Effects of thymol on amyloid-β-induced impairments in hippocampal synaptic plasticity in rats fed a high-fat diet

Publication date: Available online 13 January 2018
Source:Brain Research Bulletin
Author(s): Masoumeh Asadbegi, Alireza Komaki, Iraj Salehi, Parichehreh Yaghmaei, Azadeh Ebrahim-Habibi, Siamak Shahidi, Abdolrahman Sarihi, Sara Soleimani Asl, Zoleikha Golipoor
Obesity and a high-fat diet (HFD) are known to increase the incidence of Alzheimer's disease (AD). Oxidative stress, a major risk factor for AD, is increased with HFD consumption. Thymol (Thy) has antioxidant properties. Therefore, in the present study, we examined the protective and therapeutic effects of Thy on amyloid-β (Aβ)-induced impairments in the hippocampal synaptic plasticity of HFD-fed rats. In this study, 72 adult male Wistar rats were randomly assigned to 9 groups (n = 8 rats/group): Group 1 (control; standard diet); Group 2: Control + phosphate-buffered saline (PBS) + Oil (Thy vehicle); Group 3 (HFD + PBS); Group 4: (HFD + Aβ); Group 5: Control + PBS + Thy; Group 6: (HFD + Aβ + Oil); Group 7: Control + Aβ + Thy; Group 8: HFD + PBS + Thy; Group 9: (HFD + Aβ + Thy). After stereotaxic surgery, the field potentials were recorded after the implantation of the recording and stimulating electrodes in the dentate gyrus (DG) and perforant pathway, respectively. Following high-frequency stimulation, the long-term potentiation (LTP) of the population spike (PS) amplitude and the slope of the excitatory postsynaptic potentials (EPSPs) were measured in the DG. The HFD rats that received Aβ exhibited a significant decrease in their EPSP slope and PS amplitude as compared to the control group. In contrast, Thy administration in the HFD + Aβ rats reduced the decrease in the EPSP slope and PS amplitude. Thy decreased the Aβ-induced LTP impairments in HFD rats. The HFD significantly increased serum malondialdehyde levels and decreased total antioxidant capacity and total glutathione levels; whereas, Thy supplementation significantly reversed these parameters. Therefore, these results suggest that Thy, a natural antioxidant, can be therapeutic against high risk factors for AD, such as HFD.



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Editorial Board

Publication date: January 2018
Source:Brain Research Bulletin, Volume 136





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Normative distribution of substance P and its tachykinin neurokinin-1 receptor in the medullary serotonergic network of the human infant during postnatal development

Publication date: Available online 11 January 2018
Source:Brain Research Bulletin
Author(s): Fiona M. Bright, Roger W. Byard, Robert Vink, David S. Paterson
Substance P (SP) and its tachykinin NK1 receptor (NK1R) function within key medullary nuclei to regulate cardiorespiratory and autonomic control. We examined the normative distribution of SP and NK1R in the serotonergic (5-Hydroxytryptamine, [5-HT]) network of the human infant medulla during postnatal development, to provide a baseline to facilitate future analysis of the SP/NK1R system and its interaction with 5-HT within pediatric brainstem disorders in early life. [¹²⁵I] labelled Bolton Hunter SP (BH-SP) tissue receptor autoradiography (n = 15), single label immunohistochemistry (IHC) and double label immunofluorescence (IF) (n = 10) were used to characterize the normative distribution profile of SP and NK1R in the 5-HT network of the human infant medulla during postnatal development. Tissue receptor autoradiography revealed extensive distribution of SP and NK1R in nuclei intimately related to cardiorespiratory function and autonomic control, with significant co-distribution and co-localization with 5-HT in the medullary network in the normal human infant during development. A trend for NK1R binding to decrease with age was observed with significantly higher binding in premature and male infants. We provide further evidence to suggest a significant role for SP/NK1R in the early postnatal period in the modulation of medullary cardiorespiratory and autonomic control in conjunction with medullary 5-HT mediated pathways and provide a baseline for future analysis of the potential consequences of abnormalities in these brainstem neurotransmitter networks during development.



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Retinal Arterio-Arterial Collaterals in Susac Syndrome

Background: The ophthalmic findings of Susac syndrome (SS) consist of visual field defects related to branch retinal artery occlusion (BRAO), and fluorescein angiography (FA) reveals a unique staining pattern. To date, retinal arterial collateral development has been described only in a single patient. Given that the immunopathological process in SS induces retinal ischemia, it is conceivable that abnormal blood vessel development may occur in affected individuals. Methods: This is a retrospective observational study. The medical records including fundus photography and FA of all patients with SS were reviewed, and those with any type of retinal arterial collateral were identified. Results: A total of 11 patients were identified with retinal collaterals. Five were men. Age ranged from 20 to 50 years. Ten patients had arterio-arterial (A-A) collaterals and 1 had arterio-venous (A-V) collaterals, and all had collaterals remote from the optic disc. No collaterals were present at onset of illness and the first developed at 9 months. Conclusions: The literature reveals scant evidence for the association between BRAO and retinal arterial collaterals. Our findings indicate that retinal arterial collaterals in SS are usually A-A and not A-V and may be more common in this disorder than previously believed. Collaterals do not develop early in the disease, and there may be a predilection toward development in men. The chronic inflammatory state of SS may be the stimulus for the development of these arterial collaterals. Address correspondence to Robert A. Egan, MD, Department of Neurology, Rockwood Clinic, 910 W. 5th Avenue, Suite 1000, Spokane, WA 99204; E-mail: Eganr8@gmail.com The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Literature Commentary

In this issue of Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD and Mark L. Moster, MD will discuss the following 6 articles: Nachev P, Rose GE, Verity DH, Manohar SG, MacKenzie K, Adams G, Theodorou M, Pankhurst QA, Kennard C. Magnetic oculomotor prosthetics for acquired nystagmus. Ophthalmology. 2017;124:1556–1564.Vestergaard N, Rosenberg T, Torp-Pedersen C, Vorum H, Andersen CU, Aasbjerg K. Increased mortality and comorbidity associated with Leber's hereditary optic neuropathy: a nationwide cohort study. Invest Ophthalmol Vis Sci. 2017;58:4586–4592.Roberts DR, Albrecht MH, Collins HR, Asemani D, Chatterjee AR, Spampinato MV, Zhu X, Chimowitz MI, Antonucci MU. Effects of space flight on astronaut brain structure as indicated on MRI. N Engl J Med. 2017;377:1746–1753.Klawiter EC, Bove R, Elsone L, Alvarez E, Borisow N, Cortez M, Mateen F, Mealy MA, Sorum J, Mutch K, Tobyne SM, Ruprecht K, Buckle G, Levy M, Wingerchuk D, Paul F, Cross AH, Jacobs A, Chitnis T, Weinshenker B. High risk of postpartum relapses in neuromyelitis optica spectrum disorder. Neurology. 2017;89:2238–2244.Ahle G, Touitou V, Cassoux N, Bouyon M, Humbrecht C, Oesterlé H, Baraniskin A, Soussain C, Nguyen-Them L, Gaultier C, Hoang-Xuan K, Houillier C. Optic nerve infiltration in primary central nervous system lymphoma. JAMA Neurol. 2017;74:1368–1373.Gelfand JM, Bradshaw MJ, Stern BJ, Clifford DB, Wang Y, Cho TA, Koth LL, Hauser SL, Dierkhising J, Vu N, Sriram S, Moses H, Bagnato F, Kaufmann JA, Ammah DJ, Yohannes TH, Hamblin MJ, Venna N, Green AJ, Pawate S. Infliximab for the treatment of CNS sarcoidosis: a multi-institutional series. Neurology. 2017;89:2092–2100. © 2018 by North American Neuro-Ophthalmology Society

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Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology

Background: To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology. Design: Retrospective, cross-sectional study. Subjects: Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included. Methods: A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital. Patients were included if vision loss was unilateral and due to transient monocular vision loss (TMVL), central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Any patients with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, nonvascular intraocular pathology, and intracranial pathology other than ischemic stroke. Main Outcome Measures: The presence or absence of acute stroke on diffusion-weighted imaging (DWI) on brain MRI. Results: A total of 641 records were reviewed, with 293 patients found to have MVL. After excluding those with focal neurologic deficits, there were 41 patients who met the inclusion criteria and received a brain MRI. Eight of the 41 subjects (19.5%) were found to have findings on brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in TMVL subjects, 4/12 (33.3%) in CRAO subjects, and 2/5 (40%) in BRAO subjects. Brain computed tomography (CT) scans were not able to identify the majority of acute stroke lesions in this study. Conclusions: Patients with MVL of vascular etiology such as TMVL, CRAO, or BRAO may have up to 19.5% risk of concurrent ischemic stroke, even when there are no other neurologic deficits. These strokes were detected acutely with brain MRI using DWI but were missed on CT. Address correspondence to Jason Zhang, MD, Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, 40 Temple Street, Suite 3D, New Haven, CT 06510; E-mail: jason.zhang@yale.edu Presented at the American Academy of Ophthalmology Annual Meeting, November 14–17, 2015, Las Vegas, NV. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (http://ift.tt/2BFTkP1). © 2018 by North American Neuro-Ophthalmology Society

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Serum irisin concentrations in lean adolescents with polycystic ovary syndrome

Summary

Objective

To explore differences in irisin concentrations between lean adolescents with PCOS and age- and body mass index (BMI)-matched controls and examine the associations of irisin with core features of the syndrome.

Design

Cross-sectional study.

Patients

Lean females with PCOS, aged 13-21 years.

Measurements

Physical, hormonal and sonographic assessment. Irisin concentrations were measured with ELISA.

Results

Participants included in total 39 sedentary females (mean±SD; age 17.3±2.1 years, BMI 20.7±1.3 Kg/m²); 23 adolescents with PCOS and 16 controls. Adolescents with PCOS compared to controls, had significantly elevated concentrations of fasting serum irisin (mean±SD; PCOS, 1.7±1.0 μg/mL vs. controls, 1.0±0.4 μg/mL; P=.007), luteinizing hormone (LH), estradiol, testosterone, Δ4-androstenedione, 17-hydroxyprogesterone, glucose, as well as free-androgen index, Ferriman-Gallwey score and mean ovarian volume (MOV).

