M.K. Lee, E.H. Kwon, C.S. Kim, I.H. Choi, I.Y. Yeo, J.Y. Yoon, J.M. Im
Food samples are collected nationwide from January 2016 to February 2017 and their contents of artificial radionuclides are measured to address the growing concerns regarding the radioactive contamination of food products in Korea. Specifically, 900 food samples are collected for this study and their contents of representative artificial radionuclides ¹³⁴Cs, ¹³⁷Cs, ^239,240Pu, and ⁹⁰Sr are analyzed. The analysis shows that the activity concentrations of ¹³⁷Cs in fish range from minimum detectable activity (MDA) to 340 mBq/kg of fresh weight. The concentration factor (CF) determined for ¹³⁷Cs as a measure of its bioavailability is calculated to be ca. 74 and found to be very similar to that (100) recommended by the International Atomic Energy Agency. With an MDA of <0.221 mBq/kg, the results reveal that ^239,240Pu values in fish are below the MDA. The activity concentrations of ¹³⁷Cs and ⁹⁰Sr are lower than the MDA in both shellfish and seaweed, while the activity concentrations of ^239,240Pu in shellfish range from 0.26 to 2.18 mBq/kg, and for seaweed samples range from 2.07 to 3.38 mBq/kg. The atom ratios of ²⁴⁰Pu/²³⁹Pu in shellfish caught at the Korean coast vary from 0.209 to 0.237, with a mean of 0.227. The higher ²⁴⁰Pu/²³⁹Pu atom ratio determined in shellfish is thought to be caused by the plutonium transported from the Pacific Proving Grounds rather than other sources such as the Fukushima nuclear power plant accident. The activity concentrations of ¹³⁷Cs in mushrooms are found to vary from 1.0 to 21.4 Bq/kg, with the highest concentrations observed in the Oak (shiitake) and Sarcodon asparatus. ¹³⁴Cs is detected in three mushroom specimens collected from Jeju Island and about 3–3.6% of ¹³⁷Cs present in the wild mushrooms native to the Jeju Island are introduced as a result of the Fukushima nuclear plant accident. The annual effective doses of ¹³⁷Cs received through consumption of mushrooms and fish are 2.0 × 10⁻⁴ mSv yr⁻¹ and 3.9 × 10⁻⁵ mSv yr⁻¹, and those values are negligible compared to the annual effective doses limit of 1 mSv yr⁻¹.



http://ift.tt/2Bc6sL7

Soil-to-plant transfer factors of natural radionuclides (226Ra and 40K) in selected Thai medicinal plants

Publication date: April 2018
Source:Journal of Environmental Radioactivity, Volumes 184–185
Author(s): Kiadtisak Saenboonruang, Endu Phonchanthuek, Kamonkhuan Prasandee
A soil-to-plant transfer factor (TF) is an important parameter that could be used to estimate radionuclides levels in medicinal plants. This work reports concentrations of natural radionuclides (²²⁶Ra and ⁴⁰K) and TFs in six Thai medicinal plants grown in central Thailand using an HPGe gamma ray spectrometer. Either root, leaf, or flower parts of each medicinal plant were selected for use in the investigation according to their practical uses in traditional medicine. The results showed that due to K being essential in plants, ⁴⁰K had higher arithmetic means of activity concentrations and geometric means of TFs (geometric standard deviations in parentheses) of 610 ± 260 Bq kg⁻¹ dry weight (DW) and 2.0 (1.4), respectively, than ²²⁶Ra, which had the activity concentrations and TFs of 4.8 ± 2.6 Bq kg⁻¹ DW and 0.17 (1.8), respectively. The results also showed that the leaves of medicinal plants had higher activity concentrations and TFs than root and flower parts, probably due to higher metabolic activities in leaves. Furthermore, there was good agreement between the results from the current work and other similar reports on medicinal plants. The information obtained from this work could strengthen knowledge of natural radionuclides in plants and particularly increase available TF data on Thai medicinal plants.



http://ift.tt/2mUoFbq

Source identification of uranium-containing materials at mine legacy sites in Portugal