For the total sample, circulating irisin was positively correlated with MOV (r=.593, P=.020), glucose (r=.428, P=.007), insulin (r_s=.369, P=.021), HOMA-IR (r_s=.422, P=.007) and negatively correlated with QUICKI (r=-.329, P=.041). Follicle-stimulating hormone (B=0.295, Beta=.342, P=.042) and MOV (B=0.182, Beta=.821, P=.001) were positive predictors and LH (B=-0.108, Beta=-.523, P=.010) and testosterone (B=-0.431, Beta=-.457, P=.032) negative predictors of irisin concentrations, whereas irisin positively predicted fasting glucose (B=4.728, Beta=.428, P=.007).

In the PCOS group, irisin concentrations were positively correlated with HOMA-IR (r_s=.416, P=.048) but negatively correlated with LH (r_s=-.499, P=.015), testosterone (r=-.585, P=.003), free-androgen index (r=-.426, P=.048) and Ferriman-Gallwey score (r=-.533, P=.015).

Conclusions

Irisin was associated with the adolescents' metabolic and reproductive characteristics and the hyperandrogenic phenotype of the syndrome. More research is needed to ascertain mechanisms of elevated serum irisin in adolescent PCOS.

This article is protected by copyright. All rights reserved.

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Genetic Influences on the Development of Cerebral Cortical Thickness During Childhood and Adolescence in a Dutch Longitudinal Twin Sample: The Brainscale Study

Abstract

Previous studies have demonstrated that cortical thickness (CT) is under strong genetic control across the life span. However, little is known about genetic influences that cause changes in cortical thickness (ΔCT) during brain development. We obtained 482 longitudinal MRI scans at ages 9, 12, and 17 years from 215 twins and applied structural equation modeling to estimate genetic influences on (1) cortical thickness between regions and across time, and (2) changes in cortical thickness between ages. Although cortical thickness is largely mediated by the same genetic factor throughout late childhood and adolescence, we found evidence for influences of distinct genetic factors on regions across space and time. In addition, we found genetic influences for cortical thinning during adolescence that is mostly due to fluctuating influences from the same genetic factor, with evidence of local influences from a second emerging genetic factor. This fluctuating core genetic factor and emerging novel genetic factor might be implicated in the rapid cognitive and behavioral development during childhood and adolescence, and could potentially be targets for investigation into the manifestation of psychiatric disorders that have their origin in childhood and adolescence.

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Subthreshold Activity Underlying the Diversity and Selectivity of the Primary Auditory Cortex Studied by Intracellular Recordings in Awake Marmosets

Abstract

Extracellular recording studies have revealed diverse and selective neural responses in the primary auditory cortex (A1) of awake animals. However, we have limited knowledge on subthreshold events that give rise to these responses, especially in non-human primates, as intracellular recordings in awake animals pose substantial technical challenges. We developed a novel intracellular recording technique in awake marmosets to systematically study subthreshold activity of A1 neurons that underlies their diverse and selective spiking responses. Our findings showed that in contrast to predominantly transient depolarization observed in A1 of anesthetized animals, both transient and sustained depolarization (during or beyond the stimulus period) were observed. Comparing with spiking responses, subthreshold responses were often longer lasting in duration and more broadly tuned in frequency, and showed narrower intensity tuning in non-monotonic neurons and lower response threshold in monotonic neurons. These observations demonstrated the enhancement of stimulus selectivity from subthreshold to spiking responses in individual A1 neurons. Furthermore, A1 neurons classified as regular- or fast-spiking subpopulation based on their spike shapes exhibited distinct response properties in frequency and intensity domains. These findings provide valuable insights into cortical integration and transformation of auditory information at the cellular level in auditory cortex of awake non-human primates.

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Genetic Complexity of Cortical Structure: Differences in Genetic and Environmental Factors Influencing Cortical Surface Area and Thickness

Abstract

Quantifying the genetic architecture of the cerebral cortex is necessary for understanding disease and changes to the brain across the lifespan. Prior work shows that both surface area (SA) and cortical thickness (CT) are heritable. However, we do not yet understand the extent to which region-specific genetic factors (i.e., independent of global effects) play a dominant role in the regional patterning or inter-regional associations across the cortex. Using a population sample of young adult twins (N = 923), we show that the heritability of SA and CT varies widely across regions, generally independent of measurement error. When global effects are controlled for, we detected a complex pattern of genetically mediated clusters of inter-regional associations, which varied between hemispheres. There were generally weak associations between the SA of different regions, except within the occipital lobe, whereas CT was positively correlated within lobar divisions and negatively correlated across lobes, mostly due to genetic covariation. These findings were replicated in an independent sample of twins and siblings (N = 698) from the Human Connectome Project. The different genetic contributions to SA and CT across regions reveal the value of quantifying sources of covariation to appreciate the genetic complexity of cortical structures.

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JNA Journal Club

No abstract available

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Correction to: Effect of 1064-nm Q-switched Nd:YAG laser on invasiveness and innate immune response in keratinocytes infected with Candida albicans

Abstract

In the published online version of the article, the authors' given and family names were incorrectly captured. The corrected names are shown in the author group section above.

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Effect of preoperative immunonutrition on postoperative short-term outcomes of patients with head and neck squamous cell carcinoma

Abstract

Background

Patients with head and neck squamous cell carcinoma (HNSCC) often acquire an impaired nutritional status resulting in compromised outcomes. Perioperative immunonutrition may have a positive effect on outcomes after elective surgery.

Methods

Short-term outcomes before and after implementation of preoperative immunonutrition were retrospectively assessed. Regression models adjusted for outcome predictors were used to compare the length of stay (LOS) in the hospital, local infections, and general complications.

Results

Four hundred eleven patients were included (control group = 209 and the intervention group = 202). With immunonutrition, hospital LOS was significantly lower (median 6 vs 8 days; adjusted mean difference of −5.65 days; P < .001) and local infections were significantly reduced (7.4% vs 15.3%; adjusted odds ratio [OR] 0.30; P = .006). Subgroup analysis showed more pronounced effects in patients with previous radiotherapy and extensive surgery.

Conclusion

Patients receiving preoperative immunonutrition had a shorter hospital LOS and a lower rate for wound infections and local complications. These effects remained robust after a multivariate adjustment.

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Visualization of viscoelastic behavior in skin equivalent using optical coherence tomography-based straingraphy

Abstract

Background/Purpose

The relationships between the skin components and these mechanical roles are still unclear. To clarify these relationships, we investigated spatial mapping of the mechanical behavior of cultured skin equivalents (SEs) using optical coherence tomography (OCT)-based straingraphy.

Methods

We built a strain relaxation test system combined with OCT and developed an algorithm that could visualize a time-dependent strain distribution, named dynamic-optical coherence straingraphy (D-OCSA). Using this system, we analyzed how the spatial mechanical changes in the SEs depended on the culture duration. For quantitative analysis of viscoelastic behavior, we defined a relaxation attenuation coefficient of strain rate, which indicates the ratio of viscosity and elasticity in the Klevin-Voight model.

Results

By culturing for 4 days in comparison to culturing for 1 day, the strain relaxation attenuation coefficient of the whole skin, especially at the region of the dermal-epidermal junction (DEJ), significantly increased in the negative direction. In tissue slices taken for microscopy, several cracks were observed in the SEs cultured for 4 days.

Conclusion

This study is the first to provide quantified evidence that the DEJ is a dynamically specialized region. An OCT-based straingraphy system (D-OCSA) would be beneficial for evaluating the quality of SEs, as well as functional analysis of their mechanics.

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Wrinkle and roughness measurement by the Antera 3D and its application for evaluation of cosmetic products

Abstract

Background

Skin topographic measurements are of paramount importance in the field of dermo-cosmetic evaluation. The aim of this study was to investigate how the Antera 3D, a multi-purpose handheld camera, correlates with other topographic techniques and changes in skin topography following the use of a cosmetic product.

Methods

Skin topographic measurements were collected on 26 female volunteers aged 45-70 years with the Antera 3D, the DermaTOP and image analysis on parallel-polarized pictures. Different filters for analysis from the Antera 3D were investigated for repeatability, correlations with other imaging techniques and ability to detect improvements of skin topography following application of a serum.

Results

Most of Antera 3D parameters were found to be strongly correlated with the DermaTOP parameters. No association was found between the Antera 3D parameters and measurements on parallel-polarized photographs. The measurements repeatability was comparable among the different filters for analysis, with the exception of wrinkle max depth and roughness Rt. Following a single application of a tightening serum, both Antera 3D wrinkles and texture parameters were able to record significant improvements, with the best improvements observed with the large filter.

Conclusion

The Antera 3D demonstrated its relevance for cosmetic product evaluation. We also provide recommendations for the analysis based on our findings.

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Neural signatures for active maintenance and interference during working memory updating

Publication date: Available online 12 January 2018
Source:Biological Psychology
Author(s): Adrià Vilà-Balló, Juha Salmi, Anna Soveri, Antoni Rodríguez-Fornells, Minna Lehtonen, Matti Laine
Although working memory (WM) is amongst the most studied neurocognitive functions, temporal patterns of its component processes are not fully understood. We examined the neural underpinnings of active maintenance and interference management in the n-back task by manipulating load (1-back vs 3-back) and including so-called lure stimuli. ERPs of 27 young adults revealed that the 1-back condition enabling active maintenance showed a positive slow wave (PSW) prior to the next stimulus (-600–0 ms) and augmented P2 (190–290 ms) and P3b (330–430 ms) responses after the stimulus appeared, albeit the latter effects were driven by the initial PSW. Moreover, PSW amplitude correlated negatively with reaction time in the 1-back condition. Responses to lures showed interference, accompanied with different ERP effects for the two load levels. Our results support the view that PSW reflects efficient WM maintenance and suggest two distinct neuronal correlates for interference in WM.



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A profile of Propionibacterium acnes resistance and sensitivity at a tertiary dermatological centre in Singapore

Propionibacterium acnes (P. acnes) is a key component in the pathogenesis of acne. Both topical and oral antibiotics are key therapeutic options. Unfortunately, antibiotic resistance is rapidly increasing globally. Many countries have reported greater than 50% of P.acnes strains acquiring resistance to topical macrolides^1-3. In Singapore, antibiotic resistance rates of 8% in 1999⁴ rising to 14.9%⁵ in 2007 were reported. We aimed to update the local prevalence of antibiotic resistance and identify features which may distinguish patients demonstrating antibiotic resistance from those who are pan-sensitive.

This article is protected by copyright. All rights reserved.

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Pulsed-dye laser therapy for carcinoma in situ of the penis

Carcinoma in situ (CIS) of the penis is a precancerous condition with a 5 to 10% risk for progression into an invasive penile squamous cell carcinoma (SCC)¹. Clinical variants of genital CIS encompass bowenoid papulosis, erythroplasia of Queyrat and Bowen's disease. Treatment options of penile CIS include topical application of 5-fluorouracil (5-FU) or imiquimod, photodynamic therapy (PDT), ablative laser therapy, cryotherapy and surgery² .

This article is protected by copyright. All rights reserved.

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Omalizumab updosing allows disease activity control in refractory patients with chronic spontaneous urticaria

Omalizumab has been shown to be a very effective drug in chronic spontaneous urticaria (CSU) improving patients' quality of life.¹ Phase III clinical trials ASTERIA I/II and GLACIAL showed respectively 58.8-52.4% of patients achieving a twice daily average Urticaria Activity Score 7 (UAS7td)≤6 at week 12.² Outside of clinical trials, the response varies between 77-83%.³ However, some patients do not achieve well-controlled activity of the disease with the licensed dose of omalizumab (300mg/4 weeks).

This article is protected by copyright. All rights reserved.

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A profile of Propionibacterium acnes resistance and sensitivity at a tertiary dermatological centre in Singapore

Propionibacterium acnes (P. acnes) is a key component in the pathogenesis of acne. Both topical and oral antibiotics are key therapeutic options. Unfortunately, antibiotic resistance is rapidly increasing globally. Many countries have reported greater than 50% of P.acnes strains acquiring resistance to topical macrolides^1-3. In Singapore, antibiotic resistance rates of 8% in 1999⁴ rising to 14.9%⁵ in 2007 were reported. We aimed to update the local prevalence of antibiotic resistance and identify features which may distinguish patients demonstrating antibiotic resistance from those who are pan-sensitive.

This article is protected by copyright. All rights reserved.

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Pulsed-dye laser therapy for carcinoma in situ of the penis

Carcinoma in situ (CIS) of the penis is a precancerous condition with a 5 to 10% risk for progression into an invasive penile squamous cell carcinoma (SCC)¹. Clinical variants of genital CIS encompass bowenoid papulosis, erythroplasia of Queyrat and Bowen's disease. Treatment options of penile CIS include topical application of 5-fluorouracil (5-FU) or imiquimod, photodynamic therapy (PDT), ablative laser therapy, cryotherapy and surgery² .

This article is protected by copyright. All rights reserved.

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Omalizumab updosing allows disease activity control in refractory patients with chronic spontaneous urticaria

Omalizumab has been shown to be a very effective drug in chronic spontaneous urticaria (CSU) improving patients' quality of life.¹ Phase III clinical trials ASTERIA I/II and GLACIAL showed respectively 58.8-52.4% of patients achieving a twice daily average Urticaria Activity Score 7 (UAS7td)≤6 at week 12.² Outside of clinical trials, the response varies between 77-83%.³ However, some patients do not achieve well-controlled activity of the disease with the licensed dose of omalizumab (300mg/4 weeks).

This article is protected by copyright. All rights reserved.

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Dermoscopic features of pilar leiomyomas

Cutaneous pilar leiomyomas are benign smooth muscle neoplasms that usually present as painful firm erythematous to brown coloured papules and nodules.¹ Dermoscopy has been used as an auxiliary tool in the diagnosis of various cutaneous tumors. Herein we report the various dermoscopic features of 48 cutaneous pilar leiomyomas in five patients.

This article is protected by copyright. All rights reserved.

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Evaluation of the cognitive effect of newborn resuscitation training on health-care workers in selected states in Northern Nigeria

Lawal Waisu Umar, Hafsat Rufa'I Ahmad, Abdulkadir Isah, Hafsat Wasagu Idris, Laila Hassan, Fatima Laraba Abdullahi, Ishaku Hassan, Abubakar Yakubu, Abubakar Muhammad Zubairu, Jane Alison Jobling

Annals of African Medicine 2018 17(1):33-39

Background: Neonatal deaths contribute significantly to slower progress in under-5 mortality reduction. Lack of sufficiently trained birth assistants partly contributes to early neonatal deaths. Resuscitation training equips frontline health-care workers (HCWs) with requisite knowledge and skills to prevent birth asphyxia. Objective: The objective of this study was to evaluate the immediate impact of newborn resuscitation training on cognitive ability of HCWs. Materials and Methods: This is a descriptive observational study using pre- and posttraining scores obtained by HCWs who were participants in 1-day training on emergency newborn resuscitation. The Newborn Resuscitation Manual of the UK Resuscitation Council (2006) was used to train HCWs. The course included lectures, skill and scenario demonstrations using mannequins, and basic resuscitation equipment. Cognitive knowledge was evaluated using a pre- and post-training questionnaire. Participants' scores were collated, analyzed, and results were presented as tables, charts, and descriptive statistics with P < 0.05 considered statistically significant. Results: A total of 293 HCWs completed the course (81 doctors and 212 nurse/midwives), with variable improvements of mean posttraining marks over the pretraining scores. Resident doctors obtained significantly higher mean pre- and post-training marks with lower mean difference than senior doctors and medical officers. The junior nurses obtained significantly higher mean pretraining scores compared to the senior nursing cadre, while the intermediate nursing cadre obtained significantly higher mean posttraining scores compared to senior nurses. Conclusion: Resuscitation training improved the knowledge of HCWs. Further evaluation could ascertain impacts on knowledge/skills' retention and neonatal survival. Preservice training and continuing education for frontline HCWs who conduct deliveries are recommended.

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Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

BS Alabi, OA Afolabi, AD Dunmade, HK Omokanye, IO Ajayi, SO Ayodele, NO Busari

Annals of African Medicine 2018 17(1):1-6

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

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The astigmatic effect of pterygium in a Tertiary Hospital in Kano, Nigeria

Abdu Lawan, Sadiq Hassan, Ebisike Philips Ifeanyichukwu, Hadi Bala Yahaya, Rabi Yahaya Sani, Saudat Garba Habib, Abdulsalam Shuaib, Okpo Eme

Annals of African Medicine 2018 17(1):7-10

Aim: This study aims to determine the effect of pterygium excision on the degree of corneal induced astigmatism and visual acuity. Patients and Methods: This was a prospective interventional study conducted between September 2012 and June 2013. Consecutive patients with pterygium who met the inclusion criteria were recruited into the study. They had a basic eye examination, and those with existing comorbidity were excluded. Selected patients had pterygium excision using the bare sclera technique with intraoperative application of Mitomycin C. Detailed pre- and post-operative evaluation and refraction was done. Results: There were 45 eyes of 33 patients aged 28–75 years. The mean age was 56.12 + 12.38 years. Six eyes had Grade I, 29 eyes had Grade II and 10 eyes had Grade III pterygium. The mean value for preoperative astigmatism was 2.12 ± 1.09 diopter cylinder (DC) while that for postoperative astigmatism was 0.72 ± 0.50 DC (P = 0.000). Surgery was associated with statistically significant increase in postoperative visual acuity. (P = 0.000).Conclusion: This study has shown that the degree of pterygium-induced astigmatism reduces significantly following surgical excision. Pterygium excision was associated with improvement in visual acuity.

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Drug-induced oral erythema multiforme: A diagnostic challenge

Syed Ahmed Taqi

Annals of African Medicine 2018 17(1):43-45

Trimethoprim-sulfamethoxazole (cotrimoxazole or TMP/SMX) is commonly used for the treatment of urinary or lower respiratory tract infections. A comprehensive review is presented of the world literature on adverse reactions to TMP/SMX since its first use in 1968, when concern was expressed about possible hematologic toxicity. The adverse reactions to TMP/SMX occur in approximately 1%–3% of persons in general population. Here, we report a case of oral erythema multiforme (EM) secondary to TMP/SMX that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of distinguishing them from other ulcerative disorders involving oral cavity. The patient was treated symptomatically and given tablet prednisolone. The condition improved with stoppage of TMP/SMX therapy. It has been reported that primary attacks of oral EM is confined to the oral mucosa, but the subsequent attacks can produce more severe forms of EM involving the skin. Hence, it is important to identify for early diagnosis and management. Although EM is quite common with TMP/SMX, there are no reports of oral EM appearing after intake of this drug.

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Assessment of some indicators of oxidative stress in nigerian sickle cell anemic patients

CP Okorie, Theresa Nwagha, Fidelis Ejezie

Annals of African Medicine 2018 17(1):11-16

Background: Oxidative stress, the imbalance between the productive of reactive species and antioxidant defences notably plays an important role in the pathogenesis of sickle cell disease. Generating the necessary data about oxidative stress in patients with sickle cell anemia (SCA) would help in developing cost-effective and accessible treatment interventions of SCA in resource-poor countries. Aim: The aim of this study is to evaluate the levels plasma lipid peroxidation product, malondialdehyde (MDA), serum nitric oxide (NO), and total antioxidant activity (TAOA) as indicators of oxidative stress in sickle cell individuals. Materials and Methods: In this pilot study, 52 patients; homozygous (Hb SS) sickle cell patients confirmed by cellulose electrophoresis and 20 age- and sex-matched healthy (Hb AA) controls were subjected to analysis of NO, MDA, and TAOA. The plasma MDA was measured by a thiobarbituric reaction, (NO) was evaluated by the method described by Guevara et al. using Griess reagent and the TAOA of serum was determined by the method of Koracevic et al. Results: The results showed a statistically significant decrease and increase in baseline levels of NO and MDA, respectively, in Hb SS group when compared with the control Hb AA (P = 0.000 and 95% confidence interval [CI] of 0.10–0.18 and −9.67–−5.57, respectively). A slight decrease in the TAOA level between the groups was observed although not statistically significant (P = 0.15 95% CI was −0.28–2.90). Conclusion: The results showed of imbalance between oxidant and antioxidant status in patients with SCA. Antioxidant supplementation may be a cheap assessable intervention for in sickle cell individuals (in the steady state or in crisis) to prevent further oxidative damage to the erythrocytes.