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): A.C. Keatley, P.G. Martin, K.R. Hallam, O.D. Payton, R. Awbery, F. Carvalho, J.M. Oliveira, L. Silva, M. Malta, T.B. Scott
Whilst prior nuclear forensic studies have focused on identifying signatures to distinguish between different uranium deposit types, this paper focuses on providing a scientific basis for source identification of materials from different uranium mine sites within a single region, which can then be potentially used within nuclear forensics. A number of different tools, including gamma spectrometry, alpha spectrometry, mineralogy and major and minor elemental analysis, have been utilised to determine the provenance of uranium mineral samples collected at eight mine sites, located within three different uranium provinces, in Portugal. A radiation survey was initially conducted by foot and/or unmanned aerial vehicle at each site to assist sample collection. The results from each mine site were then compared to determine if individual mine sites could be distinguished based on characteristic elemental and isotopic signatures. Gamma and alpha spectrometry were used to differentiate between samples from different sites and also give an indication of past milling and mining activities. Ore samples from the different mine sites were found to be very similar in terms of gangue and uranium mineralogy. However, rarer minerals or specific impurity elements, such as calcium and copper, did permit some separation of the sites examined. In addition, classification rates using linear discriminant analysis were comparable to those in the literature.



http://ift.tt/2BeBpOx

Fostering Integrity in Research.

The integrity of knowledge that emerges from research is based on individual and collective adherence to core values of objectivity, honesty, openness, fairness, accountability, and stewardship. Integrity in science means that the organizations in which research is conducted encourage those involved to exemplify these values in every step of the research process. Understanding the dynamics that support — or distort — practices that uphold the integrity of research by all participants ensures that the research enterprise advances knowledge.

http://ift.tt/2riWNCF

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial.

Routine use of cell salvage during caesarean section had an uncertain effect on reducing blood transfusion and is unlikely to be considered cost-effective.

http://ift.tt/2FTb3Fe

Supplemental Project to Assess the Transparency of Reporting Requirements: Omega-3 Fatty Acids and Cardiovascular Disease [Internet].

Clinical trial registries that include prospective registration of study protocols and summarized results can inform the prevalence and impact of information bias. This methods report examines the feasibility and added utility of comprehensive searches of registries to supplement the evidence identified in an ongoing systematic review update on omega-3 fatty acids (n-3 FA) and CVD outcomes.

http://ift.tt/2rmE0WX

The Challenge of Treating Obesity and Overweight: Proceedings of a Workshop.

The Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on April 6, 2017, titled The Challenge of Treating Obesity and Overweight: A Workshop. The discussions covered treatments for obesity, overweight, and severe obesity in adults and children; emerging treatment opportunities; the development of a workforce for obesity treatments; payment and policy considerations; and promising paths to move forward. This publication summarizes the presentations and discussions from the workshop.

http://ift.tt/2FSmH3q

Lessons Learned from Diverse Efforts to Change Social Norms and Opportunities and Strategies to Promote Behavior Change in Behavioral Health: Proceedings of Two Workshops.

In 2015, the National Academies of Sciences, Engineering, and Medicine convened two workshops with oversight from the Committee on the Science of Changing Behavioral Health Social Norms. The workshops provided input to the committee's deliberations and contributed to the development of the report Ending Discrimination against People with Mental and Substance Use Disorders. That report was issued to help the Substance Abuse and Mental Health Services Administration and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, utilize the scientific evidence base in improving public attitudes toward and understanding of behavioral health, specifically in the areas of mental health and substance use disorders. This publication summarizes the presentations and discussions at the two workshops.

http://ift.tt/2rkro2O

Edoxaban (Lixiana) [Internet].

Atrial fibrillation (AF) is a common cardiac arrhythmia,, characterized by disorganized, rapid, and irregular activity of the atria (i.e., the upper chambers of the heart). AF is recognized as a chronic, progressive disorder associated with increased morbidity and mortality.– The Heart and Stroke Foundation estimates that approximately 350,000 Canadians are affected by AF. In all types of AF, embolization of atrial thrombi poses a significant risk of arterial thromboembolism, transient ischemic attack, and stroke, which are associated with high recurrence and substantial debilitating impact.,

http://ift.tt/2FP8KmK

Guidelines for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy, July 2017.

http://ift.tt/2riWK9X

Effects of Using Social Media in Health Awareness Campaigns to Promote Healthy Lifestyle Habits [Internet].

Facilitating and encouraging healthy behaviours is important to prevent illness and promote health. This systematic review investigates whether the use of social media can have an impact on healthy behavours. We included seven studies. We found many different interventions and most of the comparisons and outcomes were measured only by one small study.

http://ift.tt/2FTKIa2

Safety of BCG Vaccination in Pediatric Liver Transplant Recipients.

No abstract available

http://ift.tt/2mPoc9E

Causes, Preventability, and Cost of Unplanned Rehospitalizations Within 30 Days of Discharge Following Lung Transplantation.