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Human immunodeficiency virus seroprevalence in patients with invasive cervical cancer in Zaria, North-Western Nigeria

Adamu Abdullahi, Muhammad Inuwa Mustapha, Dawotola Ayorinde David, Olasinde Tajudeen Ayodeji

Annals of African Medicine 2018 17(1):17-21

Background: Cervical cancer is the commonest gynecological malignancy in our environment and is an Acquired Immuno-Deficiency Syndrome (AIDS)-associated malignancy. Documented data on the Human Immune-deficiency Virus (HIV) seroprevalence among patients with cervical cancer in our environment are scarce. Objective: The aim of this study is to determine the prevalence of HIV infection in women with cancer of the cervix. Study Design: The work is a descriptive survey by design, concentrating in frequency of occurrences of prevalence of the dissease in either cases for a number of years retrospectively carried out at the Radiotherapy and Oncology Centre of Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Setting: The study was carried out at the Radiotherapy and Oncology Centre of ABUTH, Zaria. Materials and Methods: A 5 years retrospective review of patients with histologically-proven cancer of the cervix seen in the Radiotherapy and Oncology Centre, ABUTH, Zaria, North-Western Nigeria was undertaken. Data such as age, clinical stage of disease and HIV seropositivity at presentation were retrieved from the case files. Data analysis was done using the SPSS statistical package version IBM 23 and results presented in frequencies and percentages and charts for graphical presentation. Results: A total of 1,639 patients seen over a period of 5 years were reviewed. The age range of both groups of patients was from 28 years to 92 years with a mean age of 50.5 years. One thousand five hundred and seventy-three of the patients (96%) were seronegative to the HIV tests while 66 (4%) were seropositive. The age range of the seropositive patients was 28 - 49 years with a mean age of 38.1 years. Their peak age at presentation was 30 - 39 years. Similarly, the age range of the seronegative patients was 30 – 92 years with a peak at 40-49 years. 51 (89.5%) of the HIV seropositive patients presented with advanced clinical stage disease, i.e, International Federation of Obstetrics and Gynecology (FIGO) stage 2B and above. 1,363 (93%) of the HIV seronegative patients presented with FIGO 2B disease and above, both scenario illustrating the general trend of late presentation of cancer patients to hospital in our environment. Conclusion: The study shows that the prevalence of HIV infection among cervical cancer patients is low in Zaria, with earlier age of development of cervical cancer among HIV seropositive patients compared to HIV seronegative counterparts. Both group of patients present with cervical cancer at an advanced stage. More studies therefore needed to be done to identify the predisposing factors to the high incidence of invasive cervical cancer in our environment and introduction of cervical cancer screening at an earlier age among HIV seropositive patients.

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Sparfloxacin-induced nail pigmentation: A case of fixed drug eruption?

Husain Yahya

Annals of African Medicine 2018 17(1):40-42

Sparfloxacin, a synthetic, second generation, broad spectrum aminodifluoroquinolone antibiotic, has excellent penetration into respiratory tissues and has good activity against Gram-positive, Gram-negative, and atypical bacteria. Although it is indicated for the treatment of adult community-acquired pneumonia and acute exacerbation of chronic bronchitis, its use has been limited by phototoxicity which is more common with it than with other quinolones. We report a case of a 20-year-old Nigerian woman who developed a diffuse blue-black nail pigmentation of thumb and big toe nails, 2 weeks after completing therapy with sparfloxacin, and a recurrence of the pigmentation in the same nails 1 year after taking the drug again. We think this is likely a case of subungual fixed drug eruption. We briefly discuss the causes and mechanisms of drug-induced nail pigmentation in general.

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Current indications for extremity amputations in Maiduguri, North-East Nigeria: A 6-year retrospective review

Theophilus Maksha Dabkana, Friday Titus Nyaku, Stanley Tella Bwala

Annals of African Medicine 2018 17(1):22-25

Objective: To know the the commonest cause for extremity amputation in UMTH in recent times, following the result of two previous studies citing malignancy and later trauma, at the University of Maiduguri Teaching Hospital, a tertiary hospital in North East Nigeria. Method: We retrieved folders of all patients who had extremity amputation from January 2010 to December 2016 in our center. There were one hundred and sixty three case notes, accounting for one hundred and sixty five amputations. Results: Of the 165 amputations in 163 patients, 94 (57.0%) were as a result of this problem. It was also noted that the affected patients were regular with their medications, bringing into question the efficacy of these medications. Trauma however remains the second common cause for amputation, accounting for 22 (13.3%), followed by complications from splints of traditional bone setters (TBS) which accounted for 20 (12.2%). Conclusion: Complicated diabetes mellitus is the commonest cause oa amputations in recent times in our center.

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Neglected Type III growing skull fracture in a 65-Year-Old female

Sonal Saran, Sameer R Verma, Vineet Tomar

Annals of African Medicine 2018 17(1):46-47



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Adaptation and micro-structure of Co-Cr alloy maxillary complete denture base plates fabricated by selective laser melting technique

Abstract

The purpose of the study was to evaluate the adaptation and micro-structure of Co-Cr alloy maxillary complete denture base plates fabricated by the selective laser melting (SLM) technique. Twenty pairs of edentulous casts were randomly and evenly divided into two groups, and manufacturing of the Co-Cr alloy maxillary complete denture base was conducted either by the SLM technique or by the conventional method. The base-cast sets were transversally sectioned into three sections at the distal canines, mesial of the first molars and the posterior palatal zone. The gap between the metal base and cast was measured in these three sections with a stereoscopic microscope, and the data were analysed using t tests. A total of five specimens of 5 mm diameter were fabricated with the Co-Cr alloy by SLM and the traditional casting technology. A scanning electron microscope (SEM) was used to evaluate the differences in microstructure between these specimens. There was no statistical difference between the three sections in all four groups (P > 0.05). At the region of the canines, the clearance value for the SLM Co-Cr alloy group was larger than that of the conventional method group (P < 0.05). At the mesial of the first molar region and the posterior palatal zone, there was no statistical difference between the gaps observed in the two groups (P > 0.05). The SLM Co-Cr alloy has a denser microstructure behaviour and less casting defect than the cast Co-Cr alloy. The SLM technique showed initial feasibility for the manufacture of dental bases of complete dentures, but large sample studies are needed to prove its reliability in clinical applications. The mechanical properties and microstructure of the denture frameworks prepared by selective laser melting indicate that these dentures are appropriate for clinical use.

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Antidepressant effects of focused ultrasound induced blood-brain-barrier opening

Publication date: 16 April 2018
Source:Behavioural Brain Research, Volume 342
Author(s): Skyler J. Mooney, José N. Nobrega, Anthony J. Levitt, Kullervo Hynynen
In many cases, hippocampal neurogenesis appears to be a hallmark of antidepressant treatments. One novel technique for inducing this type of neurogenesis is using focused ultrasound waves, in conjunction with circulating microbubbles, to open the blood-brain-barrier. The present experiment aimed to test whether this technique has antidepressant effects in a rodent model. Rats were subjected to 1, 2 or 3 weekly treatments of magnetic resonance-guided focused ultrasound in order to open the blood-brain-barrier in the hippocampal region. Before and after treatments, animals went through modified forced swim tests. 1 week after the final treatment, animals that received 2 weekly treatments showed antidepressant-like effects on behavioural measures in comparison to untreated controls. This was not the case for animals that received 1 or 3 weekly treatments. Effects had disappeared by 5 weeks following the first ultrasound treatment. These results suggest that focused ultrasound may be used for inducing short-term antidepressant effects.



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A synergetic biomineralization strategy for immobilizing strontium during calcification of the coccolithophore Emiliania huxleyi

Abstract

The coccolithophore species Emiliania huxleyi has one of the most global distributions in the modern oceans. They are characteristically covered with calcite scales called coccoliths. In this study, stable strontium immobilization during the calcification process was investigated to indirectly assess a proposed bioremediation approach for removing Sr²⁺ contamination from marine environments. Results indicate that E. huxleyi has high Sr²⁺ tolerance and removal efficiency in response to Sr²⁺ stress ranging from 5.6 to 105.6 ppm. Sr²⁺ immobilization during E. huxleyi calcification indicates a concentration-dependent synergistic mechanism. At lower concentrations of Sr²⁺ (25.6 ppm), Sr²⁺ is incorporated into coccoliths through competitive supply between Sr²⁺ and Ca²⁺. In addition, calcite productivity decreases with increased Sr²⁺ removal efficiency due to crystallographic transformation of coccoliths from hydrated calcite into aragonite at 55.6 ppm Sr²⁺. Further formation of strontianite at 105.6 ppm Sr²⁺ is due to precipitation of Sr²⁺ on the edge of the rims and radial arrays of the coccoliths. Our study implies that coccolithophores are capable of significant removal of Sr²⁺ from the marine environment.

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Effects of Coenzyme Q10 Supplementation on Serum Values of Gamma-glutamyl transferase, Pseudocholinesterase, Bilirubin, Ferritin, and High-Sensitivity C-Reactive Protein in Women with Type 2 Diabetes

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-124183

Background Type 2 diabetes mellitus (T2DM) is a disease associated with increased oxidative stress which results from mitochondrial dysfunction. Coenzyme Q10 (CoQ10) is an essential antioxidant for energy production in mitochondria. The purpose of this randomized double-blind clinical trial study was to evaluate the effects of CoQ10 supplementation on serum values of gamma-glutamyl transferase (GGT), pseudocholinesterase (PchE), bilirubin, ferritin, and high-sensitivity c-reactive protein (hs-CRP) and metabolic syndrome biomarkers in women with T2DM. Material & Methods Eighty women with T2DM enrolled in this study. Thirty six of them were randomized in the drug group (receiving 100 mg/day of CoQ10) and 44 women were randomized in placebo group. Intervention was continued for 12 weeks. In both groups 35 subjects finished the study and were included in the analysis. Serum levels of the variables were measured before and after supplementation. Results Serum values of FBS (P=0.039), HOMA-IR (P=0.01), ferritin (P<0.001), total cholesterol (TC) (P=0.006), LDL-C (P=0.007) decreased and HDL-C (P=0.02) increased significantly in the drug group after intervention. Serum levels of triglyceride (P=0.09) decreased marginally in CoQ10 group. Conclusions The results of the current study had shown that after supplementation with 100 mg/day of CoQ10 for 12 weeks, serum values of FBS, HOMA-IR, TC, LDL-C and ferritin were decreased and values of HDL-C were increased in women with T2DM.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Cardiovascular Risk Factors in Acromegaly: What's the Impact of Disease Control?

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-124668

Objective Cardiovascular disease is one of the most important causes of death in acromegalic patients. The aim of this study is to compare the prevalence of cardiovascular risk factors among acromegalic patients and to evaluate the impact of disease control on these factors. Material and Methods 11 acromegalic patients with active disease and 12 controlled patients were evaluated for blood pressure, body mass index, glucose, coagulation status, and lipid profile. A group of 11 patients with non-functioning pituitary adenomas was used as control population. Results Significant differences were found in lipid profile, glucose and coagulation status in both active and controlled patients. Higher levels of fasting glucose (151.2±102.5 mg/dL, p=0.05 and 108.3±23.4 mg/dL, p=0.02 for active and controlled patients respectively) and fibrinogen (427.1±61.9 mg/dL, p=0.02 and 437.3±106.6 mg/dL, p=0.04 for active and controlled patients respectively) were present in both acromegalic groups. Active patients had higher levels of antithrombin III (1.1±0.1 U/mL, p=0.005) and the controlled ones had higher levels of high density lipoprotein cholesterol (56.1±12.5 mg/dL, p=0.05), compared with the non-functioning group. The differences between active and controlled acromegalic patients are that the latter have reduced total cholesterol (170.4±31.7 vs 201.7±34.6 mg/dL, p=0.02), lower density lipoprotein cholesterol (96,8±25,2 vs 130.8±31.5 mg/dL, p=0.01) and antithrombin III (1.0±0.2 vs 1.1±0.1 U/mL, p=0.05). Conclusion There is some reduction in cardiovascular risk factors with control of the disease, but possibly without the return to basal levels.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Berberine Modulates Gut Microbiota and Reduces Insulin Resistance via the TLR4 Signaling Pathway

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-125066

Berberine, a natural compound extracted from several Chinese herbs including Coptis chinensis, has been shown to have anti-obesity effects and prevents insulin resistance in high-fat diet (HFD)-fed obese rats by modulating the gut microbiota; however, the molecular mechanisms underlying these activities remain unknown. We investigated the effects of berberine on obesity and insulin resistance by examining the lipopolysaccharide (LPS)/toll-like receptor 4 (TLR4)/tumor necrosis factor (TNF)-α signaling pathway in livers of HFD-fed obese rats. Our results showed that 8-week berberine (200 mg/kg) treatment significantly reduced fasting blood glucose, triglyceride, low-density lipoprotein-cholesterol and insulin resistance in HFD-fed obese rats. However, berberine had no significant effects on body weight, visceral fat mass or the visceral fat to body weight ratio. Berberine also attenuated HFD-induced hepatic steatosis. A prolonged HFD altered the gut microbiota composition by reducing protective bacteria like Bifidobacterium and increasing gram negative bacteria like Escherichia coli, which resulted in increased LPS release into plasma. Berberine reversed these effects and inhibited LPS-induced TLR4/TNF-α activation, resulting in increased insulin receptor and insulin receptor substrate-1 expression in the liver. These findings suggested that berberine may reduce insulin resistance, at least in part by modulating the gut microbiota along with inhibiting LPS/TLR4/TNF-α signaling in the liver.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Screening for Hypogonadism in Primary Healthcare: How to do this Effectively

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-114866

Background Testosterone, the most important androgen produced by the testes, plays an integral role in male health. Testosterone levels are increasingly being checked in primary healthcare as awareness of the risks of male hypogonadism grows. Aim To investigate what tests are performed to screen for hypogonadism and to exclude secondary hypogonadism. Design and Setting All participants attended general practices in the UK. Methods Data search was performed using the EMIS® clinical database (provider of the majority of GP operating systems in Cheshire). The anonymised records of male patients aged 18–98 years who had undergone a check of serum testosterone during a 10-year period were analysed. Results Overall screening rate was 4.3%. Of 8 788 men with a testosterone result, 1 924 men (21.9%) had a total testosterone level <10 nmol/L. Just 689 of 8 788 men (7.8%) had a sex hormone-binding globulin (SHBG) result, corresponding to 30.5% of those potentially hypogonadal. Estimated free testosterone was negatively associated with BMI (Spearman's rho -0.2, p<0.001) as was total testosterone in the over 50 s. Of 1 924 potentially hypogonadal men with a serum testosterone <10 nmol/L, 588 of 1 924 (30.6%) had a check of serum prolactin. 46.3% and 41.7% had LH and FSH measured, respectively. Only 19.1% of 1 924 men with a hypogonadal total testosterone level were subsequently put on testosterone replacement. The percentage of men in the relatively socially disadvantaged category was similar for both eugonadal and hypogonadal men with a much higher rate of screening for hypogonadism in more socially advantaged men. Conclusions Screening in primary healthcare identified a significant minority of men who had potential hypogonadism. Interpretation of a low serum testosterone requires measurement of serum prolactin, LH and FSH in order to rule out secondary hypogonadism. We suggest that this becomes part of routine screening with a balanced screening approach across the socioeconomic spectrum.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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A Big Thank You to Our Reviewers in The Past Year!

Exp Clin Endocrinol Diabetes 2018; 126: 4-6
DOI: 10.1055/s-0043-124476

© Georg Thieme Verlag KG Stuttgart · New York

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Submaximal Normalizing Methods to Evaluate Load Sharing Changes in the Shoulder During Repetitive Work

Publication date: Available online 9 January 2018
Source:Journal of Electromyography and Kinesiology
Author(s): Alison C. McDonald, Daanish M. Mulla, Paul W. Stratford, Peter J. Keir
The EMG-force relationship changes with muscle fatigue, making interpretation of load sharing between muscles challenging. The purpose of this investigation was to evaluate the efficacy of normalizing EMG to repeated, static, submaximal exertions to mitigate fatigue artifacts in EMG amplitude (increased amplitude without muscle force change). Participants completed repetitive work tasks, in 60-second cycles, until exhaustion. Surface EMG was recorded from 11 shoulder muscles (anterior, middle and posterior deltoids, infraspinatus, upper, middle and lower trapezius, latissimus dorsi, serratus anterior, sternal and clavicular heads of pectoralis major). Every 12 minutes, participants completed 4 submaximal reference exertions. Reference exertion EMG data were used in 6 normalizing methods including 1 standard (normalized to initial reference exertion) and 5 novel methods: (i) Fatigue Only, (ii) Linear, (iii) Cubic, (iv) Points Forward, and (v) Points Forward/Backward. Data normalized with each novel method were compared to the Standard Method using mixed effects modelling. Significant differences depended on the muscle and the number of time points included (p<0.05). The cubic model correlated better to the actual data points than linear predicted values. The novel cubic normalizing method created muscle activity ratios that appear to mitigate the fatigue effects and better reflect muscular loads during fatiguing work.



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Effects of lighting illuminance levels on stair negotiation performance in individuals with visual impairment

Publication date: Available online 16 January 2018
Source:Journal of Electromyography and Kinesiology
Author(s): Aliah F. Shaheen, Alexandros Sourlas, Khim Horton, Christopher McLean, David Ewins, David Gould, Salim Ghoussayni
BackgroundStair-related falls of older people cause a substantial financial and social burden. Deterioration of the visual system amongst other factors put older people at a high risk of falling. Improved lighting is often recommended. The aim of this study was to investigate the effect of lighting illuminance on stair negotiation performance in older individuals with visual impairment.MethodsEleven participants aged 60 or over with a vision of 6/18 or worse ascended and descended a staircase under: 50lx, 100lx, 200lx, 300lx and distributed 200lx lighting. A motion capture system was used to measure movements of the lower limb. Clearance, clearance variability, temporal and spatial parameters and joint/segment kinematics were computed.FindingsThere was no effect on clearance or clearance variability. Participants had lower speed, cadence, increased cycle time and stance time in the 50lx compared to 300lx and distributed 200lx lighting in descent. The minimum hip angle in ascent was increased in the 200lx lighting. Clearance was found to be moderately correlated with balance scores.InterpretationIndividuals with visual impairment adopt precautionary gait in dim lighting conditions. This does not always result in improvements in the parameters associated with risk of falling (e.g. clearance).



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Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation

Publication date: Available online 10 January 2018
Source:Journal of Electromyography and Kinesiology
Author(s): Behnam Liaghat, Birgit Juul-Kristensen, Thomas Frydendal, Camilla Marie Larsen, Karen Søgaard, Aki Ilkka Tapio Salo




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Reduced immunohistochemical PTEN staining is associated with higher progression rate and recurrence episodes in non-invasive low-grade papillary urothelial carcinoma of the bladder

Abstract

Non-invasive low-grade papillary urothelial carcinoma (NILGPUC) of the bladder is regarded as a relatively indolent disease. However, its propensity for frequent recurrences constitutes a major clinical problem. Additionally, there is a progression risk of 10–15% to either a higher grade and/or a higher stage disease in these tumors. The molecular factors that will predict recurrence and progression in low-grade pTa bladder carcinoma have not yet been elucidated. Herein, we investigated the association of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) alterations with recurrence and progression in NILGPUC using immunohistochemistry. Eighty-one cases of bladder cancer initially diagnosed as NILGPUC in a single institution with follow-up were encountered after searching medical records. Tissue microarrays (TMA) that contained both tumor and non-neoplastic mucosa from each case were constructed using paraffin blocks of transurethral resections. Sections from TMA blocks were stained immunohistochemically for PTEN protein and were evaluable in 76 cases. Any absence of staining was recorded and correlated with clinical findings. Ten patients (13.2%) showed progression and 41 (53.9%) showed recurrence. Reduced PTEN expression was observed in 29 cases (38.1%). Cases with reduced PTEN had higher progression rate compared to cases with intact PTEN (p = 0.026). Tumor relapse was more frequent in cases with reduced PTEN (65.5 vs 46.8%), but this difference was not statistically significant (p = 0.112). On the other hand, decreased PTEN expression was associated with higher number of recurrence episodes (p = 0.002). PTEN seems to have a link with the disease course in NILGPUC of the bladder.

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Effect of a Mat Pilates Program with TheraBand on Dynamic Balance in Patients with Parkinson's Disease: Feasibility Study and Randomized Controlled Trial

Rejuvenation Research , Vol. 0, No. 0.