Background: Unplanned rehospitalizations (UR) within 30 days of discharge are common following lung transplantation. It is unknown whether UR represent preventable gaps in care or necessary interventions for complex patients. The objective of this study was to assess the incidence, causes, risk factors, and preventability of UR following initial discharge after lung transplantation. Methods: This was a single-center prospective cohort study. Subjects completed a modified Short Physical Performance Battery (SPPB) to assess frailty at listing and at initial hospital discharge after transplantation and the State-Trait Anxiety Inventory (STAI) at discharge. For each UR a study staff member and the patient's admitting or attending clinician used an ordinal scale (0, not; 1, possibly; 2, definitely preventable) to rate readmission preventability. A total sum score >=2 defined a preventable UR. Results: Of the 90 enrolled patients, 30 (33.3%) had an UR. The single most common reasons were infection (7 (23.3%)) and atrial tachyarrhythmia (5 (16.7%)). Among the 30 UR, 9 (30.0%) were deemed preventable. UR that happened before day 30 were more likely to be considered preventable than those between days 30-90 (30.0% versus 6.2%, p = 0.04). Discharge frailty, defined as SPPB

http://ift.tt/2Do6ipJ

Quantifying Frailty in Post Lung Transplant Patients - Can We Predict Who Will Need Readmission?.

No abstract available

http://ift.tt/2DnpZ0L

Do Patients Supported With Continuous-Flow Left Ventricular Assist Device (CF-LVADS) Have a Sufficient Risk of Death to Justify a Priority Allocation? A Propensity-score Matched Analysis of Patients Listed In UNOS Status 2.

Background: Outcomes of Continuous Flow Left Ventricular Assist Devices (CF-LVADs) as bridge to transplant have significantly improved. The question has arisen whether patients on CF-LVADs have an increased risk of death on the waiting list as to justify a priority allocation (status 1). The aim of this study was to compare the survival following implantation of CF-LVADs to the survival on the waiting list for patients initially listed in United Network for Organ Sharing (UNOS) status 2. Methods: All patients >18 years listed for Heart Transplantation (HT) in the United States between 2011 and 2013 in UNOS status 2 with no mechanical circulatory support at time of listing were analyzed. Patients were divided into two groups depending on whether they received a new CF-LVAD while listed (CF-LVAD group) or not (NO-LVAD) and were further matched on their Propensity Score (PS) in a 1:2 ratio. Results: Two hundreds and eighty-seven CF-LVAD patients were matched to 574 NO-LVAD patients. Survival after CF-LVAD was significantly lower at 24-month compared to waiting list (75.4+4.4 versus 91.2+8.9%, p

http://ift.tt/2mN0Di0

The Authors' Reply.

No abstract available

http://ift.tt/2mP0KJQ

Important Facts About Organ Donation and OPO Performance.

No abstract available

http://ift.tt/2DnpDHt

Impact of Willingness to Accept Hepatitis C Seropositive Kidneys Among Hepatitis C RNA-positive Waitlisted Patients.

Background: Kidney transplantation from hepatitis C seropositive (HCV+) donors may benefit hepatitis C RNA-positive (RNA+) candidates, but it is unclear how the willingness to be listed for and accept such kidneys affects waitlist and transplant outcomes. Methods: In a single-center retrospective analysis, HCV+ transplant candidates (N=169) listed from March 2004 to February 2015 were evaluated. All RNA+ candidates were offered the option to be listed for HCV+ donors. RNA- candidates were listed only for HCV- donors. Results: Fifty-seven patients (51% of all RNA+ transplant candidates) willing to accept HCV+ donors were listed for both HCV+ and HCV- donor kidneys. During 6-yr follow up, 43 of 57 (75%) patients accepting HCV+ vs. 19 of 55 (35%) patients not accepting HCV+ received a deceased donor kidney transplant (DDKT, P

http://ift.tt/2mMo4I4

Prospective Assessment of Adenovirus Infection in Pediatric Kidney Transplant Recipients.