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Chondroid nodule in the female peritoneum arises from normal tissue and not from teratoma or conception product

Abstract

The pathogenesis of benign-looking cartilaginous tissue within the peritoneum is unknown. Chondroid metaplasia of subcoelomic mesenchyme has been suggested, as has been the case for other gynecological diseases such as endometriosis, peritoneal leiomyomatosis, or gliomatosis peritonei, but has never been proven. Chondroid nodules in the peritoneum may represent either teratomatous tissue, fetal rests from a conception product, or metaplasia of pluripotent mesenchymal cells. Herein, the unique genetic characteristics of ovarian teratomas (homozygous at many polymorphic microsatellite loci) versus normal tissues (heterozygous at the same loci) were used to investigate the origin of chondroid nodules in the peritoneum. DNA samples extracted from paraffin-embedded normal peritoneal tissue and chondroid peritoneal nodules from two patients were studied. In both cases, chondroid and normal tissue showed heterozygosity at each informative microsatellite locus on different chromosomes, with a profile similar to the mother. These results indicate that peritoneal chondroid nodules arise within the peritoneum, presumably from pluripotent mesodermal stem cells, and are not related to teratomatous proliferation, or previous pregnancy. This finding shows once again the plasticity and metaplastic potential of stem cells within the peritoneal cavity.

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Selected Literature Watch

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


http://ift.tt/2FbDkWK

Anhydramnios in Patients With Pemphigoid Gestationis

This case report describes the occurrence of anhydramnios in 2 patients with pemphigoid gestationis.

http://ift.tt/2E73xX8

The US Food and Drug Administration’s Approach for Safe Innovation of Medical Devices in Dermatology

With the increased awareness of skin conditions and demand for aesthetic treatments requiring the expertise of dermatologists, there has been a growth in the associated medical device industry. Dermatology medical devices include point-of-care diagnostics, ablative technologies, skin imaging devices, dermal fillers, lasers, and wound dressings. Many new devices in dermatology offer practitioners and patients additional options for a variety of conditions including diabetic wound care, skin lesion screening, and alopecia treatment.

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Dermatologic Device Approval by the US Food and Drug Administration

This cross-sectional database study characterizes the postapproval changes to Class III dermatologic devices and evaluates inconsistencies in the use of the premarket approval pathway.

http://ift.tt/2E6cmjX

Sun Protection Behaviors in Early Childhood Education Programs

This survey study assesses the current policies, practices, and attitudes among staff of Head Start/Early Head Start and day care centers regarding sun protection in children aged 2 to 6 years.

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Use of statistical analysis to validate ecogenotoxicology findings arising from various comet assay components

Abstract

Cirrhinus mrigala, Labeo rohita, and Catla catla are economically important fish for human consumption in Pakistan, but industrial and sewage pollution has drastically reduced their population in the River Chenab. Statistics are an important tool to analyze and interpret comet assay results. The specific aims of the study were to determine the DNA damage in Cirrhinus mrigala, Labeo rohita, and Catla catla due to chemical pollution and to assess the validity of statistical analyses to determine the viability of the comet assay for a possible use with these freshwater fish species as a good indicator of pollution load and habitat degradation. Comet assay results indicated a significant (P < 0.05) degree of DNA fragmentation in Cirrhinus mrigala followed by Labeo rohita and Catla catla in respect to comet head diameter, comet tail length, and % DNA damage. Regression analysis and correlation matrices conducted among the parameters of the comet assay affirmed the precision and the legitimacy of the results. The present study, therefore, strongly recommends that genotoxicological studies conduct appropriate analysis of the various components of comet assays to offer better interpretation of the assay data.

http://ift.tt/2DxfEM1

Differential distribution of metals in tree tissues growing on reclaimed coal mine overburden dumps, Jharia coal field (India)

Abstract

Opencast bituminous coal mining invariably generates huge amount of metal-polluted waste rocks (stored as overburden (OB) dumps) and reclaimed by planting fast growing hardy tree species which accumulate metals in their tissues. In the present study, reclaimed OB dumps located in Jharia coal field (Jharkhand, India) were selected to assess the accumulation of selected metals (Pb, Zn, Mn, Cu and Co) in tissues (leaf, stem bark, stem wood, root bark and root wood) of two commonly planted tree species (Acacia auriculiformis A.Cunn. ex Benth. and Melia azedarach L.). In reclaimed mine soil (RMS), the concentrations of pseudo-total and available metals (DTPA-extractable) were found 182–498 and 196–1877% higher, respectively, than control soil (CS). The positive Spearman's correlation coefficients between pseudo-total concentration of Pb and Cu (r = 0.717; p < 0.05), Pb and Co (r = 0.650; p < 0.05), Zn and Mn (0.359), Cu and Co (r = 0.896; p < 0.01) suggested similar sources for Pb-Cu-Co and Mn-Zn. Among the five tree tissues considered, Pb selectively accumulated in root bark, stem bark and leaves; Zn and Mn in leaves; and Cu in root wood and stem wood. These results suggested metal accumulation to be "tissue-specific". The biological indices (BCF, TF_leaf, TF_{stem bark} and TF_{stem wood}) indicated variation in metal uptake potential of different tree tissues. The study indicated that A. auriculiformis could be employed for Mn phytoextraction (BCF, TF_leaf, TF_{stem bark} and TF_{stem wood} > 1). The applicability of both the trees in Cu phytostabilization (BCF > 1; TF_leaf, TF_{stem bark} and TF_{stem wood} < 1) was suggested. The study enhanced knowledge about the selection of tree species for the phytoremediation of coal mine OB dumps and specific tree tissues for monitoring metal pollution.

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Enhanced removal performance of Cr(VI) by the core-shell zeolites/layered double hydroxides (LDHs) synthesized from different metal compounds in constructed rapid infiltration systems

Abstract

Nine kinds of LDHs were synthesized by the co-precipitation method under alkaline conditions with different combinations of trivalent metal compounds (FeCl₃, AlCl₃, CoCl₃) and divalent metal compounds (CaCl₂, MgCl₂, ZnCl₂), which were then coated in situ on the surface of zeolites to synthesize core-shell zeolites/LDHs composites. The zeolites before and after modification were characterized by SEM and X-ray fluorescence spectrometry. Using the different core-shell zeolites/LDHs and original zeolite substrates, the constructed rapid infiltration systems (CRIS) simulated test columns were set to treat the municipal sewage containing hexavalent chromium, Cr(VI). Isothermal adsorption tests were subsequently performed. The average removal efficiencies of the small-sized zeolites were much higher than those of the large-sized zeolites. For the small-sized zeolites, the Cr(VI) removal performances of the Mg-LDHs- and Al-LDHs-modified zeolite substrates were efficiently enhanced in particular, which could reach over 90%. And the removal rate of core-shell zeolites/ZnAl-LDHs reached 94.5%. Meanwhile, the maximum adsorption capacity of ZnAl-LDHs-modified zeolites could reach 51.0 mg/kg, indicating that the adsorption properties could be enhanced by ZnAl-LDHs coating. During the purification experiments, most of the LDHs-modified zeolites maintained their predominant chemical adsorption ability for the removal of Cr(VI). Therefore, the small-sized core-shell zeolites/ZnAl-LDHs composites could be used as potential substrates for the efficient removal of Cr(VI) in CRIS.

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Fraction distribution and leaching behavior of heavy metals in dredged sediment disposal sites around Meiliang Bay, Lake Taihu (China)

Abstract

The objectives of this study were to characterize the heavy metal contamination status of surface soils sampled at two dredged sediment land disposal sites (the Baimao and Kongwan landfills) in Meiliang Bay, Lake Taihu, China, as well as to investigate the effect on their leaching behaviors due to acid rain. Among all the metals, only the nickel content in the Baimao landfill was higher than the Chinese reference value, and all metal contents were below the limit values for agricultural soils. The fraction distribution of metals by sequential extraction was similar at both sites. Cadmium had a relatively high proportion of exchangeable-carbonate fractions, while the other metals were mainly classified as residue fractions. The metals released from soils by simulated rainwater comprised less than 1% of the total soil metal content, and the effect of acid rain on heavy metal release from dredged sediments in land disposal sites was found to be negligible at both sites. All results indicate no environmental concern for the land disposal of dredged sediments and support the feasibility of beneficially reusing dredged sediment soils as a supplement to agricultural soils.

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What you should know about third nipples

A look a third (sometimes called supernumary) nipples, a rare condition where a person has an extra one. Included is detail on causes and diagnosis.

http://ift.tt/2DyubXA

What you should know about third nipples

A look a third (sometimes called supernumary) nipples, a rare condition where a person has an extra one. Included is detail on causes and diagnosis.

http://ift.tt/2DyubXA

Trace metal occurrence in Mediterranean seaweeds

Abstract

Seaweeds have been used as animal feed since a long time and are consumed as food in several cultures. In fact, macroalgae are a source of protein, fiber, polyunsaturated fat, and minerals. The concentration of trace elements was determined in dominant macroalga species from three sites of the northwestern Mediterranean Sea. A high interspecies variability was observed, with higher metal levels in brown and green than those in red seaweeds. The maximum values set by European regulations for arsenic, mercury, and cadmium in food and feed were never exceeded, but a few samples were very close to limits set for mercury. Conversely, the maximum limit for lead in feed was exceeded in all species from one of the considered sites. Analogously, lead in seaweeds could constitute a potential risk for human health, due to the exceeding of the maximum value set for food supplements.

http://ift.tt/2rE7ujk

Studies on biogas-fuelled compression ignition engine under dual fuel mode

Abstract

Experimental investigation has been carried out to utilize biogas as an alternative source of energy in compression ignition (CI) engine under dual fuel operational mode. Biogas was inducted into the inlet manifold at different flow rates along with fresh air through inlet manifold and diesel was injected as a pilot fuel to initiate combustion under dual fuel mode. The engine performance and emission characteristics of dual fuel operational mode were analyzed at different biogas flow rates and compared with baseline conventional diesel fuel. Based upon the improved performance and lower emission characteristics under the dual fuel operation, the optimum flow rate of biogas was observed to be 2.2 kg/h. The lower brake thermal efficiency (BTE) and higher brake-specific energy consumption (BSEC) were noticed with biogas-diesel fuel under dual fuel mode when compared with neat diesel operation. Test results showed reduced NO_x emissions and smoke opacity level in the exhaust tailpipe emissions. However, higher hydrocarbon (HC) and carbon monoxide (CO) emissions were noticed under dual fuel mode at entire engine loads when compared with baseline fossil petro-diesel. Hence, the use of low-cost gaseous fuel such as biogas would be an economically viable proposition to address the current and future problems of energy scarcity and associated environmental concerns.

http://ift.tt/2GgCpFO

Hodgkin-Lymphom – neue Horizonte

http://ift.tt/2rEjmlc

Stellenwert der isolierten Extremitätenperfusion bei Sarkomen

Zusammenfassung

Hintergrund und Ziel

Die isolierte Extremitätenperfusion mit Tumornekrosefaktor-α (TNF-α) und Melphalan (TM-ILP [ILP: „isolated limb perfusion"]) ist eines der wirksamsten Therapieverfahren zur neoadjuvanten Therapie von nicht resektablen Weichgewebesarkomen der Extremitäten. Diese Übersichtsarbeit beschreibt die Zusammenhänge und Wirkungsweise der TM-ILP, v. a. im Hinblick auf die Einhaltung der Sicherheitsabstände und die Möglichkeiten der TM-ILP, diese durch Devitalisierung der Tumorzellen in den Randbereichen bzw. den zukünftigen Resektionsrändern zu verbessern.