Background: Adenovirus infection is associated with graft dysfunction and graft loss in in pediatric cardiac, lung, and liver transplants in prior retrospective studies, but data in pediatric kidney transplant recipients is limited. Methods: We conducted a prospective single-center cohort study of 75 consecutive pediatric kidney transplant recipients who underwent monthly screening for adenovirus viremia and symptom assessment for 2 years posttransplant. Results: Adenovirus viremia was detected in eleven (14.7%) patients at a median onset of 173 (IQR 109-310) days posttransplant; six (8%) had asymptomatic viremia and five (6.7%) had symptomatic disease (2 with hematuria and 3 with an acute febrile respiratory illness). Viremic patients did not differ from nonviremic patients in age, immunosuppression management, or CMV or EBV serostatus, but were more likely to develop CMV viremia during the first 2 years posttransplant. No patient had an increase in creatinine from baseline during the time of adenovirus viremia. In a Cox proportional hazards regression, subclinical adenovirus viremia was not associated with a faster time to a 30% decline in eGFR. Conclusion: Adenovirus infection is common among pediatric kidney transplant recipients and frequently causes symptomatic disease; however, symptoms are often mild and are not associated with a decline in graft function. Routine monitoring for adenovirus viremia in pediatric kidney transplant recipients may not be warranted. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2Dnpzrd

Towards Systematic Screening for Persistent Hepatitis E Virus (HEV) Infections in Transplant Patients.

Background: Persistent hepatitis E virus genotype 3 (HEV G3) infections affect solid organ transplant (SOT) recipients and haematopoietic stem cell transplant (HSCT) recipients, but the burden in these cohorts in the UK is unknown. We established an audit to determine the point prevalence of HEV viraemia in SOT and HSCT patients in the UK and compare different testing approaches to inform screening strategies. Methods: Between 5th January and 21st September 2016, 3044 patients undergoing therapeutic drug monitoring at a single transplant centre were screened for HEV RNA in minipools. A total of 2822 patients who could be characterised included 2419 SOT patients, 144 HSCT patients and 259 patients with no available transplant history. HEV RNA-positive samples were characterised by serology and genomic phylogeny. HEV antigen (HEV-Ag) testing was performed on RNA-positive samples, 420 RNA-negative samples and 176 RNA-negative blood donor samples. Results: Nineteen of 2822 patients were viraemic with G3 HEV giving a prevalence of 0.67%. The median alanine aminotransferase (ALT) was significantly higher in the HEV viraemic patients (p

http://ift.tt/2Dq5Es0

Ethical Analysis and Policy Recommendations Regarding Domino Liver Transplantation.

Due to the widening gap between supply and demand, patients who need a liver transplant due to metabolic disease may be asked to serve as domino liver donors-to have their native liver transplanted into another candidate. We here analyze the ethical problems surrounding informed consent for the implant and explant procedures in transplant candidates who will serve as domino donors, using the case of a child with maple syrup urine disease. We discuss the need for two distinct consent processes separated in time to ensure that potential domino donors (or their surrogates) give a truly voluntary consent. We propose a Domino Donor Advocate - based on the concept of the Independent Living Donor Advocate to help the patient and/or his or her surrogates consider the risks, benefits and alternatives. Finally, we evaluate the Organ Procurement and Transplantation Network policy regarding "therapeutic organ donation" and propose several modifications to ensure that the decision by the potential domino donor (and/or his or her surrogate) is voluntary and informed. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mQFCTE

Superior Hypertension Management in Pediatric Kidney Transplant Patients After Native Nephrectomy.

Background: Native nephrectomy in pediatric kidney transplant recipients is performed for multiple indications. Posttransplant hypertension requiring medical management is common and the effect of native nephrectomy on posttransplant hypertension is poorly studied. Our aim is to evaluate the impact of native nephrectomy on posttransplant hypertension. Methods: 136 consecutive pediatric kidney transplant recipients from 2007 to 2012 were studied at a single institution and divided into 2 groups: no nephrectomy and native nephrectomy (unilateral and bilateral nephrectomy). Antihypertensive medication use was evaluated prior to nephrectomy/transplant, at discharge from transplant and at 1-, 3- and 5-years posttransplant. Results: In a bivariate analysis, nephrectomy was associated with a significant reduction in the percentage of patients requiring antihypertensive medication at the time of discharge (27.3%) and 1 year posttransplant (10.7%) as compared to patients without nephrectomy (71.7%, and 50%, respectively, p

http://ift.tt/2DoJjLn

Adipocytokines in Steatotic Liver Surgery/Transplantation.

Due to the shortage of liver grafts available for transplantation the restrictions on graft quality have been relaxed and marginal grafts such as steatotic livers are now accepted. However, this policy change has not solved the problem, because steatotic liver grafts tolerate ischemia-reperfusion injury poorly. Adipocytokines differentially modulate steatosis, inflammation, and fibrosis and are broadly present in hepatic resections and transplants. The potential use of adipocytokines as biomarkers of the severity of steatosis and liver damage to aid the identification of high-risk steatotic liver donors and to evaluate hepatic injury in the postoperative period are discussed. The hope of finding new therapeutic strategies aimed specifically at protecting steatotic livers undergoing surgery, is a strong impetus for identifying the mechanisms responsible for hepatic failure after major surgical intervention. Hence, the most recently described roles of adipocytokines in steatotic livers subject to ischemia-reperfusion injury are discussed, the conflicting results in the literature are summarized, and reasons are offered as to why strategic pharmacologic control of adipocytokines has yet to yield clinical benefits. Following this, the next steps needed to transfer basic knowledge about adipocytokines into clinical practice in order to protect marginal livers subject to ischemia-reperfusion injury are presented. Recent strategies based on adipocytokine regulation which have shown efficacy in various pathologies, and hold promise for hepatic resection and transplantation are also outlined. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mQFhAm

Degradation behavior of triclosan by co-exposure to chlorine dioxide and UV irradiation: influencing factors and toxicity changes

Abstract

This study investigated the transformation of triclosan (TCS) following co-exposure to UV irradiation and ClO₂. Special attention was given to understand the influencing of water quality parameters and toxicity changes during the co-exposure process. The results show that the co-exposure process prompted TCS elimination quickly and effectively, with more than 99% of TCS degraded under the experimental conditions. The molar yield ratios of 2,4-dichlorophenol/TCS (2,4-DCP/TCS) were calculated to be 35.81–74.49%; however, the by-product of 2,8-dichlorodibenzop-dioxin (2,8-Cl₂DD) was not detected. The TCS degradation was sensitive to ClO₂ dosage, pH, H₂O₂, and natural organic matter (NOM), but not to the carbonate (CO₃²⁻) concentration. Neutral and slightly alkaline condition were favorable to TCS elimination. The TCS removal rate increased from 85.33 to 99.75% when the ClO₂ concentration increased from 0.25 to 1.5 mg L⁻¹. TCS degradation can be promoted at low NOM level (1, 3, and 5 mg L⁻¹), whereas was inhibited at high NOM concentrations of 7 and 9 mg L⁻¹. While adding H₂O₂, the degradation rate of TCS increased with increasing H₂O₂ concentration from 1 to 3 mg L⁻¹; however, too low or overdosed H₂O₂ (0.5 and 5 mg L⁻¹) hindered TCS degradation. Based on the results of a microtox bioassay, the toxicity did not change following the co-exposure process.

http://ift.tt/2DoDZYp

Can Cd translocation in Oryza sativa L. be attenuated by arbuscular mycorrhizal fungi in the presence of EDTA?

Abstract

Arbuscular mycorrhizal (AM) fungi play an important role in plant tolerance of heavy metal contamination. In this study, a pot experiment was conducted to illustrate the effects of the two AM fungi species Funneliformis mosseae (Fm) and Rhizophagus irregularis (Ri) on plant growth of Oryza sativa L. either with or without ethylenediamine tetraacetate (EDTA) addition and during exposure to five Cd concentrations (in the range of 0–5 mg kg⁻¹). The results showed that Fm inoculation achieved greater mycorrhizal colonization and mycorrhizal dependency indexes than Ri inoculation. In addition, the effects of AM fungi on Cd biosorption and translocation in rice were also investigated in the presence of EDTA. Despite cooperative adsorption, the Freundlich isotherm could describe the biosorption effects of Cd on rice roots regardless of AM fungi inoculation or EDTA addition. Cd concentrations in mycorrhizal roots increased but decreased in mycorrhizal shoots in contrast to the control treatment. Although EDTA addition negatively inhibited the uptake of Cd to mycorrhizal shoots, lower translocation factor (TF) and bioconcentration factor (BCF) were still observed in treatments with EDTA compared to control treatment. Our findings suggest that Ri and Fm inoculation enhanced Cd immobilization in the roots, thus preventing Cd entry into the food chain during exposure to low and high Cd stress, respectively.

http://ift.tt/2mOGx6P

Enhanced reductive dechlorination of 1,1,1-trichloroethane using zero-valent iron-biochar-carrageenan microspheres: preparation and microcosm study