Methoden

Es wurden eine Recherche und Auswertung aktueller Literatur durchgeführt.

Ergebnisse

Durch die Vorbehandlung mittels TM-ILP kann eine sonst notwendige Amputation in 80 % der Fälle vermieden werden. Im Rahmen eines kurativen, multimodalen Therapieansatzes kann der Tumor nach der initialen TM-ILP 6–8 Wochen später mit knappen Sicherheitsabständen unter Erhalt der Extremität entfernt werden. Auch in palliativer Therapieintention kann die TM-ILP Anwendung finden. Hierdurch kann, insbesondere in Kombination mit einer anschließenden systemischen Chemotherapie, ein längerfristiger Wachstumsarrest des Tumors erreicht werden. In Kombination mit einer anschließenden Strahlentherapie kann dieser Effekt noch verstärkt werden.

Schlussfolgerung

Trotz der bestehenden Amputationsindikation zeigen Patienten nach ILP hervorragende Lebensqualität, die auch im längerfristigen Verlauf konstant bleibt.

http://ift.tt/2GeVx6L

Genome-wide single nucleotide polymorphism-based autozygosity mapping facilitates identification of mutations in consanguineous families with epidermolysis bullosa

Abstract

Autozygosity mapping (AM) is a technique utilized for mapping homozygous autosomal recessive (AR) traits and facilitation of genetic diagnosis. We investigated the utility of AM for the molecular diagnosis of heterogeneous AR disorders, using epidermolysis bullosa (EB) as a paradigm. We applied this technique to a cohort of 46 distinct EB families using both short tandem repeat (STR) and genome-wide single nucleotide polymorphism (SNP) array-based AM to guide targeted Sanger sequencing of EB candidate genes. Initially, 39 of the 46 cases were diagnosed with homozygous mutations using this method. Independently, 26 cases, including the seven initially unresolved cases, were analyzed with an EB-targeted next-generation sequencing (NGS) panel. NGS identified mutations in five additional cases, initially undiagnosed due to presence of compound heterozygosity, deep intronic mutations, or runs of homozygosity below the set threshold of 2 Mb, for a total yield of 44 out of 46 cases (95.7%) diagnosed genetically.

This article is protected by copyright. All rights reserved.

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Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study

Abstract

Background

The Urticaria Activity Score summed over 7 days (UAS7) assesses the itch severity and hive count in chronic spontaneous urticaria (CSU) using once- or twice-daily diary-based documentation.

Objective

The aim of this study was to evaluate the comparability of twice-daily versus once-daily versions of the UAS and the resulting UAS7 values.

Methods

Data came from the ASSURE-CSU study. The twice-daily and once-daily UAS7 was calculated from morning and evening ratings, as well as from exact 24-h evening ratings of hive count and itch severity, respectively. Three UAS7 scores were computed: UAS7 twice daily (UAS7_TD), UAS7 once daily for maximum itch (UAS7_OD1MAX), and UAS7 once daily for average itch (UAS7_OD2AVG). UAS7 values were assigned to five score bands (0, 1–6, 7–15, 16–27, 28–42), reflecting urticaria-free to severe disease activity. The score values and score band ratios of the UAS7_TD and UAS7_OD versions were compared and assessed for correlation by weighted Cohen's kappa statistics.

Results

Data from 614 patients were analyzed. All three versions of the UAS7 yielded very similar results, with a mean (standard deviation) UAS7_TD, UAS7_OD1MAX, and UAS7_OD2AVG of 17.3 (10.49), 17.7 (8.90), and 16.2 (8.68), respectively. Correlation coefficients between UAS7_TD and UAS7_OD1MAX, UAS7_TD and UAS7_OD2AVG, and UAS7_OD1MAX and UAS7_OD2AVG were 0.94, 0.95, and 0.99, respectively, showing very high positive pairwise correlation. The weighted kappa coefficient, κ (95% confidence interval) was 0.78 (0.75–0.82) for UAS7_TD versus UAS7_OD1MAX, and 0.82 (0.78–0.85) for UAS7_TD versus UAS7_OD2AVG, demonstrating substantial agreement.

Conclusions

The once- and twice-daily UAS7 scores were highly consistent, supporting the use of either version when evaluating CSU activity.

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Immediate Health Consequences of Female Genital Mutilation/Cutting (FGM/C) [Internet].

Female genital mutilation/cutting (FGM/C) has been performed in various forms for millennia and involves the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. In this systematic review we addressed harm occurring during the cutting or alteration modification process and the short-term period.

http://ift.tt/2DEvkko

Prevention of Suicide. Part 1: Psychotherapy, Drug Treatment and Electroconvulsive Treatment [Internet].

Background The Norwegian Directorate for Health and Social Affairs requested the Norwegian Knowledge Centre for the Health Service (NOKC) to do a health technology assessment (HTA) of the effects of interventions by the psychiatric health services for the prevention of suicide. The HTA will be part of the basis for national guidelines for suicide prevention.

http://ift.tt/2r1UtzA

A mesh masquerading as malignancy: a cancer misdiagnosed

After a positive faecal occult blood test, a 60-year-old woman underwent a screening colonoscopy which identified a malignant-looking ulcer in the ascending colon. Biopsies from the lesion were inconclusive. A subsequent CT scan of the abdomen and pelvis commented on a polypoid lesion in the ascending colon. A colorectal cancer multidisciplinary team discussion concluded that a right hemicolectomy was indicated as the lesion was suspicious for malignancy. Intraoperatively, there was a firm ascending colon mass adherent to the abdominal wall, which was resected with clear margins. There were no other complications, and the patient was discharged without further issues. Histopathology from the retrieved specimen revealed a complete absence of malignancy, but rather, inflamed granulation tissue with 'reaction to foreign birefringent material'—likely to represent a mesh from an incisional hernia repair 9 years previously. The patient is currently recovering well without complication.

http://ift.tt/2DCwJZ2

The effect of a therapeutic lithium level on a stroke-related cerebellar tremor

Lithium is a mood stabiliser used in the treatment of acute mania, bipolar disorder and as augmentation for unipolar major depression. Tremor is a common adverse effect associated with lithium at both therapeutic and toxic serum levels. We present a case of dose-dependent changes in the quality and intensity of a stroke-related, chronic cerebellar tremor with lithium treatment at serum levels within the therapeutic range. On admission, the patient in this case had a baseline fine, postural tremor, which increased in frequency and evolved to include myoclonic jerks once lithium therapy was initiated. Although the patient's serum lithium level was never in the toxic range, his tremor returned to baseline on reduction of his serum lithium level. This case highlights that a pre-existing, baseline tremor may lower the threshold for developing myoclonus. It also suggests that caution may be warranted with lithium therapy in the setting of known cerebellar disease.

http://ift.tt/2n811aZ

Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout

We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3–L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.

http://ift.tt/2DCXX1L

Parapedicular vertebral augmentation with polymethylmetacrylate for pedicle screw loosening

A 71-year-old man who had a L1/S1 posterior fusion revision surgery complained of increasing back pain 5 weeks after the open surgical procedure. The pain was initially estimated at 9/10 on the visual analog scale (VAS) and thought to be related to a right-sided L2 screw loosening. A right parapedicular vertebroplasty was performed and polymethylmethacrylate cement was instilled around the right pedicle screw, filling the anterior two-thirds of the vertebral body. On postvertebroplasty day 1, the patient had significant improvement in his low back pain. The pain further decreased at 1 and 3 months after the intervention (2/10 on the VAS). Vertebroplasty is a minimally invasive, accessible, effective, and long lasting treatment for compression fractures. We believe that this technique could also be indicated to treat pain related to low grade screw loosening in properly selected patients.

http://ift.tt/2n7Hck4

Super obesity is not necessarily a contraindication to deep inferior epigastric perforator flap breast reconstruction

The deep inferior epigastric perforator (DIEP) flap is widely recognised as a safe and reliable flap for use as a first-choice option in autologous tissue breast reconstruction. Patients with obesity represent a challenging group for autologous breast reconstruction, as they are at increased risk of developing major and minor complications in comparison with patients with normal weight. We report a 59-year-old woman with super obesity, who presented to our department with right breast skin necrosis after implant reconstruction following mastectomy for right breast cancer. After implant removal and local treatment with both surgical debridement and negative pressure wound therapy, the patient successfully underwent a DIEP flap breast reconstruction. We conclude that super obesity should not be a contraindication to DIEP flap breast reconstruction.

http://ift.tt/2n7GWBC

The curse of relieving pain

A 39-year-old woman with a history of chronic back pain due to spinal haemangiomas, multiple malignancies and depression was brought by Emergency medical servicesS to the emergency centre (EC) after being found unresponsive on the bathroom floor. The patient had an exacerbation of her back pain the previous day for which she admitted to taking double her usual dose of oxycodone, in addition to alprazolam, lorazepam, diphenhydramine and a glass of wine. She reported that she lost consciousness and was down for over 8 hours. In the EC, she complained of right forearm pain which was accompanied by mild diffuse soft-tissue swelling and decreased sensation in the right hand. Radial pulse was intact. Creatine kinase was found to be at 4663 U/L. The patient was found to have acute compartment syndrome and underwent emergent forearm fasciotomy. She eventually regained full function of the right arm.

http://ift.tt/2DCXMn7

Fulminant myocarditis

Description

A previously healthy 36-year-old man presented to the emergency department with dyspnoea after 3 days of fatigue and coughing. He experienced shortness of breath and had 8 hours of fever before admission. His body temperature was 38°C. His ECG showed a wide QRS complex with no signs of acute myocardial infarction (figure 1). Echocardiography demonstrated oedematous left ventricular myocardium and severe, diffusely hypokinetic left ventricular wall motion with estimated ejection fraction of 30%. Intra-aortic balloon pump (IABP) insertion was immediately performed for cardiogenic shock. Meanwhile, he experienced cardiac arrest with ventricular tachycardia. As cardioversion was unsuccessful, peripheral venous-arterial extracorporeal membrane oxygenation (va-ECMO) was initiated, with temporary pacemaker placement and dobutamine administration. Coronary angiography revealed normal coronary arteries. Shortly thereafter, he developed complete ventricular standstill, with no ventricular activity on the ECG and echocardiogram (figure 2 and video 1). Endomyocardial biopsy revealed massive...

http://ift.tt/2n79TOJ

Rare presentation of AICA syndrome

We report a rare presentation of an anterior inferior cerebellar artery (AICA) infarct in a 74-year-old woman with acute-onset nausea, vomiting, vertigo and gait instability long before the full onset of symptoms and a negative MRI on admission. Over the next several days the patient developed left facial weakness, numbness, hypoacusis, and limb and gait ataxia, and was found to have acute infarcts of the left pons and cerebellar peduncle consistent with an AICA syndrome. We discuss this rare stepwise presentation in AICA syndrome and possible underlying pathophysiology. Such patients at risk for cerebrovascular disease should undergo a careful history, exam and follow-up, even with negative MRI findings, as their symptoms may precede a serious vascular event.

http://ift.tt/2BpD8R9

Combination drug chemotherapy and massive skeletal allograft in the management of hydatid disease of femur

Hydatid disease of long bone is a rare presentation. Chemotherapy and surgery constitute the standard treatment of choice. Non-union of a pathological fracture of femur particularly due to hydatid disease has been known to be resistant to treatment. These resistant cases require combination drug chemotherapy and excision of the lesion. Reconstruction of a large skeletal defect following resection of the lesion poses a challenge to the orthopaedic surgeons. We discuss the staged treatment of hydatid disease of shaft of femur with resection and cement spacer application followed by reconstruction using massive skeletal allograft under cover of combination drug chemotherapy.

http://ift.tt/2n5iSQy

Cranial neuropathy and severe pain due to early disseminated Borrelia burgdorferi infection

A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at the scalp and spine. Prior work up was unrevealing. The patient resided in the upper Midwest region of the USA and worked outdoors, optimising the landscape for white tailed deer. Repeat cerebrospinal fluid testing revealed a lymphocytic pleocytosis and positive IgM Lyme serology. Brain MRI demonstrated enhancement of multiple cranial nerves bilaterally. He was diagnosed with early Lyme neuroborreliosis and treated with 28 days of intravenous ceftriaxone. While the painful meningoradiculitis, also known as Bannwarth syndrome, is more commonly seen in Europe, facial palsy is more frequently encountered in the USA. Clinical manifestations of neuroborreliosis are important to recognise as the classic presentation varies by geography and on occasion repeat serological testing may be necessary.

http://ift.tt/2BqaQWL

Post-cholecystectomy partial biliary stricture leading to primary intrahepatic calculi

Description

A 40-year-old woman presented with complaints of pain in the right hypochondrium and intermittent high-grade fever with chills for 3 months. She had a history of waxing and waning jaundice for the last 2 months. She had undergone open cholecystectomy 15 years back. Abdominal examination revealed a non-tender hepatomegaly. Blood investigations showed a deranged liver function suggestive of obstructive biliary pathology. Total bilirubin level was raised (4.6 mg/dL) with predominant direct component (3.5 mg/dL). Her serum alkaline phosphatase was elevated (1683 U/L) but transaminase levels were within normal range.

An abdominal ultrasound showed mild hepatomegaly with bilateral intrahepatic biliary radicle dilation. Multiple calculi were present in the intrahepatic bile ducts and a hypoechoic shadow was seen near hilum. In view of suspected mass lesion at hilum, an abdominal CT scan was obtained that showed thickening of the common hepatic duct. Intrahepatic ducts were grossly dilated and were filled with multiple...

http://ift.tt/2n6LdpN

Intracranial myopericytoma: a tumour in a rare location

A 49-year-old female with history of headache, nausea and vomiting with some weeks of evolution, without neurological symptoms. Radiology revealed an expansive lesion near the inferior vermix and cerebellar tonsils, with heterogeneous gadolinium uptake and mass effect on the fourth ventricle, representing a probable extraventricular origin for the lesion. Pathological examination showed a proliferation of oval/spindle cell proliferation with eosinophil cytoplasm and small and monotonous nuclei, without mitoses. The cells had a concentric growth, surrounding thin-walled blood vessels with foci of stromal myxoid degeneration and whorled pattern. The vessels had a haemangiopericytoma pattern and were lined by non-atypical endothelial cells. The tumorous cells expressed vimentin, alpha-smooth actin and heavy-chain caldesmon and were negative for epithelial membrane antigen, protein S100, HMB45, CD34, calponin and desmin, thus providing the final diagnosis of intracranial myopericytoma.

http://ift.tt/2BqiAYZ

Doxycycline sclerotherapy for post-traumatic inguinal lymphocele in a child

Lymphoceles are abnormal collections of lymphatic fluid caused by a disruption in the lymphatic channels and leakage of lymph. This most commonly occurs after surgical procedures, but occasionally lymphoceles may be the result of trauma, more commonly penetrating trauma. Lymphoceles resulting from blunt trauma are rare in both adults and children. In the adult population, there are few published case reports, and management principles vary. To date, there are no reports of traumatic lymphoceles in the paediatric population, and therefore there is no precedent for treatment. Here, we report the case of a young boy who developed an inguinal lymphocele from a bicycle handle bar injury which was successfully treated with doxycycline sclerotherapy.

http://ift.tt/2n87qDC

Extensive skin ulcers in a child with juvenile dermatomyositis

Juvenile dermatomyositis (JDM) is a multisystemic disorder. Vasculitic ulcers in JDM have been reported to involve axilla, elbow or extensor surfaces of other joints. We report a young boy with JDM who presented with extensive cutaneous ulcers involving scrotum, prepuce, gluteal region, neck, bilateral axilla, periumbilical area and bilateral elbows and popliteal fossa. His disease course was marked by several relapses and he required immunosuppression with prednisolone, subcutaneous methotrexate and intravenous cyclophosphamide. His muscle weakness improved and skin ulcers healed after 6 months of intensive immunosuppressive therapy. Children with JDM and ulcers often show increased resistance to immunosuppressive therapy. Extensive cutaneous ulcers in JDM, especially those involving the scrotum, have never been described. Awareness regarding the uncommon manifestations is important to guide appropriate therapy.

http://ift.tt/2BpD8k7

Multiple anomalies in the origin and course of vertebral arteries and aberrant right subclavian artery in a child with moyamoya syndrome

Here we report, for the first time, a combination of five-vessel aortic arch, anomalous origin of the right vertebral artery (VA) from the common carotid artery (CCA), an aberrant right subclavian artery (SCA), and bilateral symmetrical segmental agenesis of VAs.In this case report, we present a patient with moyamoya syndrome (MMS) and Down syndrome (DS) who has bilateral symmetrical segmental agenesis of VAs, left VA originating from aortic arch and anomalous origin of right VA arising from CCA in combination with an aberrant right SCA. Therefore, five vessels are originating from aortic arch. Here, we report, for the first time, a combination of five-vessel aortic arch with an aberrant right SCA and symmetrical segmental agenesis of both VAs. The possible embryological mechanisms of the anomalies as well as an relation with MMS and DS are discussed.

http://ift.tt/2n7jw06

Ipilimumab or FOLFOX in Combination With Nivolumab and Trastuzumab in HER2 Positive EsophagoGastric Adenocarcinoma

Conditions:   Gastric Cancer;   Esophageal Cancer;   Adenocarcinoma Gastric;   HER2 Positive Gastric Cancer;   Metastatic Gastric Cancer;   GastroEsophageal Cancer
Interventions:   Drug: Nivolumab;   Drug: Ipilimumab
Sponsors:   AIO-Studien-gGmbH;   Bristol-Myers Squibb
Not yet recruiting

http://ift.tt/2G8Idku

Ipilimumab or FOLFOX in Combination With Nivolumab and Trastuzumab in HER2 Positive EsophagoGastric Adenocarcinoma

Conditions:   Gastric Cancer;   Esophageal Cancer;   Adenocarcinoma Gastric;   HER2 Positive Gastric Cancer;   Metastatic Gastric Cancer;   GastroEsophageal Cancer
Interventions:   Drug: Nivolumab;   Drug: Ipilimumab
Sponsors:   AIO-Studien-gGmbH;   Bristol-Myers Squibb
Not yet recruiting

http://ift.tt/2G8Idku

Effect of the Neck Extension on Blind Intubation Via Ambu® AuraGain™

Conditions:   Intubation; Difficult or Failed;   Intubation Complication
Interventions:   Device: Ambu® AuraGain™;   Procedure: neck extension
Sponsor:   Seoul National University Hospital
Not yet recruiting

http://ift.tt/2rzTcjF

A Dose Escalation and Confirmation Study of PT-112 in Advanced Solid Tumors in Combination With Avelumab

Conditions:   Non Small Cell Lung Cancer (NSCLC);   Urothelial Carcinoma (UC);   Squamous Cell Carcinoma of the Head and Neck (SCCHN);   Metastatic Breast Cancer (mBC);   Castration-resistant Prostate Cancer (CRPC)
Interventions:   Drug: PT-112;   Biological: avelumab
Sponsors:   Phosplatin Therapeutics;   Pfizer;   EMD Serono
Not yet recruiting

http://ift.tt/2G9Mcxj

upper respiratory tract infection; +51 new citations

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upper respiratory tract infection

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