Abstract

In this study, a composite remediation material for the enhanced reductive dechlorination (ERD) of 1,1,1-trichloroethane (1,1,1-TCA) in aqueous solution was prepared. This material was comprised of biochar as the carrier and adsorbent, and carrageenan (CG) as the embedding medium to entrap the organic carbon sources and zero-valent iron (ZVI). We determined the suitable biochar dosage and organic carbon source in the composite alongside the optimal preparation conditions. Furthermore, using an anaerobic microcosm study, we discussed the performance and possible mechanisms of the composite on 1,1,1-TCA removal in aqueous solution. From this, we found that the suitable dosage of biochar in water during the preparation of composite microspheres was 0.2% (w/v). Under this condition, the biochar had a strong capacity to adsorb 1,1,1-TCA with a removal efficiency of 84.2%. Soluble starch was selected as the appropriate organic carbon source, because starch-microspheres show an excellent slow-release effect in water. The optimal preparation conditions of microspheres were identified as follows: 2% CG (w/v) colloidal solution, 6% CaCl₂ (w/v) solution, and a 12-h curing time. After 25-day incubation with the composite prepared under optimized conditions, the removal efficiency of 1,1,1-TCA was 95.68%, which was 24.69% higher than that observed in the microcosm with a commercial remediation material. The scanning electron microscopy (SEM) images show that the amounts of ZVI and soluble starch inside the microsphere decreased obviously, while the biochar amount remained about the same. This indicates that 1,1,1-TCA in aqueous solution was mainly removed via soluble starch-enhanced biotic reductive dechlorination and ZVI-enhanced abiotic reductive dechlorination. The changes in microbial community structure demonstrate that the composite stimulated the activities of functional anaerobic bacteria, in particular, regarding dechlorination and fermentation abilities in the microcosm, therefore enhancing the anaerobic biodegradation of 1,1,1-TCA. This study suggests that the composite, entrapping biochar, ZVI, and organic carbon source in CG microspheres can significantly enhance the reductive dechlorination of 1,1,1-TCA in aqueous solution. We anticipate this novel remediation material could be successfully applied to the in situ ERD remediation of natural groundwater mainly contaminated with 1,1,1-TCA.

http://ift.tt/2DpuSXq

Refractory Pain Management in Amyloid-Associated Peripheral Neuropathy.

Objective: Systemic amyloidosis is a disease that often involves multiple organ systems, including the peripheral nervous system. Patients may present with severe, refractory neuropathic pain; however, the optimal treatment approach for pain for these patients remains unclear. Case Report: A man with severe, refractory neuropathic pain in his bilateral upper and lower extremities and the trunk secondary to amyloid neuropathy is presented. Multiple medication trials, including neuropathic and opioid agents, produced considerable adverse effects and minimal relief. Scrambler therapy, a novel electrical stimulation modality, was used and was associated with substantial short-term but nonsustained benefit. Spinal cord stimulation was considered, but given his diffuse symptoms, it was deemed a less-than-optimal approach. Ultimately, an intrathecal drug delivery system was placed with infusion of hydromorphone, resulting in substantial pain reduction in all involved areas and with an improved adverse effect profile. This intervention resulted in immense improvement in the patient's quality of life, despite progression of his systemic amyloidosis. Conclusions: Severe pain in the setting of amyloid neuropathy is often difficult to treat. To our knowledge, this represents the first report of Scrambler therapy or an implanted intrathecal drug delivery system used for a patient with refractory amyloidosis-related neuropathic pain, resulting in substantial analgesic benefit and improved quality of life. Copyright (C) 2018 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2DNATdm

Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone.

Background and Objectives: High-dose intravenous dexamethasone reduces the postoperative opioid requirement and is often included in the multimodal analgesia strategy after total knee arthroplasty (TKA). Combined obturator nerve and femoral triangle blockade (OFB) reduces the opioid consumption and pain after TKA better than local infiltration analgesia (LIA). The question is whether preoperative high-dose intravenous dexamethasone would cancel out the superior analgesic effect of OFB compared with LIA. The aim was to evaluate the analgesic effect of OFB versus LIA after TKA when all patients received high-dose intravenous dexamethasone. Methods: Eighty-two patients were randomly assigned either to OFB or LIA after primary unilateral TKA. All patients received 16 mg dexamethasone. Primary outcome was morphine consumption via patient-controlled analgesia during the first 20 postoperative hours. Secondary outcomes were pain, nausea, dizziness, and length of hospital stay. Results: Seventy-four patients were included in the analysis. Median total intravenous morphine consumption during the first 20 postoperative hours was 6 mg (interquartile range [IQR], 2-18 mg) in the OFB group and 20 mg (IQR, 12-28 mg) in the LIA group. The 14-mg difference (95% confidence interval, 6.4-18.0 mg) was significant (P

http://ift.tt/2DhBqDc